Prime Care Support Limited

Updated 1 March 2023

The inspection

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.

Inspection team

This inspection was carried out by two inspectors, a medicines team inspector, and an Expert by Experience. 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 and flats, and specialist housing.

Registered Manager

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 not a registered manager in post. However, a new manager had been recruited, and had begun the application process to register with the Commission.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider would be in the office to support the inspection.

Inspection activity started on 23 November 2022 and ended on 21 December 2022. We visited the location’s office on 23 and 24 November 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service, and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

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 spoke with nine people who used the service and 12 people’s representatives about their experience of the care provided. We made follow up calls to four representatives to further discuss the feedback they provided. We spoke with 15 members of staff, including the manager, business manager and the nominated individual. The nominated individual is also the provider, and therefore responsible for supervising the management of the service.

We reviewed a range of records relating to staff. This included recruitment documentation, induction, training and supervision records. We also viewed specific care records for 34 people. Records viewed included care plans, risk assessments, monitoring documentation, medicine and care visit records. Additionally, we reviewed quality monitoring documents, policies and other records relating to the management and oversight of the service.

We held video calls with the provider, manager and business manager in addition to our visits to their office location.

Updated 1 March 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Prime Care Support Limited is a domiciliary care agency providing personal care to people in their own homes, some of whom may live with dementia, may be autistic or living with a learning disability. At the time of inspection, 93 people were receiving the regulated activity of personal care.

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 the wider social care provided.

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

Right Support: Staff did not always retain information from training completed, and the provider did not have a robust process to continually review staff knowledge.

We have made a recommendation for the provider to review how they check staff knowledge following training completed.

Staff mostly communicated in a way people could understand. Trained staff supported people with their medicines, however, some protocols and procedures required improvement. People were involved in planning their care, and their desired outcomes were recorded. Staff promoted people’s independence and encouraged choice.

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.

Right Care: Some people, their representatives and staff told us when care visits were delayed, communication was not always effective.

We have made a recommendation for the provider to review their communication methods with people, representatives and staff to make improvements.

People mostly received their care calls at the expected time, and we found planned care calls were reflective of contractual agreements. Risks to people had been assessed. However, some risk assessments required review to ensure the information was accurate, and reflective of people’s needs. Staff promoted people’s dignity, privacy and human rights.

Right Culture: The quality assurance systems had been reviewed by the provider, since the last inspection, and progress was notable. However, further time and improvements were required to ensure the systems are robust in identifying and addressing shortfalls.

A new manager had been recruited since the last inspection. Staff told us they felt able to approach the management team, and the provider, with concerns. However, feedback received from people, their representatives, and staff, indicated general management communication, and responsiveness, could be improved.

The new manager, provider and care team were passionate to further improve the service. For the most part, staff recognised when people’s needs changed, and the provider made timely referrals to external healthcare professionals to ensure effective care and support was in place. A comprehensive service improvement plan was in use, and the provider was responsive to feedback throughout the inspection process.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 21 June 2022) and there were breaches of regulation. At this inspection we found improvements had been made, and the provider was no longer in breach of all the regulations found at the last inspection. However, the provider was still found to be in breach of two regulations at this inspection.

At our last inspection we recommended the provider review their renewal process for Disclosure and Barring Service checks of longstanding staff, and their food hygiene procedures. At this inspection we found the provider had acted upon both recommendations made, and reviews had been completed.

This service has been in Special Measures since 01 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified two continued breaches in relation to safe care and treatment, and good governance, at this inspection.

Furthermore, we have made two recommendations to the provider at this inspection. We recommend the provider further reviews their communication methods with people, their representatives and staff. And, we recommend the provider establishes an effective process to confirm training effectiveness and knowledge retention with staff.

We issued two warning notices to the provider in response to breaches of regulation 12 (safe care and treatment) and regulation 17 (good governance). We have imposed a timescale for the required improvements to be completed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.