Archived: Princess Homecare

Updated 13 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook the comprehensive inspection of Princess Homecare on the 29 September and 5 October 2016. We gave the provider 48 hours’ notice of the inspection to ensure the relevant people would be available. We inspected the service against each of the five questions we ask about services: is the service safe, effective, caring, responsive and well led? This was because the service was not meeting the legal requirements in relation to these questions.

The inspection was carried out by two inspectors. Before our inspection we reviewed the information we held about the service. This included the provider's action plan, which set out the action they would take to meet the legal requirements.

During our inspection we spoke with the registered provider, deputy manager, a quality assurance manager and two care staff. Following the inspection we spoke with two relatives of people who use the service and one person who used the service. We received feedback about the service from two health and social care professionals.

We reviewed a range of records and systems which included care records, financial processes, quality monitoring and audits, staff files including training and supervision records, policies and procedures.

Updated 13 December 2016

At the comprehensive inspection of this service in November and December 2015 we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to safe care and treatment of people, the management of medicines, a lack of a clear pricing policy, adhering to the principles of the Mental Capacity Act 2005, record keeping, safe recruitment practices, staff training and supervision and how the service was managed. We issued the provider with a notice to cancel the provider registration stating they must take action. We shared our concerns with the local authority safeguarding and commissioning teams.

We carried out a comprehensive inspection on 29 September and 5 October 2016, to assess whether the provider had taken action regarding the breaches we found of the Health and Social Care act 2008 (Regulated Activities) Regulations 2014, and to provide an overall quality rating for the service.

The registered provider had made significant improvements around the safety of people’s care and treatment. People and families told us they felt safe with the staff who delivered care and in the way care was given. All staff had received training in the management of medicines and behaviour which may challenge. Staff told us this training had been valuable.

Risk assessments relating to people’s care and treatment had been rewritten and for the most part gave clearer guidance on how to minimise potential risks. However, further development of risk assessments was required. There was a lack of detailed information when recording incidents.

A more robust pricing and invoicing system was in place which assured people of clearer and more accurate billing.

At this inspection we found the provider had made important improvements in their management of medicines. However, improvements were still required in the accurate recording of medicines and more robust auditing of medicines.

The system for staff training and supervision had been updated and staff received training relevant to their role. All staff including the registered provider and deputy manager received on-going support through supervision. Regular team meetings were held and staff told us they felt supported by the management team.

With the exception of one person, where people’s capacity to consent to specific decisions was in question, a mental capacity assessment had been completed. This was in relation to taking their medicine, the use of some types of equipment which may act as a restraint, consenting to their care and treatment and sharing their information with other agencies. Mental Capacity assessments were now reviewed as part of the care review process or when people’s circumstances changed.

The registered provider told us that some people had arrangements in place for their nutritional and hydration needs to be met as part of the provision of care and treatment. Within people’s care plan there was information as to people’s likes and dislikes regarding food and any special dietary requirements. The guidance in place for eating and drinking was not always being followed or potential risks identified.

People received support from health and social care professionals and the registered provider ensured relevant information was shared with staff.

People and their families told us staff were kind, caring and respectful. Staff knew people well and their preferences for the way they wished their care to be delivered. Care records were person centred as they reflected in detail the wishes of the person. The tone and language used in the recording of people’s care was appropriate and the service continued to monitor this.

Care records were person centred and described in detail people’s care routines and their preferences. However, some records such as risk assessments and management plans were unclear and further improvements were required.

Information was available to people about local activities and clubs where they could socialise and meet new people.

The provider’s website and information leaflet had been updated to reflect accurate information about the service. All of the provider’s policies and procedures had been revised. Working practices were being monitored and staff were involved in the future development of the service.

A new addition to the management of the service was a quality assurance manager. The deputy manager and the quality assurance manager had been integral to the changes which the service had made and were working on embedding these improvements. The registered provider told us there was now a clear vision of where the service was going and its future development. One aspect of this was changes which were going to be made organisationally and to the management structure of the service.

In October 2015 the overall rating for this service was ‘Inadequate’ and the service was therefore in ‘Special Measures’. Following the inspection carried out in September and October 2016 we have changed the rating to overall ‘Requires Improvement’. The service is therefore no longer in special measures. You can read the report from this inspection by selecting the ‘all report’ link for Princess Homecare on our website at www.cqc.org.uk.