Premier Care Limited - Specialised Services

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the safe management of people’s medicines.

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 provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

An electronic system ensured key people within the service were notified of key incidents. All incidents were now logged and reviewed by a manager and monthly meetings took place to examine themes and trends.

Processes in place to support staff to record, report and respond to incidents were now effective. Staff told us these processes were clear and they were encouraged to report all incidents.

The safeguarding team told us concerns about information sharing at the last assessment had been addressed. They told us, “Please be advised that since the new management team took over the service, we have seen a significant improvement in the reporting and management of safeguarding concerns.”

The provider worked well with people and healthcare partners to establish and maintain safe systems of care. Documentation needed further improvement to ensure continuity of care, including when people moved between different services.

Referrals into the service had been suspended by the local authority since May 2025. The suspension was lifted in May 2026, and new referrals were being accepted.

Care planning processes had been improved, and a new template had been introduced. Hospital passports had also been implemented since the last assessment. Hospital passports are used by services to ensure all relevant information about the person’s care and support needs are shared. However, hospital passports were not always accurate and had not included risks related to medicines administration. This was corrected during the assessment. We also requested more detail was added to one hospital passport to ensure the communication needs of people with a learning disability was clearer. This was also updated during the assessment.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems and processes to manage safeguarding concerns internally were now established within the service. The documentation reviewed was to a good standard and recorded the actions taken in response to each concern.

However, systems for identifying and notifying CQC of key incidents had not been effective. These were all submitted during the assessment and measures taken to ensure future compliance. People had not been harmed as a direct result, and actions had been taken by staff after each incident to keep people safe.

Staff had access to policies and procedures in safeguarding. Staff were supported through their induction and training to understand their safeguarding responsibilities. We discussed safeguarding with 3 staff and checked their learning in practice. They all understood their responsibilities and how they should report concerns. They were confident managers would respond appropriately. They told us, “I got into trouble in the past for raising a safeguarding. I feel confident with this team now to raise a safeguarding.”

Processes were in place to ensure people consented to their care. Staff received training in the Mental Capacity Act. This supported them to uphold people’s rights.

The provider worked well with people to understand and manage risks. Staff provided care to meet people’s needs that was supportive and enabled people to do the things that mattered to them.

The management team had introduced a new care plan template, and they had used this to review people’s needs with them since the last assessment. People were more involved in discussions about risk and risk assessments were completed and provided staff with improved guidance to support people to stay safe.

The training and support provided to staff had improved since the last assessment. Staff said risk assessments in care plans had improved and the support they received to manage risk had also improved. They told us, “It is a lot better than before. The basics are now in place. It did not happen before. The risk assessments and plans are now in place with clear instructions on how to deal with clients” and “There has been a tremendous improvement with care plans and risk assessments.”

There had also been a renewed focus on ensuring staff understood people’s rights to make their own choices and that any actions required by staff should be the least restrictive. Care plans focused on what was important to people and people were supported to take positive risks where required.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There had been significant improvement since the last assessment. The provider had effective systems in place to ensure people’s home environments were safe. Processes and systems were now in place to ensure there was oversight of key tasks related to safe environments.

This included up to date safety certificates for gas, electric and regular checks of fire safety equipment.

Personal Emergency Evacuation Plans (PEEP) were not up to date and available within the properties we visited. Immediate action was taken to correct this during the assessment.

Renovation of the properties was ongoing to bring them up to the required standard and plans were in place to move people to fully equipped, modern and newly refurbished homes. In the interim some people were still living in a poor standard of accommodation. People had their own tenancies and had been offered options to redecorate their current properties and had declined.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There had been a clear focus on raising standards and supporting staff to perform to the expected standard since the last assessment. Training and the application of training in practice had improved. A plan was also in place to enhance the level of training available to staff in future.

The induction process had improved. The process now ensured staff received the appropriate level of support to support them in their roles. This included shadowing, spot checks, 1-1 support and mentoring. Staff told us, “Yes, I feel very supported by the management. If I need anything they help me” and “Yes, this has improved. We have had more training.”

The provider told us the requirement introduced by the Health and Care Act 2022 to provide all staff with the right level of training on learning disability and autism would be completed in October 2026. An external trainer had been identified and training booked.

The provider operated a thorough recruitment process. Checks were undertaken on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining two references and carrying out a Disclosure and Barring Service (DBS) check. DBS checks help prevent unsuitable people from working with vulnerable people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were supported by staff who had received training in infection prevention and control. The staff we spoke with understood their responsibilities.

The houses we visited were still in a poor condition and this impacted on the cleanliness of the homes. Cleaning schedules and spot checks had been implemented since the last assessment and people received regular support to maintain their homes. Plans were ongoing to renovate the properties to a higher specification, and this would undoubtedly help to improve the cleanliness of the homes.

The service did not make sure that medicines were safe. Care plans and medicine related documentation was not up to date or person centred to ensure service user’s were supported safely.

There were discrepancies between the medicines administration records (MAR) and the medicines listed in medicine related documentation. For example, one person had medicines listed in their care plan to treat a respiratory condition which were not listed on their MAR. There was a risk people might not be given their prescribed medicines.

The MAR was not always signed in line with the prescribed instructions. We saw one person’s MAR had not been completed; therefore, we could not be assured the medicines were administered correctly.

We found allergy information was not always documented on the MAR, as set out in best practice guidance. This meant there was a risk people might be given a medicine they had previously reacted to.

Care plans did not always contain sufficient information about medicines to ensure staff could safely support people. We found staff did not always have access to peoples care plans, therefore there was risk staff might not be able to support them properly.

The provider completed audits, however the same issues were identified in several of the audits around access to the digital systems and therefore showed the actions taken were not always effective to drive forward improvements at the service.

Not all information relating to medicines, requested from the service as part of the assessment process was provided.