4 September 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection team consisted of one 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. Their area of expertise was with older people.
Service and service type
Pramacare is a domiciliary care agency. It provides personal care to people living in their own homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection visit. We needed to be sure that people were informed that we would be contacting them by telephone, and we needed a manager to be available to facilitate this inspection.
Inspection site visit activity started on 13 May 2019 and ended on 24 May 2019. We visited the office location on 13 and 17 May 2019.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We also spoke with commissioners of the service from the local social services department and clinical commissioning group to obtain their views about the service. We used all of this information to help us plan the inspection.
During the inspection
During the inspection we spoke with 19 people and two relatives. We also spoke with the director of care, the registered manager and three staff. We had emails from 17 members of staff in response to our enquiries about the service and obtained feedback about the service from four health and social care professionals.
We reviewed a range of records including four care plans, three staff files, staff rotas and training records and other information about the management of the service. This included quality assurance records and audits, medicines records and maintenance of equipment.
4 September 2019
About the service:
Pramacare is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 140 people received care and support from the service.
People’s experience of using this service and what we found:
Everyone we spoke with provided exceptional feedback about how caring and supportive the staff were and so often went the extra mile to ensure people were happy and felt well cared for.
We found overwhelming evidence of the positive impact the service had on people's lives. This was due to positive culture created by the registered provider and registered manager.
The providers values of compassion, helpfulness, respect, integrity, sensitivity and trust were embedded in the culture of the service and reflected in all areas of the service, especially from the staff and feedback from people confirmed this.
The registered provider and registered manager continually reviewed the service and sought ways to improve the service to benefit both the people receiving the service and staff. They had built strong relationships with relevant professionals and within the local community to promote learning and meeting people’s needs. They had introduced innovative projects to improve people’s overall wellbeing and care as well as try to reduce social isolation and loneliness.
People received personalised care which was responsive to their individual needs. Staff had an excellent understanding of the care and support people needed and provided this with great care and understanding.
People told us they felt listened to and consulted when planning and agreeing what care and support they needed.
Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.
Risks to people were assessed and regularly reviewed. Staff understood the actions needed to minimise the risk of avoidable harm including the prevention of avoidable infection.
Staff supported people to take medicines safely. Staff were trained in medicines management and knew how to ensure that people received their medicines on time and as they had been prescribed.
There were sufficient numbers of trained, experienced staff to meet people’s needs. Safe recruitment practices were followed, and appropriate checks completed to ensure that only suitable staff were employed.
Four people were concerned that staff worked long hours and did not always have sufficient time to travel between calls. They said this did not affect the standard of care they received. Three staff also told us that scheduling of calls could be improved. However, the majority of staff reported that schedules were satisfactory, and they were listened to if they raised an issue with travel times or the schedule. We have made a recommendation about this.
Staff received induction and on-going training and support that enabled them to carry out their roles positively and effectively.
People had access to healthcare services and were involved in decisions about their care wellbeing. Partnerships with other agencies and health professionals enabled effective outcomes for people.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People and where appropriate their relatives were involved in decisions about their care.
People, relatives and professionals told us they could confidently raise any concerns, and these were addressed appropriately.
Governance systems and oversight of the service were robust. Issues were identified, and actions taken to address any shortfalls.
Rating at last inspection
At the last inspection in June 2017, the service was rated Good overall and Outstanding in one area.
Why we inspected:
This was a planned inspection based on the previous rating.
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk