Premier Care Services Limited

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture

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 good governance.

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 service had a shared vision, strategy and culture. This was based on transparency, equity, inclusion, engagement, and understanding challenges and the needs of people. People, their relatives and staff had contributed to the development of the service.

The provider had a statement of purpose and a written set of values, which were given to staff and discussed with them. The provider also had a business development plan in place, which was shared with staff to obtain their input and make sure everyone worked together to achieve the aims and objectives. The policies in place were given to staff and the registered manager explored how they related to people with them.

The registered manager said, “It is a journey, I don't expect staff to be expert in one day if they are open to learning and development. I pair new staff with experienced carers and get feedback from the experienced carer regarding the newer staff member’s performance”.

A member of staff told us, “We can call colleagues to request assistance or cover. I have even helped the office find cover. There is a team spirt”. Another member of staff said, “The teamwork is very good. When it comes to work, we are all one”. One other member of staff also told us, “I work with [member of staff], she prompted me when I started, I learnt everything very quickly, and I have good relationships with my clients”.

A person’s relative said, “They make sure we get consistent carers. We have a [social media] group with all the staff who are involved in [mum’s/dad’s] care. Communication is really good; I don’t live locally, so I can see all that is going on. It works so well. I can’t see the logbook, but I can see the [social media] messages”. Another person’s relative told us, “They let us know if they are running late on the [social media] chat or the manager calls to let us know”.

All the people and relatives we spoke with told us they received consistent care staff who stayed the right amount of time. One person said, “I get the same carer all the time. [Member of staff] is part of the family now”. A person’s relative said, “Overall, I would say we are happy. We get mainly consistent care from the same carers”.

The service had inclusive managers at all levels who understood the context in which they delivered care and support and embodied the culture and values of their workforce and organisation. They did so with integrity, openness and honesty. People, their relatives and staff told us managers were approachable and responded to any concerns raised.

The registered manager participated in the local authority’s support group for registered managers, which provides information, training and development to registered managers. They also received support from the provider’s external trainer, updates from their compliance service and emails with new information from the NHS. Managers shared updates and changes with staff and gave staff responsibility to lead on some things, so a member of staff could read policies and updates and then share the learning with the rest of the team. 

Managers had the skills, knowledge, experience and credibility to lead effectively. However, we found they would benefit from refreshing their knowledge of the NICE guidelines for ‘Managing medicines for adults receiving social care in the community’, the AIS, and quality assurance systems and processes, including carrying out audits.

We recommend the provider sources professional support to improve their knowledge and practice of managing medicines, the AIS and auditing systems and processes.

The service had a positive culture where people felt they could speak up and their voice would be heard. People, their relatives and staff were aware of how to raise concerns. They told us they were confident they would be listened to, and their views or concerns would be respected, taken seriously and treated compassionately, without negative repercussions. The provider had a ‘Raising Concerns, Freedom to Speak Up and Whistleblowing’ policy and procedures in place.

The registered manager said, “When we employ staff, we always tell them they have freedom to speak up. I tell them about the whistleblowing policy and assure them it will not lead to a reduction in hours or any trouble. I encourage them to raise concerns and let them know it is confidential. I carry out my own investigation into concerns and I let the person who raised the concern know the outcome, and I tell them they can contact the local authority or CQC if they are not reassured or satisfied, and I let them know they can do that without telling me”. 

The registered manager also told us, “We have a staff [social media] group and staff can raise concerns there and ask questions, which often leads to a quick solution, as staff all work as a team and support each other with good practice advice. I always tell staff they can contact me twenty-four hours a day, every day of the week. It has been good because staff do not feel scared and can always confide in me”.

A member of staff said, “I really appreciate my manager and my colleagues. They are very supportive”.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for staff and adjustments had been made to ensure all staff were valued.

The provider managed the service around staff annual leave requests in relation to school holidays and their childcare needs. They matched staff who had specific health conditions with people and families that were safe for them to work with, scheduled their shifts around their medical appointments and allowed them to take time off work when they were not feeling well. They also allowed pregnant staff to work flexibly around their pregnancy needs.

In addition, the provider promoted staff development, for example, the registered manager had trained some care staff to write people’s care plans and supported some staff with applications to study nursing. The provider also supported staff who were struggling with their work by meeting with them to identify their strengths and areas for improvement and providing them with further training and extra supervision. A member of staff told us, “I was trained to do a client care plan for some clients of mine. The manager trained me”.

The registered manager had started work at the service as a carer, went to college and university and worked their way up through the service to become a supervisor and then the registered manager. Their journey was shared with staff to help motivate them. 

The provider had not sufficiently established and operated effectively quality assurance systems and processes to assess, monitor and improve the quality and safety of the services provided.

They had not audited care call monitoring data or complaints and their audits of medicines, accidents and incidents and care plans had not identified the issues we found during our assessment. Audits that had been completed did not always include lessons learned and it was not always clear that audits had led to improvements.

Some people’s assessments and care records were not always complete and up to date.

The provider did not have a business continuity plan in place in case of emergencies or natural disasters that either affected the delivery of the service or stopped the service. This meant there were no contingency plans in place, which put people at risk of not receiving care and support and therefore, potential harm, in the event of a significant emergency.

These issues were a breach of legal Regulation 17: Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Staff had clear roles and responsibilities and there were systems of accountability. Managers supported staff, and all staff we spoke with were clear about their individual roles and responsibilities. Managers met with staff regularly to provide supervision and carried out competency checks and spot-checks to ensure staff performance. Staff had regular appraisals and performance reviews.

Staff could access all required policies and procedures and managers held regular meetings with staff to discuss concerns and emerging risks.

A person’s relative told us, “The manager has a good overview of everything”. Another person’s relative said, “I do think she [the registered manager] is a good leader”.

The provider understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information with partners and collaborated with them for learning and improvement.

The service worked well with social services, commissioners, GPs, district nurses, occupational therapy, the SALT team, hospitals, the ICB and people and their relatives.

The provider understood their duty of candour and shared information with people, their relatives and other professionals in an open and honest way when something went wrong.

The provider had systems and processes in place to support continuous learning, innovation and improvement of the service and they actively contributed to safe and effective practice.

There was an annual training plan in place, which set out the staff training to be completed over the course of the coming year. The registered manager had completed ‘Train the Trainer’ training, which meant they were qualified to deliver training to staff. Information, learning and updates were shared with staff in team meetings, supervision and via a staff social media group and meetings over the internet.

The registered manager was linked in with the local authority’s registered managers’ support group and had used it to identify Care Certificate training for staff. The Care Certificate is a set of 16 standards for the health and social care workforce that ensures support workers have the foundational skills and knowledge for safe, compassionate, and high-quality care. The registered manager arranged for staff to do the training with the local authority and now all the services’ care staff have completed the training and obtained the Care Certificate.

The provider had also provided a student with a work placement, and the registered manager had completed the student’s work placement report for their college. 

The provider had created and implemented a confidential and secure individual social media group for each person and their relatives, where possible. People, their relatives, staff and the provider used it to communicate with each other to stay informed and updated about each person’s care, support and wellbeing. It meant people and their relatives were able to share information, discuss things and make decisions with the provider and staff in real time and the provider and staff were able to respond to people’s changing needs almost immediately. This made everybody involved feel better informed and had made people and their relatives feel safer and better supported.

A person’s relative said, “I can see the [social media] messages”. Another person’s relative told us, “We have a [social media] group with all the staff who are involved in [mum’s/dad’s] care”.