Premier Care Limited - Specialised Services

Premier Care Limited – Specialised Services is a domiciliary care agency, providing personal care to people living in their own homes. The service provides support to people who require care and supervision in relation to their mental health. The service was provided to people living in supported living arrangements.

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 this inspection 3 people were receiving personal care.

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

Risks to people's safety were assessed but these had not been reviewed and updated following any incidents or accidents. We have made a recommendation regarding this. Care plans informed staff about people’s preferences, likes and dislikes but required further review to ensure these were fully person-centred. Safe recruitment practices were followed, and suitable induction and ongoing training was in place for staff. Staff were signed up for external mental health training.

At the time of inspection, people were supported with the safe administration of medication. Recent improvements had been introduced and were being fully embedded into staff practice. There were sufficient staff to support people. Staff were safely recruited and felt well supported by the management team.

People received safe care and were protected against avoidable harm, abuse, neglect, and discrimination. People told us they were treated with kindness, compassion, and respect. People we spoke with felt they had developed good relationships with staff, some of whom had been providing support to them for several years. Staff encouraged people to maintain their independence and do as much for themselves as they were able to. People knew how to make a complaint. No end-of-life care was being delivered. People felt that staff understood their needs well.

There was no registered manager at the time of this inspection, but the provider was actively recruiting to this role. The provider understood their responsibilities and worked in an open and transparent way. Staff considered they were well supported by the managers of the service.

A service improvement plan was in place and the provider was working closely with commissioners of care. Reviews of care were ongoing to ensure people received appropriate care and support at the right time. Quality assurance systems were in place however, systems and processes in place had not identified the lack of regular review to risk assessments and support plans. These had not been updated following any incidents or accidents. Senior managers were working to implement changes needed to the service.

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.

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 requires improvement (published 18 May 2021) and there were breaches of regulation. 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 some improvements had been made, however the provider remains in breach of regulation.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The provider has operated under the Cera brand since January 2022.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Premier Care Limited – Specialised Services is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided support to people with a learning disability, or who required support in relation to their mental health. The service was provided through both a domiciliary care service and care to people living in supported living arrangements.

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 our inspection, five of the 57 people using the service were receiving support with a regulated activity.

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

The risk assessments and associated guidance for staff to manage these risks were of variable detail and did not contain sufficient information. The manager was in the process of writing a new care plan to be more person centred and detailed.

The quality assurance systems were not robust, with the manager not being able to easily access the information required to give them oversight of the service. The Head of Governance performance report was not fully completed to give guidance for the manager where actions were required to improve the service.

People received their medicines as prescribed. A new medicines compliance officer was supporting the manager to ensure systems were introduced to manage changes in people’s medicines and audit the medicines administration records.

There were sufficient staff to support people. Staff were safely recruited and felt well supported by the management team.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

People lived in small houses in their community and were involved in their day to day choices and activities.

Right care:

People’s support needs were in the process of being reviewed at the time of our inspection. New care and support plans were being introduced to be more person-centred.

Right culture:

The service promoted people’s independence and choice to support people to be part of their community and participate in the activities they wanted to do.

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 3 May 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident involving the theft of money from a person using the service. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The inspection was also prompted in part due to concerns received about calls not being completed by staff but being claimed as if they had been.

The information CQC received about the incident indicated concerns about the management of people’s finances and the rota to ensure people received their assessed support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Specialised Services 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.

At this inspection we have identified breaches in relation to the quality assurance systems at the service and the content of the risk assessment guidance to effectively manage people’s identified risks.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Premier Care Limited – Specialised services is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided support to people with a learning disability, or who required support in relation to their mental health. The service was provided through both a domiciliary care service and care to people living in supported living arrangements.

The part of this service providing support to people with a learning disability and/or autism has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. People lived in their own, or small shared houses that were ordinary residential homes. Part of the service had recently been registered as a care home, and the provider was continuing to consider how best to continue to change the way the service was provided to ensure it was person-centred in its approach.

People’s experience of using this service:

• People received support from consistent teams of staff who knew them and understood their needs and preferences.

• Staff supported people to take part in activities and occupation that were meaningful to them. This included supporting people to access services that would allow them to explore employment opportunities.

• People and relevant representatives were involved in planning and reviewing their care and goals.

• There was evidence that the service learned from past issues such as safeguarding and complaints. However, the service was more reactive than pro-active in identifying ways to improve the quality and safety of the service.

• People had health action plans in place. However, we found staff had not given full consideration as to how they could meet recommendations made in relation to one person’s health care needs.

• There were systems and processes in place to help the registered manager monitor the quality and safety of the service, which had improved since our last inspection. However, we identified further improvements could be made in this area.

