Premier Care Services Limited

People’s experience of using this service and what we found

People felt safe receiving care from Premier Care Services. Staff had been trained and were knowledgeable in recognising and reporting signs of possible abuse. Risk assessments were carried out and regularly reviewed to identify any potential risks to people and how these were to be managed. Medicines management processes had been strengthened to ensure people received their medicines as prescribed. There were sufficient suitable staff employed to meet people’s needs. Staff adhered to infection control procedures to reduce the risk of cross-contamination. New processes had been implemented following incidents that occurred.

A new training provider was in place to ensure staff received appropriate training and updated their knowledge and skills to support people in line with best practice guidance. Staff received regular supervision and appraisal. The assessment process had been reviewed to ensure people were assessed in line with best practice guidance. The registered manager had improved their practice to ensure they adhered to the principles of the Mental Capacity Act 2005. 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. Where people required it, staff supported them with their meals. Staff liaised with healthcare professionals if they had any concerns about a person’s health or welfare.

Staff provided kind, compassionate care. People confirmed they were treated with dignity and respect. Staff were aware of people’s individual differences and supported people in line with their preferences. People and their family members were involved in decisions about their care and were part of the assessment and care planning process.

Care plans had been reviewed and updated to ensure they adequately reflected people’s care and support needs. New processes had been implemented to ensure people’s care needs were regularly reviewed. Staff were aware of people’s communication needs and adjusted their methods to ensure people were able to understand what was being communicated. Staff provided people with support at the end of their life when this was required. The complaints process had been reviewed and there was now greater oversight of all complaints to ensure they were managed appropriately and learnt from.

Since our last inspection the management team had been strengthened with an additional registered manager and two field supervisors. This enabled greater leadership and oversight of the service. Quality monitoring processes had been strengthened to ensure regular auditing and review of key areas of service delivery. Staff were clear about their roles and responsibilities. The registered manager was aware of their CQC registration requirements and was submitting statutory notifications about key events as required. People and their relatives were asked for their feedback about the service so this information could be incorporated into continuous learning and development of the service.

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 this service was requires improvement (published 9 January 2019).

The provider completed an action plan after our inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Premier Care Services Ltd is registered as a domiciliary care agency. The service provides personal care to people living in their own homes. The Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'. For example, 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 the inspection 72 people living in the London Borough of Croydon were using the service.

The service had a registered manager in post who was available during both days of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, 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.

The provider did not always properly assess risks relating to people's care, such as risks relating to medicines management, pressure ulcers and nutritional risk. There were no robust management plans in place for staff to follow in reducing the risks.

The provider did not always manage people's medicines well. For example, the provider did not ensure staff made records of medicine administration accurately and did not ensure staff were sufficiently trained in the specialist skills they needed.

The provider did not keep an overview of staff training so we could not be sure all staff had received the training they needed, when they needed it. We were concerned the training provided was out of date and did not include current best practice and guidance.

Some parts of people's care plans lacked detail to inform staff about the people they were caring for. For example, a person's care plan did not set out the communication difficulties a person experienced or the best ways for staff to communicate with them.

The provider did not have effective systems in place to monitor, assess and improve the service. The provider had not identified the issues we found during our inspection and so had not made the necessary improvements to meet the fundamental standards.

The provider did not always submit statutory notifications to CQC as required by law which meant they did not support us to carry out our role in monitoring services to make sure the appropriate action was taken to protect people’s health, safety and welfare.

People’s ability to make decisions was not always recorded in line with the Mental Capacity Act (MCA) 2005.

People knew how to complain and believed the registered manager would investigate any concerns they raised properly. The complaints policy needed to be amended and the way complaints were recorded needed to be improved.

Staff told us and records indicated they received appropriate supervision to support them in their role. The service followed safe recruitment practices.

Systems were in place to involve people in developing and reviewing their care and to gather their feedback about the service they received. Although sometimes the information recorded was poor.

People were safeguarded from abuse and neglect. Office staff were confident in the reporting procedures they should use and staff knew when they should notify the office if they suspected people may be being abused to keep them safe.

People were supported in relation to eating, drinking and their healthcare needs when this was part of their agreed package of care. However, record keeping around the type of support people required was sometimes poor.

Staff were kind and knew the people they were caring for. Staff supported people to maintain their privacy and dignity and treated people with respect.

We found breaches of the regulations relating to safe care and treatment, staffing, person centred care, good governance and notifications. You can see what action we have asked the provider to take to address these breaches at the back of this report.

We have made a recommendation to follow the current best practice guidelines for the MCA.

Further information is in the detailed findings below.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, 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.

People and their relatives told us they trusted staff and felt safe when staff were there. There were processes in place to help make sure people were protected from the risk of abuse and understood how to safeguard the people they supported.

There was an out of hours on call system in operation, this made sure support and advice was available for staff working outside office hours.

People’s individual risk was assessed to help keep them safe. Staff supported people to attend appointments and liaised with their GP and other healthcare professionals to help meet their health needs.

Staff were up to date with training and the service followed appropriate recruitment practices. However, some information was not recorded in staff files that should have been. We have made a recommendation about the information that is needed in staff files.

The provider told us they tried to match care workers with the people who use the service and to keep the same staff with the same person when possible.

We saw people were involved in making decisions about their care, treatment and support and the care plans we checked reflected this. People told us their privacy and dignity was respected by staff. Staff we spoke with explained how they would always ask for consent before assisting people and explained the methods they used to help maintain people’s privacy and dignity.

People were asked about their food and drink choices and staff assisted them with their meals when required.

People and their relatives said they would complain if they needed to, they all knew who the manager was and felt comfortable speaking with them about any problems.

People were contacted regularly to make sure they were happy with the service and spot checks helped review the quality of the care provided.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, looking at records and speaking with people using the service and members of staff.

Please read the full report for evidence that supports our summary.

Is the service safe?

We found that staff were supported with regular training and supervision to provide safe and appropriate care. There were regular spot checks on staff whilst they were delivering care in people's homes. We saw that there were effective recruitment and selection policies in place. Appropriate checks on staff took place before they started their employment.

We looked at a random selection of care plans for people using the service. We found that they were person centred and reflected the individual needs of each person. We saw that they covered a comprehensive range of care and healthcare needs including individual risk assessments. We found that care plans were regularly reviewed and up to date which supported staff to deliver safe and appropriate care.

We found that there were procedures in place to deal with foreseeable emergencies. People using the service could contact the service 24 hours a day, seven days a week.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We saw that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Staff received appropriate professional development. We were provided with information and records to show that staff received regular training. Staff were able, from time to time, to obtain further relevant qualifications

Is the service caring?

We spoke with people using the service. Their comments included: 'Fantastic mate, top of the tree.' 'I love all my carers.' 'They always turn up on time. They are brilliant.' 'I have a permanent carer, she is excellent, really good.' 'Staff are very nice.' 'They always turn up on time.'

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. We saw that care plans were person centred and recorded how people preferred their care and treatment to be delivered.

We saw that people were contacted on a regular basis and any concerns they raised were addressed. One person asked for their care worker to be made permanent which the service agreed to.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We spoke with people using the service and members of staff who told us that manager was approachable. People told us that they were confident that they could raise issues with members of staff or the manager and they would be dealt with.

All of the people we spoke with said that they had been fully involved in drawing up their care plans and in the review process. They all told us that they received the care and support they needed. People said that they felt safe with their care workers partly because there was consistency and continuity with the staff that cared for them and also because they were well trained and kind in the delivery of their care.

Everybody we spoke with told us that if they needed to they knew how to make a complaint and that they felt their concerns would be listened to if the event arose.