Premier Care Services Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

The service was in breach of legal regulation in relation to safe care and treatment and staffing.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had processes for staff to report accidents and incidents and they were recorded. However, the learning from accidents and incidents was not always recorded. This meant it was not clear lessons had always been learned and action was taken to improve the service and mitigate the risk of similar incidents.

However, people, their relatives and staff felt comfortable to raise concerns and felt the provider would listen to them and act.

A person’s relative said, “I have a good relationship with the manager, and she calls me if there are any issues. I trust her”. Another person’s relative told us, “I can call the office whenever I need them. They are always there to help”.

The provider worked with people, their relatives and healthcare professionals to establish and maintain safe systems of care. They made sure there was continuity of care when people accessed different healthcare services, including GPs, hospitals, occupational therapy and speech and language therapists (SALT).

The registered manager said, “We have joint meetings. Before a client is discharged from hospital or coming from another service, we meet with the social worker and the other service, and we ask them questions while the client is still new to us. We have a transition meeting, and we let the client and family know we will liaise with the other services involved”. 

The provider had a safeguarding policy and procedures in place and staff had received safeguarding training and knew how to identify and report safeguarding concerns.

People and their relatives said they felt safe with their carers and the service. One person said, “They know exactly how to keep me safe, as they are trained well”. One person’s relative told us, “[Mum/dad] is very safe with them” and another person’s relative said, “[She/he] is very safe with [name of member of staff]”.

The provider had not always carried out a risk assessment for all a person’s needs and associated risks. Risk assessments that had been completed were not always sufficiently detailed and informative, and were task orientated and did not contain specific information about how to support people as individuals.

The provider had not carried out risks assessments in relation to some people’s epilepsy, Parkinson’s disease, mental health needs, allergies, eyesight issues and asthma, for example. People’s moving and handling risk assessments were not person-centred.

These issues put some people at risk of potential harm.

This was a breach of Regulation 12: Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

However, staff knew people well and worked well with them and their families to understand and manage risks and supported people to do the things that mattered to them in a safe and person-centred way.

A person’s relative said, “[Mum/dad] knows them [staff] and they know [him/her] very well. They know how to calm [him/her] and realise sometimes they just have to walk away when [mum/dad] is non-receptive. They understand [him/her] and how [he/she] is”. Another person’s relative told us, “[He/she] has the same consistent staff all of the time. They know [him/her] very well. [he/she] knows them well too”.

The provider risk assessed people’s homes to support the delivery of safe care.

Staff had not always received sufficient training, for example, staff had not received epilepsy awareness training, Parkinson’s disease awareness training, ventilator awareness training or IDDSI (International Dysphagia Diet Standardisation Initiative) training. However, some staff worked with people with these needs. The IDDSI is a global standard for texture-modified foods and thickened liquids to help people with swallowing difficulties eat and drink safely. Staff and managers had also not received EDHR (Equality Diversity and Human Rights) training.

Some people that required 2 staff to provide their care had not always received their care from 2 staff. At times they had received their care from 1 member of staff because the 2 members of staff had not arrived at the same time. Some people had a high number of care calls that were late and where staff had not stayed for the full duration of the call. Some of the provider’s care call monitoring data was not robust, as it showed staff having no travel time between 2 care calls or being at 2 different care calls at the same time. This meant the provider’s care call monitoring data could not always be relied on.

Staff recruitment did not always follow safer recruitment practice, for example, the provider had not always obtained a full employment history and had not always appropriately followed-up references for new staff.

These issues put some people at risk of potential harm.

This was a breach of Regulation 18: Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

However, staff had received induction training and completed refresher training covering numerous other areas of social care work. Staff received effective support, supervision and development and worked closely with people and their relatives to provide people with safe and effective care and support.

The provider had carried out enhanced Disclosure and Barring Service (DBS) checks for new staff. The DBS helps employers make safer recruitment decisions by carrying out criminal record checks.

During our assessment the provider made enquiries to find out about arranging ventilator training for staff.

One person told us, “They know exactly how to keep me safe as they are trained well”. A person’s relative said, ““They are trained well I think. They definitely know what they are doing”. Another person’s relative told us, “The staff definitely know what they are doing. They are all trained very well”.

The provider had processes for staff to report accidents and incidents and they were recorded. However, the learning from accidents and incidents was not always recorded. This meant it was not clear lessons had always been learned and action was taken to improve the service and mitigate the risk of similar incidents.

However, people, their relatives and staff felt comfortable to raise concerns and felt the provider would listen to them and act.

A person’s relative said, “I have a good relationship with the manager, and she calls me if there are any issues. I trust her”. Another person’s relative told us, “I can call the office whenever I need them. They are always there to help”.

The provider had not always followed NICE guidelines for ‘Managing medicines for adults receiving social care in the community’. Not all people’s medicines administration records (MAR charts) or care records included a list of their medicines, what their medicines were for and instructions for staff regarding possible side effects/adverse reactions. The provider used a combination of electronic MAR charts using an app and paper MAR charts kept in people’s homes. This made the medicines quality assurance process disjointed and there was potential for error, as medicines audits were not always effective. Some people’s paper MAR charts did not contain their full personal details and did not include a list of their medicines, and some did not make the times people received their medicines clear. However, some of the provider’s medicines audits stated all MAR charts did include that information.

People’s ‘when required’ medicines protocols did not meet the required standard, they did not contain the required level of information about the person, their medicine or sufficient instructions for staff about how to give the person their ‘when required’ medicine safely.

These issues put some people at risk of potential harm.

This was further evidence of a breach of Regulation 12: Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

However, staff had received medicines training, and their competency had been assessed, and people had received their medicines as prescribed and there had been no medicines errors.

One person told us, “They give me all my medicines as the doctor prescribes them for me. There’s no problem there”. A person’s relative said, “They do all [his/her] meds. [Name of staff member] writes on the boxes the dates, so we use them in date order. It works well”. Another person’s relative told us, “They [staff] do all of [his/her] meds. They sign to say [he/she] has had all of [his/her] medicine”.