• Safe practice was generally followed in relation to the management of medicines. However, we found that in two instances, a person had not received their medicines in a timely way due to running out of stocks of medicines kept at their home. The provider reviewed their procedures during the inspection to help prevent this recurring.

• Staff felt supported, listened to and told us they received adequate training. The registered manager encouraged an open culture where staff could challenge things they thought ‘were not right’.

• We received positive feedback from two social care professionals. They told us the service had worked in partnership with them, and others involved in people’s care to help design services that met their needs effectively.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence, and inclusion. The provider recognised the need to continue to review and make the service more person-centred. This was particularly the case for people who were living in the homes that were previously registered as a care home.

Rating at last inspection:

The overall rating at our last inspection of this service was requires improvement (published 04 April 2018).

Why we inspected:

This was a planned comprehensive inspection. The date of the inspection was based on our timescales for returning to services rated requires improvement.

Following our last inspection, we required the provider to send us an action plan. This was to tell us how they would make improvements to meet the requirements of the regulations in relation to a breach found of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance). At this inspection, we found the requirements of this regulation were being met.

Follow up:

We will continue to monitor the service.

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

We last inspected the service on 16, 17 and 21 June 2016 when the service was called ‘Premier Care Limited - Trafford & Manchester Mental Health Branch’. At that time we rated the service requires improvement overall, and found five breaches of the regulations. We asked the provider to make improvements in relation to safeguarding processes, good governance, staff training, submitting notifications to CQC about alleged abuse, and to their statement of purpose. A statement of purpose is a legally required document that provides key information about a service. The provider sent us an action plan and told us they would have made these improvements by December 2016. At this inspection we found the provider had made improvements and was meeting the requirements of the regulations for all previous breaches other than in relation to good governance. You can see what action we have told the provider to take at the back of the full version of this inspection report. Although we found some improvements had been made, this is the second time we have rated the service requires improvement.

Premier Care Limited – Specialised services is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided support to people with a learning disability, or who required support in relation to their mental health, including people who required support with medicines administration. The service was provided through both a domiciliary care service and care to people living in supported living arrangements. At the time of our inspection, the service was supporting 25 people. Two people using the service received support with the regulated activity of personal care. CQC only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where people receive support with personal care, we also take into account any wider social care provided.

Both people who received support with personal care were using the service’s supported living service. These people lived in two supported living settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Since our last inspection, a new manager had registered to manage the service. 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.

Staff understood their responsibilities in relation to safeguarding, and were aware of how to raise and escalate any concerns they might have. The service had an appropriate safeguarding policy in place, and we saw information on safeguarding procedures was readily available to staff.

Staff had received training in medicines administration, and a senior member of staff had assessed their competency to administer medicines safely. There were procedures in place to help the provider monitor the safe management of medicines, but these had not always been effective. We saw one person had not been administered their medicine in accordance with the prescribing instruction printed on their medication records. The medicines audit had not identified this shortfall. The registered manager took action to request a review of this medicine with the person’s GP as staff felt it was no longer required.

Risks to people’s health, safety and wellbeing had been assessed, and there were plans in place to help staff reduce the risk of harm occurring. Staff demonstrated an understanding about the importance of supporting people to make positive risks where these were managed appropriately. The registered manager had recently revised the risk assessment form to include the views of the person it related to, which would help ensure these were taken into account and that risk assessments did not impose unnecessary restrictions.

Care was provided by small, consistent staff teams. This helped ensure staff understood the needs and preferences of the people they supported. We saw 24-hour care was provided to both individuals, which was reflected on the rotas. We saw staff were sometimes asked to work long shifts. The provider told us they were addressing this issue by recruiting additional staff, and there were measures in place to ensure staff were able to safely carry on working for extended periods.

We found an ongoing issue in relation to the intensity of the induction and refresher training. Multiple courses were covered over a relatively short period of time. The registered manager had recognised there was a need to increase the range of training offered to staff. We saw they had produced a training plan, and staff had started to attend additional training on top of the internal training given by the provider. Spot-checks were performed to help ensure staff were providing good quality care and were competent.

Staff understood the principles of the Mental Capacity Act 2005, and we saw staff had considered any issues relating to consent and capacity as they provided care.

Staff understood the importance of supporting people to be as independent as possible and to gain new skills when this is what they wanted. We saw staff had considered whether people might wish to access volunteering or employment opportunities. Staff supported people to be involved in their communities and to take part in a variety of activities in line with their preferences.

People’s needs and preferences were recorded in their care plans. However, relevant information was not always easy to access as it was spread across several care plans that were completed to varying levels of detail. One person’s care plan had not been updated following a significant change in their support needs, although a separate interim care plan had been put in place. Staff told us they would involve people in reviewing and planning their care. However, there was limited evidence of this being done routinely or consistently.

