Prior Care Limited

Prior Care Limited is a domiciliary care agency and is based in the London Borough of Havering. The service provides personal care to adults in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of the inspection, the service was supporting 34 people with personal care.

People’s experience of using this service

We found that robust systems were not in place to ensure staff attended calls on time and stayed the duration of the call. Robust quality assurance systems were not in place to identify shortfalls and take prompt action to ensure people received safe and effective care in a timely manner.

Risks were identified and assessed to ensure people received safe care. Staff were aware of how to safeguard people from abuse. Systems were in place to prevent and minimise the spread of infections when supporting people. Pre-employment checks had been carried out to ensure staff were suitable to work with vulnerable people. Medicines were being managed safely.

Staff had been trained to undertake their roles effectively. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care from staff who were caring and had a good relationship with them. People’s privacy and dignity was respected. People were encouraged to be independent and to carry out tasks without support.

People received person-centred care. Care plans had been reviewed regularly to ensure they were accurate.

Systems were in place to get feedback from people. Feedback was used to make improvements to the service.

Rating at last inspection

The previous rating for this service was Good (published 12 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Prior Care Limited on our website at www.cqc.org.uk.

Follow up

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.

Prior Care Limited - 139 Hornchurch Road is based in Romford, Essex. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults.

Not everyone using Prior Care Limited receives regulated activity; the CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of our inspection, 45 people were using the service, who received personal care. The provider employed 20 care staff.

The service did not have a registered manager in post but had a service manager who had applied to be registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered care homes, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

However, shortly before our inspection the provider informed us that the service manager passed away.

At our last inspection, we found people did not always receive safe care because the provider did not always assess, monitor and mitigate risks associated with the service to ensure people received safe care at all times. The provider sent us an action plan detailing how they would make improvements and told us they would be compliant by February 2017. At this inspection we saw that risks to people, such as falls, were assessed more effectively to ensure staff had adequate information to identify and manage and reduce these risks.

However some further improvements were required with quality assurance systems to ensure the service was well led. For example, not all staff followed procedures to log in and out of calls to people’s homes. This meant the provider was not able to assess whether staff were arriving on time. We noted that analysis undertaken by the management demonstrated that the service was underperforming in this area and had been doing so for some time. There was not a clear plan for how this would be improved.

People were protected from abuse. Staff understood procedures to follow in order to safeguard people from potential abuse.

The provider had sufficient numbers of staff available to provide care and support to people. Staff had been recruited following pre-employment checks such as criminal background checks, to ensure staff were suitable to work with people safely.

Staff received an induction and relevant training. They shadowed experienced staff in order for them to carry out their roles effectively.

When required, staff prompted people to take their medicines and recorded this in Medicine Administration Records (MAR).

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and people’s capacity to make decisions was assessed when required.

Staff told us that they received support and guidance from the management team. People's care and support needs were assessed and reviewed regularly.

People were registered with health care professionals, such as GPs and staff contacted them in emergencies.

People were supported to have meals and drinks of their choice, when this was requested.

People were involved in their care and support planning. They were treated with dignity and respect when personal care was provided to them.

Care plans provided staff with information about each person’s individual preferences.

Complaints about the service were responded to appropriately.

The management team carried out monitoring checks on staff providing care in people’s homes. This ensured staff followed the correct procedures and people received the care they had been assessed for. People were able to provide their feedback on the service.

Prior Care Hornchurch delivers personal care and support to people in their own homes within the London Borough of Havering and some areas of Barking and Dagenham. At the time of our inspection, approximately 65 people were using the service. The service was employing 20 care workers who visited people living in the community.

The service did not have a registered manager in place because the previous registered manager had recently left the provider. A new manager had started a month prior to the inspection and was in their probationary period. They informed us they would seek to register after this period. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered care homes, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that systems were in place to ensure people were protected from the risk of abuse. Staff were able to identify different types of abuse and knew how to report any concerns.

People received care at home from staff who understood their needs. People had their individual risks assessed and staff were aware of plans to manage the risks. However, not all risks to people were suitably managed because risk assessments were not effective or detailed enough for staff to minimise identified risks. This meant people were not being protected as safely as possible.

Call times to people were not always accurately reflected on the provider’s online system. We made a recommendation about having more effective call monitoring procedures.

When required, staff administered people’s medicines and had received the appropriate training to do this. The provider had sufficient numbers of staff available to provide support to people. Staff had been recruited following appropriate checks with the Disclosure and Barring Service.

Staff received training in a number of topics that were important for them to be able to carry out their roles. They told us that they received support and encouragement from the manager and were provided opportunities to develop. Staff were able to raise any concerns and were confident that they would be addressed.

People were treated with privacy and dignity. They were listened to by staff and were involved in making decisions about their care and support. People were supported to meet their nutritional needs. They were registered with health care professionals and staff contacted them in emergencies.

People told us they received support from staff who understood their needs. However, care plans were not always suitably personalised to include people’s personal histories and preferences about how they preferred to be cared for. We made a recommendation about developing more person centred care plans.

A complaints procedure was in place. People and their relatives were able to make complaints, express their views and give feedback about their care. They told us they could raise any issues and that action would be taken by the manager.

The manager was committed to developing the service and monitoring the quality of care provided to people. They ensured that regular checks were completed and looked at where improvements could be made. We made a recommendation about ensuring records are kept up to date and appropriately signed by authorised staff.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.

We looked at safeguarding records for all staff and saw evidence that all staff had received safeguarding training. Staff had been trained to identify and escalate signs of potential abuse and neglect. Staff we spoke with understood what safeguarding was and their role in protecting people who used the service.

We looked at how the service supported staff and found that suitably trained and experienced staff were used. We found that the provider was conducting thorough checks to ensure that staff were suitably qualified, skilled and experienced before starting work.

We looked at how the manager monitored the quality of care provided. We found that there were systems in place to ensure quality was maintained and when it wasn't of a high standard, the provider acted quickly to rectify this.

We saw evidence of a complaints log and that the provider reviewed and assessed the complaints received. Staff we spoke with demonstrated that they knew how to escalate complaints. Relatives and people who used the service told us that they to felt able to contact senior staff if they had concerns.

People's needs were assessed and care plans were developed to address the areas where people needed care and support. The care plans were detailed to enable a care worker reading these to understand the care and support people required. Care plans and risk assessments were reviewed annually with people's involvement to ensure these were up to date.

Two out of five people expressed concerns that they did not always have permanent care workers and were not satisfied with the temporary care workers. One out of the five people said the care workers did not always come on time which sometimes affected their daily routines.

A shortage of office staff during part of the last year meant that staff did not receive regular supervision and appraisals. Some of quality assurance processes were not very clear and the ones that were in place were not being implemented effectively to monitor and assess the quality of the service.

The manager in response to the above said more staff had been recruited and they had an action plan to address the issues that needed to improve.