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Inspection carried out on 13 May 2019

During a routine inspection

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.

Follow up:

We will c

Inspection carried out on 27 June 2017

During an inspection looking at part of the service

This focussed inspection was announced and took place on 27 and 28 June 2017. We told the provider two days before our visit that we would be coming to ensure people and staff we needed to speak with would be available. At the last inspection completed in August 2016, we found a breach in the regulations relating to medicines. We found people were not always protected against the risks associated with the unsafe management and use of medicines. As a result we undertook this announced focussed inspection to review what improvements the provider had made in regard to their medicine management systems. At this inspection we found the provider had implemented a range of improvements and was compliant with the regulations.

Pramacare has a registered manager in post. 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.

Pramacare provides personal care and support to people who live in their own homes. The service is a registered charity and their stated vision is, 'A world where no-one is unfairly disadvantaged or excluded because of age or infirmity and where every person can enjoy life as they age'.

People were positive about the care and support they received from Pramacare staff. They told us, “The service is very good, I’m confident all the staff do the medicines safely”.

The provider had implemented a range of systems to ensure people were protected against the risks associated with administering people’s medicines.

There were clear systems in place to guide and support staff when administering creams to people. These involved the use of body maps so staff could easily see where and how to administer creams.

The provider had implemented a revised Medicine Administration Record (MAR), this was colour coded which staff said enabled easier, clearer guidance when administering people’s medicines.

Where people wished to take their medicines after care staff had left there was a system of risk assessments completed for them to ensure they were safe to do this.

Staff had received thorough training in all areas of medicine management and administration and told us they found the training to be good and they felt well supported in their role.

Inspection carried out on 10 August 2016

During a routine inspection

This inspection was announced and took place on 10, 11 and 16 August 2016. We told the provider one day before our visit that we would be coming to ensure that the people we needed to talk to would be available. At the last inspection in November 2013 the service was meeting the requirements of the regulations that were inspected at that time.

Pramacare has a registered manager in post. 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.

Pramacare provides personal care and support to people who live in their own homes. The service is a registered charity and their stated aim is, "To help older people and vulnerable adults to enjoy their independence while staying where they feel happiest, at home. We also do our best to encourage support from family, friends and the local community. Every client is an individual, that’s why we pride ourselves on providing everyone with an individual programme of care."

The service ensured that people received effective care that met their needs and wishes. People experienced positive outcomes as a result of the service they received and gave us excellent feedback about their care and support.

People said they felt safe and had confidence in the staff that worked for the service. There were systems in place to protect people from harm and abuse. Staff knew how to recognise and report concerns. However, we found that the management of people's medicines was not always safe and we could not be certain that people always received their medicines as they had been prescribed.

People received personalised support from staff who were motivated, kind and caring. All of the people we spoke with told us they appreciated the service they received and the little extra's that staff did for them that made a big difference. Where possible, people were matched with staff who shared similar interests in order that common ground could promote working in partnership to provide a person centred focus.

There was a strong and visible person centred culture. The service had created a client forum where people were encouraged to attend quarterly meetings to discuss the service and to represent "the voice" of people who used the service. Transport was arranged by the service for those people who needed assistance to get to the meetings. The client forum was also used to gather feedback from people about how they would like the service to be organised and managed in the future.

An innovative project had been created as part of the work of the client forum, which was called the Smile project. It allowed staff to identify vulnerable and isolated people and offer them two free hours per month, in addition to their day to day care visits, to spend time with staff doing something to make them smile. Examples that we heard about included arranging transport and coordinating with a professional dog walker to take someone who was usually housebound on a walk at a local beauty spot with their dogs. This was something they had not thought they would be able to do and had given them great pleasure. Staff had also organised shopping trips for some people who were unable to go shopping on their own, completing crosswords with someone who was being cared for in bed and no longer able to do this themselves and spending time making arts and crafts with people who had previously had an interest in this area but no longer had the equipment and materials to do this. The registered manager advised that the project had been very successful.

Staff were exceptionally knowledgeable about the people they supported and respected their choices and preferences. Care plans were detailed and regularly reviewed. This meant that there was

Inspection carried out on 3 December 2013

During a routine inspection

We carried out this announced inspection and looked at five people's care plans, safeguarding and medication records and staff training records. We spoke with 12 members of staff and looked at the systems the provider had in place to monitor the quality of service provision. We sent a total of 61 surveys and received 17 responses.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person commented: "Our working relationship is one that is built of deep respect, good boundaries, best practise. This... means that having prama as a solid - continual component in my life greatly enhances my well being".

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Appropriate arrangements were in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We received only two concerns from people who responded to our survey. These concerned people not being informed if a care worker was running late and some care workers being inexperienced and not well trained. We have highlighted this to the provider to take appropriate action.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Inspection carried out on 11 February 2013

During a routine inspection

At this unannounced inspection we spoke with the manager, four members of staff, a relative and three people who used the service provided by Pramacare.

During this inspection we visited three people in their own homes and talked to them and their relatives about the care they received from Pramacare. All of the people we spoke with told us they were very happy with the service they received.

People told us that staff treated them with dignity and respect and provided all the help and care they needed. They told us the staff completed their personal care in a friendly and respectful manner.

We spoke with four members of staff. They stated the agency had provided thorough training and gave them good support in order for them to provide effective personal care.

Pramacare followed thorough processes and procedures when new staff were recruited. This meant that people were protected from harm.

Medicines were handled appropriately.

We saw the provider had a quality assurance system in place to ensure standards were maintained.