We saw there was a system of audits and checks to help the registered manager and provider monitor the service. However, these were not always robust, and did not always identify issues we found. There was little evidence that the quality of care plans had been considered, and the audit of medicines had not identified an ongoing issue in relation to the administration of one person’s medicine. There was a tool available to staff to evidence they had reviewed people’s care records, but this had not been used.

Staff felt supported in their job-roles and were confident they could approach the registered manager or director of Premier Care if they had any concerns they wanted to discuss. An external auditor had commented on an increasing sense of ‘openness’. We also found the registered manager was encouraging staff to work in open and honest ways to help enable any issues to be identified and for learning to take place.

At our last inspection we found the service’s statement of purpose was not up to date. The registered manager had submitted a revised statement of purpose to CQC following our last inspection. However, this still did not identify the needs of the people the service was providing support to as is required. We discussed this with the registered manager and they sent us an updated statement of purpose during the inspection.

The registered manager had submitted notifications to CQC about notifiable events such as incidents involving the police, deaths and instances of alleged abuse.

The previous inspection took place in May 2013 when no concerns were identified.

Premier Care Limited - Trafford & Manchester Mental Health Branch provides care and support for people living in their own homes in and around Old Trafford, in Manchester. At the date of this inspection 27 people were being supported. Most people were living in shared houses. Most of the people using the service had experienced mental illness in the past, and the service monitored their mental health. There were also three people with learning disabilities living in one house.

There was a registered manager in post who had been registered in April 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 they felt safe. For the most part their care workers arrived reliably on time. The care workers contacted them if they were going to be late. The office monitored calls and could respond if the care worker had not turned up for any reason. The service also carried out a daily check that houses were secure.

Staff were trained in safeguarding although not all staff were up to date with refresher training. The safeguarding policy was not up to date. We found that some events which should have been reported to us as incidents of abuse had not been reported. This was a breach of the regulation relating to safeguarding people from abuse.

The service ordered medicines and delivered them to people’s homes. Some people administered their own medicines, other people were prompted. Staff kept records which were checked each week to ensure that medicines were taken as prescribed.

Staff were involved in helping and encouraging people to keep their houses clean.

Proper processes were followed to ensure that only suitable people were employed. New staff received induction training and shadowed existing staff. Ongoing training was provided through annual training days but some staff were overdue refresher training. There had not been role-specific training in recognising a deterioration in mental health, although we were told there was an intention to reintroduce it. This deficiency was a breach of the regulation relating to providing suitable training for staff.

There was regular supervision of staff, who told us they felt supported in their work. Staff assisted people using the service with shopping and cooking, according to their level of need for support. The service helped people with accessing healthcare. The service had not carried out any mental capacity assessments on people using the service.

People told us they felt well looked after, and that they were helped to have a good quality of life. People were encouraged and enabled to live as independent lives, as they could. However we did not find evidence that people were actively supported to move on to a more independent living arrangement.

Some people received support to access the community. We also saw that staff would sometimes go beyond what they were contracted to do, to support people. There was one person who complained about the support they were receiving.

Care records were kept confidentially in the office but not in people’s homes.

Care plans were created on the provider’s standard template which could be made more specific to the needs of people using this service. Some of the details we saw in people’s plans were incorrect. There was some evidence that files were reviewed, but it was inconsistent.

Annual surveys of people’s views took place, but on the last occasion only half the people had received a survey to complete. People told us the registered manager came to see them to ask their views.

The complaints policy was out of date. The complaints log recorded only two complaints in 18 months.

The failure to report notifiable incidents was a breach of the relevant regulation. There was also a breach of the regulation requiring providers to update the organisation’s statement of purpose, when the service took on people with learning disabilities.

Some audits were done, for example the medication audit, but there had not been any audits of care plans. This was a breach of the regulation relating to monitoring the quality of the service.

The service had a clear purpose of maintaining people’s mental health while assisting them with daily activities. Staff said they found the job challenging but worthwhile. Some of the processes and paperwork needed to be updated.

We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and two regulations of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the end of the full version of the report.

We spoke with three members of staff who told us they always asked permission from people before carrying out any activity. One person said 'I always ask permission to read a person's care plan for example and I respect their wishes'.

The person we spoke with told us 'I am happy and the staff are good, they know what they are doing'.

The staff we spoke with confirmed they received up to date training. One person told us 'I am up to date with training for example medications and safeguarding'. Another person told us 'I am trained to do my job appropriately'.

The manager told us there were up to date policies and procedures in place for staff to follow such as staff training, informed decision making and confidentiality.

We spoke with one person who used the service who told us 'I know how to complain, I would go to the office'.