Premier Care Limited - Specialised Services

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to person centred care and need for consent.

This service scored 38 (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 did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

The 6 care plans we reviewed were not fit for purpose. A care plan format more suited to domiciliary care had been used in a supported living setting. Care plans were also not accurate, and they were incomplete. People’s needs were not comprehensively assessed, and care planning did not include sufficient consideration of people’s physical, mental, sensory, social and communication needs. Care plans were not personalised, holistic, strengths-based and they did not reflect people’s needs and aspirations.

There was no evidence people had been involved in their care plans when they were written or when they were reviewed. This was not person centred, and we could not be assured care planning met people’s needs and reflected their preferences.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards,

The provider acknowledged staff lacked a clear understanding of the relevant legislation, national standards, and best practice guidance for supported living, substance misuse, mental health, learning disability, and autism. This resulted in inconsistent practice and safety gaps. Plans were in place to provide enhanced training to staff. Without the necessary support people did not understand how this current ‘best practice’ was relevant to them, and they were not involved in planning how this was reflected in the care and treatment they received.

We could not be assured people’s nutritional and hydration needs were being met in line with current standards and evidence-based guidance. Some staff we spoke with told us people were supported to cook and to eat healthier food where required; however, the care records did not support good practice and there was no effective oversight of this work. We requested case studies to help evidence this work but none were provided.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We asked for evidence to demonstrate how information about people was shared with other services and healthcare professionals. This was not provided.

Communication had not been effective within the staff team and staff told us there were significant issues impacting on the service. They told us, “I had some issues with the previous management [they were]…not very accommodating. I used to stay away from the office before, unless I had to come, as the atmosphere was not very nice. This happened for a number of months” and “Under [previous office staff] it was poor as we felt we were in trouble all the time. It was hit and miss before.”

The provider acknowledged there had also been significant shortfalls in leadership and communication with external partners. These poor relationships resulted in delayed responses to people’s risk, gaps in support planning, missed opportunities for early intervention, inconsistent boundaries between people and staff and senior staff and external partners. This impacted on people and led to increased levels of frustration as their needs were not being met due to poor communication and delays.

The new leadership team had quickly grasped the key issues and plans were in place to transform the culture of the service. Staff told us they had already seen some positive change. They told us, “This has improved. Staff and [people] feel more comfortable now. [Previous office staff] were making people feel uncomfortable” and “The guys in the office now are great. They are supportive, more relaxed and welcoming. If I have issues, I feel I can come to them.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

All 6 care plans reviewed lacked detail, and they failed to outline clearly what people’s health related needs and goals were. When needs were identified they failed to explain in sufficient detail how support would be delivered in practice. Health action plans were not in place for people with learning disabilities and autism and we did not see any evidence of people being supported to access GPs and other health professionals.

The provider told us plans were in place to ensure people’s care plans would outline clear health related goals, such as improving diet and increasing activity and senior staff will ensure all health-related interventions are recorded, monitored and reviewed.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People using the service needed more structured support to enable them to focus on recovery and to live well. There had been a failure to successfully introduce an outcome focused monitoring tool to support this work. Plans were in place to address this by training all staff in a new approach and introducing more comprehensive care plans.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Care plans contained very basic information indicating if people could consent to their care or not and contained no guidance to support staff. The lack of records and information made it difficult to assess if people’s rights were being met.

We could see no evidence of a human rights approach with a focus on the least restrictive option and taking all practicable steps to support people to make their own decisions. Where people lacked capacity there was no evidence of any best interest documentation to support decision making and there were concerns where people who lacked capacity were not receiving the appropriate support.

The provider committed to providing all staff with refresher training in the Mental Capacity Act, making sure there were clear capacity assessments for each decision and best interest process in place for people unable to make decisions.