Archived: Premier Homes

The previous inspection took place in August and September 2016 where seven breaches of the Health and Social Care Act 2008 were identified. The provider was rated as Inadequate and placed into special measures by CQC. We took enforcement action after the last inspection. This inspection was carried out to check on the improvement actions identified in the provider’s representations.

Premier Homes is a care home which provides accommodation, personal care and support for up to 17 people living with mental health needs. There were 15 people in receipt of care at the time of our inspection. Accommodation was split between five separate houses, all located within a small geographical area within the same street. People lived in small groups with between two and four people in each property. People’s needs were such, that staff support was available to them 24 hours a day, either when staff were working with people in their houses during core set hours, or at any time if people visited the office and asked for assistance.

The service did not have a registered manager as the previous manager left following our last inspection. The responsible individual had been acting manager since the registered manager had left. The directors have another company which is registered with the Care Quality Commission (CQC). At one of these services a manager had been newly appointed. Since our inspection this manager has been registered with the CQC. The directors planned that this manager would also

manage Premier Homes until the service changes its registration to become a supported living service. At this point the service will be part of the company mentioned above.

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.

Person centred risk assessments had been produced with people living at the service. The service had not taken action to minimise some of the risks identified putting people at risk from harm for example, we found a risk assessment stating someone was at risk form drinking bleach when they became unwell, yet we found they had access to bleach which was being stored under the kitchen sink. The service took immediate action once this was brought to their attention.

Medicines were not always managed safely and staff did not always follow best practice guidelines when administering medicines. There had however been a number of improvements since we last inspected.

Quality assurance checks were being completed, these did not always provide detailed information about the issues identified by them or how the service was going to address the concerns. People told us they reported concerns and these were acted on. We saw there was a formal complaints procedure in place which responded to complaints appropriately.

Records and recording across the service had improved since our last inspection they were more detailed and thorough. Care plans and risk assessments provided details about the person and their individual needs. People had been involved in their care planning and had signed to say they agree with what was recorded.

People felt safe with the care and support they received. Staff were aware of the safeguarding process and how to report any concerns they had. Staff had received up to date training in safeguarding adults and we found the policies and procedures staff were required to follow, were up to date containing reference to recent legislation.

Staff engaged with people politely and appropriately throughout our visit and people told us they liked the staff. People were supported to attend medical appointments and referrals were made in a timely manner.

Staffing levels within the service were appropriate for the current level of need. Staff recruitment was robust as the service completed the required checks to ensure staff were suitable to work with vulnerable people. Staff were provided with sufficient training to support them in their role.

People’s views were sought at resident meetings and keyworker sessions. People living at the service were mostly independent with how they spent their days, other people received support with activities of daily living. We saw the service had arranged for additional activities in the coming months for people to participate in if they wanted to.

Staff sought consent from people before providing care or support. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. There was no one subject to a DoLS at the time of our inspection and we saw the service had considered what was in a person’s best interest within their care files.

We found improvements had been made with regards to safe care and support provided by Premier Homes since our last inspection, these improvements need time to embed in the service and we will check on these at our next inspection.

During this inspection we found three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Premier Homes is a care home which provides accommodation, personal care and support for up to 17 people with mental health needs. There were 15 people in receipt of care at the time of our inspection. Accommodation was split between five separate houses, all located within a small geographical area within the same street. People were accommodated in groups of between two and four people in each property. People's needs were such that staff support was available to them 24 hours a day, either when staff were working with people in their houses during core set hours, or at any other time if people visited the office and asked for assistance.

A registered manager was in post who had been registered with the Commission to manage the carrying on of the regulated activity since April 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We identified serious concerns with people's safety in respect of risks they were exposed to in their daily lives and the environments in which they lived. The provider had not taken steps to identify and address risks associated with people's mental health. Some people were at risk of self-harm and measures had not been put in place to prevent people from being exposed to avoidable harm. Documented risk assessments had not been drafted to inform and guide staff about how to deliver care to each person safely. Environmental risks such as those from defect flooring, legionella bacteria and fire, had not been appropriately considered and reasonable steps to mitigate these risks had not been taken. Accidents and incidents that occurred within the service were not recorded, managed or monitored for patterns and trends to be identified.

Safeguarding incidents were not reported in line with safeguarding protocols to either the local authority safeguarding adults team, or CQC. Therefore people were not appropriately protected from harm or abuse, as investigations were not carried out and protection plans could not be put into place. Staff did not recognise their own personal responsibility to report matters of a safeguarding nature.

Medicines were not managed safely and staff did not follow best practice guidelines which administering people's medicines. We could not reconcile what medicines some people should be taking or whether they had received the right medicines at the right time. There was evidence that some people had not received the medicines that they had been prescribed. Recording around the administration of medicines was poor and some of these records were missing.

Cleanliness levels within the accommodation were poor and best practice guidance about the prevention of the spread of infection were not followed. Bedrooms and communal areas were stained with brown water marks and equipment was not clean. Some people had stained bedding in their rooms. The procedures for the decontamination of commode basins did not follow best practice guidance and soiled linen was transported uncovered through one accommodation property, posing a cross contamination risk.

