Prime Care Support Ltd

Aylesbury Prime Care is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 133 people using the service. 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.

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

At our last inspection we found many areas of the service were inadequate which placed people at risk of harm. We served three Warning Notices and issued five requirement notices for breaches of regulations. At this inspection, we found the service had improved and taken action to meet the Warning Notices and were no longer in breach of regulation.

People told us they felt safe with staff from the service. Staff had received safeguarding training and told us they would not hesitate to report any concerns. Any safeguarding concerns had been reported to the local authority and CQC had been notified. Staff had worked hard to ensure there were no missed care visits. Further work was needed to make sure visits were carried out on time, the provider was monitoring this. The provider monitored times and durations of care calls, data was collected, analysed and shared with the local authority weekly.

Risks to people’s safety had been identified and assessed. Management plans were in place which the provider had reviewed. Further improvement was needed to make some risk management plans more personalised. Since the last inspection the provider had moved all records onto an electronic care planning system which helped them keep oversight of risk management. Incidents and accidents were recorded, and the provider reviewed them to identify any themes. Any lessons learned were shared with staff to try and prevent reoccurrence.

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. People’s whole needs were assessed and recorded in individual care plans. This gave staff guidance on a range of support people required to maintain independence living in their own home.

Medicines were managed safely. Staff had been trained to administer medicines and recorded all the medicines administered on people’s individual records. Staff liaised with various healthcare professionals when needed to make sure people’s health needs were met. Feedback we received from professionals about staff and the service was positive. They found staff to be responsive and knowledgeable about people’s needs.

People and relatives told us staff were kind and caring. People spoke to us about how they looked forward to their care workers visit. Overall people thought staff were trained but there was not the same confidence with newer workers. Staff had an induction when they started work which included all modules of the Care Certificate. Staff were able to shadow a more experienced worker and had their competence assessed. Staff received an ongoing programme of refresher training which was monitored and delivered in part by a training manager.

Recruitment was safe. Staff had the required pre-employment checks carried out. The provider had faced challenges recruiting new staff which they were trying to overcome. People told us there were times the service felt short of staff, which they said resulted in late visits. Whilst overall people did not feel rushed, they knew their care workers were busy. We shared feedback from people with the provider who was also carrying out quality surveys to gather people’s views.

There was a registered manager in post who had registered since the last inspection. Staff told us the registered manager was approachable and dealt with any concerns. People and relatives did not all know who the registered manager was. We shared this with the provider who told us they would send out some communication about the manager. Staff felt supported by the provider and many were long standing staff who all enjoyed their jobs. Staff had meetings and opportunities to share their views. The provider carried out spot checks regularly with staff to monitor quality and safety.

People were cared for by staff wearing suitable personal protective equipment. Staff tested for COVID-19 regularly and had received training on working safely. The provider made sure staff had all they needed to work safely during COVID-19.

Quality monitoring was taking place and the provider was regularly carrying out checks with people to monitor improvement since the last inspection. The provider had reflected on what had gone wrong at the last inspection and made many changes to carry out the improvement required. The provider worked in partnership with the local authority to meet people’s needs.

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 22 June 2021) and there were eight breaches of regulation. We served the provider three Warning Notices following the inspection and five requirement notices. The provider completed an action plan after the last 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.

This service has been in Special Measures since 22 June 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Aylesbury Prime Care is registered to provide personal care and support to people 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 supported approximately 300 people who had a wide range of physical and health care needs.

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

We found people were not routinely and consistently supported to received safe care and treatment. People were not protected from hazards which had the potential to cause harm. We found the service failed to routinely and consistently assess risk to people. For instance, people who were at risk of choking did not have a risk assessment in place, people who were prescribed medicines which had the potential to cause harm had no risk assessment in place.

People who had medical conditions which needed to be monitored did not have risk assessments in place.

People were not routinely supported safely with their prescribed medicines. We found records relating to medicine lacked detail to ensure staff knew how to support people.

People were not routinely supported by staff who had been recruited in a manner to ensure they had all the required skills and experience. Staff were not supported to enhance their knowledge through training in a timely manner.

People did not routinely have the support they required or expected. This was because the service failed to ensure care visits were planned in a safe way. Staff were not always allocated travel time between care visits and were expected to visit too many people at the same time. People told us this had impacted upon them. Comments included “I do get frustrated, I’m in bed all day and if they are late, I get very angry”, “I can’t plan anything” and “I’m getting fed up with them”. Another person told us “I often feel I’m just the next job, I don’t see the same team very often and don’t feel respected”.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were supported by a service which was not well-led. One person told us, “The organisation of Aylesbury Prime care is non-existent, hopeless at times”. Another person told us “The company needs a shake up and needs to employ more carers. One carer showed me they had visited 30-35 people a day. ‘Look at this madam, all these visits, all at the same time’”.

Systems in place to monitor the service were not effective. We found records were lacking in dates, times, and author. We found people’s care records contained contradictions which could have led staff to be confused as to how to support them. Audits carried out by the service failed to drive the required improvement. They had not identified some of the issues we found.

