2 February 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
The inspection was carried out by 1 inspector and 2 Experts by Experience who contacted people and their relatives by telephone for feedback on the care they received. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats and/or specialist housing.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post. The service had also appointed a new manager as the current registered manager was leaving the organisation.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We used information gathered as part of a monitoring activity that took place on 7 June 2022. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We reviewed a range of records including 10 people's care records and several medicines records. We looked at 6 staff files in relation to recruitment, training and supervision. A variety of records relating to the management of the service, including policies and procedures, complaints and audits were also reviewed.
We spoke with 6 members of staff including 3 care workers, the registered manager, the newly appointed manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
Following the inspection visit, we spoke with 9 people who used the service and 14 relatives about their experience of the care provided.
We spoke with a further 5 care workers by telephone.
2 February 2023
Primera Assisted Living Limited is a domiciliary care service that provides care and support to people living with dementia, physical disabilities and older people. At the time of our visit, the service was providing care and support to 101 people living predominantly in North London.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. At the time of our visit, 98 people received personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People's experience of using this service and what we found
The service assessed and managed risks related to people’s health, care and welfare. However, we found not all risks were thoroughly assessed. For example, where some people had certain health conditions, guidance was not always in place on how to support them safely.
We also found inconsistencies with how people’s medicines were managed. Medicines records often contained unclear instructions and staff’s competence on the management of medicines were not routinely assessed.
While recruitment checks were in place to ensure the right staff were recruited safely, we were not assured with how staff were deployed. We found evidence where, on several occasions, care workers attended to people later than their agreed timeslots. There were also cases where people did not receive their care visits due to staff deployment issues.
The service had not identified all of the shortfalls we found and where they did identify certain issues, these were not always addressed promptly.
People felt safe with the staff who supported them, and were protected from abuse. Staff followed the appropriate infection control measures to keep people safe from the risk of infections.
People received a comprehensive assessment of their needs before they received care. People had access to healthcare when needed. Staff supported people to eat and drink as per their wishes.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff received appropriate support from their managers and training to be able to perform their roles and provide good care to people.
Staff were kind and caring and treated people with respect. People’s values and religious beliefs were respected by staff. Staff treated people with dignity while promoting their independence.
People received care and support that met their individual needs. Staff offered people choices and sought their views when providing care.
The provider managed complaints effectively and had systems in place to capture people’s feedback on the care they received. People, their relatives and staff were comfortable to raise concerns and felt the service listened to them.
The provider worked in collaboration with other agencies to ensure people received good care and support.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for the service at the previous premises was good, published on 2 November 2018.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We have identified breaches in relation to managing people’s risks, safe management of medicines, staff deployment and good governance, at this inspection.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.