Staffing levels appeared appropriate to meet people's needs, however staff told us they did not have the ability to clean each accommodation thoroughly during their shift times. Recruitment procedures were robust and appropriate checks were made before staff were employed to work for the service. However, staff were not supported with appropriate training and they were not equipped with the skills they needed to carry out their roles once they were employed. This had a high impact on people, as they did not receive an effective service because staff were not competent in their roles.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The registered manager told us that no people in receipt of care were subject to a DoLS and we saw no restrictions were placed on their movements. However, in relation to consent and capacity assessment we found the principals of the MCA were not embedded within the service. There was little evidence that service users’ consent had been obtained, other than in some people's records where they had signed their very basic plans of care. There were no systems in place to assess service users’ capacity levels to consent and make their own choices, especially where their capacity levels may fluctuate in line with changes in their mental health. We could not establish how people's consent to their care and treatment had been obtained.

Staff engaged with people politely and appropriately during our visit and most people said they liked the staff. However, the care people received was not person-centred. People had choices about how they lived their lives but they were not supported to set and achieve realistic goals. People were supported to attend medical appointments if it was linked to their general health and wellbeing, but where the provider needed to be responsive, for example to people's changing behaviours or mental health needs, they were not. External input into people's care was not always sought. People were not supported to meet their nutritional needs and this had resulted in some people becoming increasingly frustrated where they had requested specific foods be provided.

Records and recording across the service overall was very poor and the records we asked to see could not always be found. There was insufficient detailed information within people's care records and documents used to record incidents and handover information between changing staff shifts were limited. Complaints were also not recorded and there was no record of them being appropriately investigated and resolved.

Governance of the service was extremely limited and there was a lack of management oversight. Audits were not carried out internally and the provider did not carry out their own audits or inspections of the service to monitor its performance. People and staff told us they had reported concerns and issues on several occasions but these had not been appropriately dealt with. We identified issues that had been brought to the attention of the registered manager, but could find no evidence to show that steps had been taken to drive improvements within the service.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 relating to the notification of other incidents. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Due to the serious shortfalls in many aspects of the service, we wrote to the provider during our inspection to request an urgent action plan which stated what actions they would immediately take to improve. We visited the service again on 14 September 2016 and found that at that time, insufficient improvements had been made to ensure people’s immediate health, safety and wellbeing. We therefore imposed some urgent conditions on the provider's registration and asked for further information and evidence of remedial actions taken to improve the service. This was duly received and we were reassured the provider had addressed our most serious concerns. We will continue to monitor the provider’s progress against their action plan and will revisit the service to ensure that people’s health, safety and wellbeing is protected and promoted.

People received care and treatment that was so poor, we have judged that the service was failing to meet every aspect of the CQC assessment framework and we have rated it as ‘inadequate’. This has also meant that the service has been placed into special measures. Services in special measures are kept under review and where action is not taken to immediately remove the location from the provider’s registration, we will inspect the service again within a maximum of six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If they do not, we will take action to prevent the provider from operating this service.

Policies and procedures were in place and accessible to staff. However, at the time of our visit a new management system was in the process of being implemented which would involve adding and updating all the company's policies and procedures.

We saw people were treated with respect and afforded privacy and dignity, having locks on their bedroom doors. We looked at care files for three people and saw a range of up to date documentation which demonstrated inclusion of input from service users. Health and personal information was factual and kept up to date.

We spoke with six people who used the service. One person told us, "This is my home', another said, 'Staff are sound, dead helpful, they are good'. A third person commented, 'It's nice here, staff are nice'. All said they had no concerns and were well cared for and happy.

People who used the service told us they felt safe. We spoke with three members of staff who demonstrated knowledge of safeguarding procedures and were confident of following these if necessary.

The staff members with whom we spoke felt that staffing levels were appropriate. This was confirmed by recent staff rotas which we were shown.

Complaints were taken seriously and followed up appropriately and regular audits were carried out. The results were analysed and improvements made as appropriate.

We saw that some of the accommodation had been upgraded. However some areas were in need of attention. We spoke with staff. They confirmed to us that they were in the process of upgrades to all of the homes and we saw evidence of workmen in one of the locations.

Staff told us that they were happy in their role. One staff member told us they were 'very happy and the manager is very good'. We were told by staff that they 'felt supported'.

We spoke with people who use the service. People told us they were 'happy, and feel supported by staff'. One other person said they felt 'happy' and the staff were 'nice people'.

One person told us they can 'go out if they want'. Another person told us they 'go out to see their mum and go shopping'.

We saw that there was a good rapport between staff and people who use the service.

People who used the service were able to go out when they wanted to. Staff told us that people who used the service had been on holiday last year.

We saw panic alarms in each room in the houses to gain immediate help and we saw closed circuit television in the hall and front door to each house linked to screen in the office accommodation.