People told us where they had a regular carer they were happy with the service provided, comments included, “I have no complaints as care is very good and staff are approachable, by and large carers are absolutely superb" and “We are quite happy with the service and pleased with most prime staff". Other comments included, “Most of them [staff] are caring” and “All the carers have been excellent but since a regular one has left the care has been intermittent”.

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 good (published 15 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about risk management, medicine management, poor care planning to ensure people received a personalised service. We had also received concerns about the management and oversight of the service to drive improvements. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, medicine management, recruitment of staff and ongoing support and training for staff. We have also identified concerns in the managerial oversight of the service.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Aylesbury Prime Care provides a domiciliary care service to enable people living in Aylesbury and the surrounding areas to maintain their independence at home. There were 300 people using the service at the time of the inspection, who had a wide range of physical and health care needs. Not everyone who used the service received personal care. The CQC only inspects services where people receive personal care which is help with tasks related to personal hygiene and eating. Where services offer personal care, we also consider any wider social care provided.

People’s experience of using this service

People told us staff were caring. Staff’s commitment enabled people to receive care from staff who knew them well.

The manager and staff went strived to provide safe care and support. The manager worked closely with the GP and other healthcare professions to ensure the service responded to people’s changing needs safely and effectively. People’s care was personalised and matched their needs, which promoted their wellbeing and improved their quality of life.

The service was well-led by a manager who was registering with the Care Quality Commission and was continually looked for ways to improve people’s lives. Staff culture was positive and the team was caring. This had resulted in the provision of compassionate and personalised care. The service had a clear management and staffing structure in place. Staff worked well as a team and had a sense of pride working at the service. The provider had quality assurance systems in place to monitor the quality and safety of the service.

People received safe care from skilled and knowledgeable staff. People told us they felt safe receiving care from the service. Staff fully understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were very well supported to maintain good health and to meet their nutritional needs.

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

Rating at last inspection:

At our last inspection we rated the service Good (published in January 2017).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Primecare Support is registered to provide domiciliary care to people who require support and assistance in their in their own home in the Buckinghamshire area. On the day of our visit there were 209 people using the service.

The registered manager has been in post since 2010. 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 we spoke with told us staff were caring and considerate and promoted their independence. One person told us, “They come in and do a bit of tidying and help me prepare my food. I look forward to seeing them”.

Comments from staff included, “This is a great place to work” and “They are like a big family, you can talk to all of them they are always at the end of the phone”.

Staff received training in safeguarding and told us they would not hesitate to report anything of concern. Staff we spoke with told us, “I would report concerns to the office, and document this in the person’s care plan”.

Policies and procedures for the safe management of medicines were in place and being followed. Regular audits were carried out and any discrepancies were dealt with. We inspected the service’s medicine charts and found where staff had not signed for a medicine; an action plan was put in place by the registered manager. Staff were asked to sign the chart and where necessary further training was arranged.

Safe recruitment procedures were carried out. Recruitment files we saw contained relevant documentation required to ensure only suitable staff were appointed. Staff received appropriate induction, training and supervision. One member of staff told us, “We have got a good name out there, I have seen some changes. I do believe Primecare are the best at training”. Staff received a quick reference guide to outline basic principles of community care and some basic company procedures in a pocket sized book. One member of staff said, “It goes with me everywhere”.

People said they knew how to make a complaint and were given the information to do so when they first received a care service. Staff were aware of the process to follow if someone made a complaint. This was in line with the service’s complaints procedure. One person told us, “I have contacted the office and they have always been very pleasant”.

People had access to healthcare services to maintain good health. We spoke with one person, who told us, they had nursing needs and saw the community nurse on a regular basis. One member of staff told us, “I work alongside the district nurse occasionally. We have built up a good rapport.”

The service had effective quality monitoring systems in place to drive improvements and ensure the safety of people who use the service.

People's needs were assessed and the care and support was planned and delivered in line with their individual care plan. The care plans were detailed, regularly reviewed and updated. Risk assessments had had been written to identify and reduce the likelihood of injury or harm with guidelines in place for staff to follow.

People told us they were happy with the care and support they received. They said they were involved in the care planning and review process and their views taken into consideration. One example was given to us was over the gender of carer, the person told us 'I was asked if I would mind having a male member of staff and I said I did not want one. I have never had a male come here'.

People told us staff stay for the agreed time but three people commented that they were occasionally rushed. One person said 'Sometimes I have different staff and I feel a little rushed'.

Staff we spoke with felt well supported and told us there was an open door policy, that they could approach the manager at any time if they had any concerns.

The staff we spoke to showed a good knowledge of safeguarding procedures and policies and demonstrated how they would recognise and report suspected abuse. Staff told us they were supported through supervision and regular staff meetings and this enabled them to provide a good quality service to the people who used the service. The people who used the service were complimentary about the provider and the quality of care they received and the professionalism of care staff. One person told us 'I am very happy with the service I receive, all the staff are professional in their approach and are able to support my needs.'