Prime Care at Home Limited

Prime Care at Home is a domiciliary care service. It is registered to provide personal care to people living in their own homes in the community, including older people and people living with dementia. 23 people received a regulated activity of personal care at the time of the inspection. The service can support up to 26 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People’s needs associated with risk had been assessed, but not fully explored to ensure staff had sufficient guidance to support and manage all known risks. Safeguarding systems were in place to keep people safe from harm. People and their families felt safe with the staff that cared for them. Recruitment processes were robust enough to ensure people employed were safe to work with the people who used the service. Where people required medicine, this was administered as prescribed and in a safe way. People were protected from cross contamination because staff followed infection control policy and procedures. Lessons were learned and action taken when things went wrong.

People consented to the care and support, but those who lacked capacity had no mental capacity assessments completed for decisions they needed to make, or decisions made in their best interest. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s needs were assessed and delivered as reflected in their care plan. Staff received sufficient training to support them in their role. People were fully supported to have sufficient to eat and drink. People attended appointments, such as hospital or chiropodist to help achieve a positive outcome for people’s health and wellbeing and were fully supported by staff.

People were cared for by kind, compassionate and caring staff. There was an opportunity for people to discuss their care and support on a regular basis. Advocate support was acquired if people needed support to express their views. People were shown respect and their dignity was protected always.

People’s care plans were written by them and included choice, needs and preferences. People’s communication needs were appropriately accommodated. People were supported to avoid social isolation and supported to follow their hobbies and interests. Systems were in place to monitor and address complaints. Staff had been trained in end of life care. Policy and procedures in regard to end of life care ensured people had the opportunity to share and understand their wishes, needs and preferences.

The provider promoted an honest and open culture. The provider understands and acts on the duty of candour. The registered manager was aware of their responsibility and had a clear oversight of the service. The management were open and transparent with a willingness to learn and improve. The provider worked with other professionals and developed networks within the community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published 13 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A registered manager was in place. 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 and associated Regulations about how the service is run.

Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

People and relatives we spoke with told us they thought the service ensured that people received safe personal care. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

Risk assessments were not consistently in place to protect people from risks to their health and welfare.

We saw that medicines were, in the main, supplied safely and on time, to protect people’s health needs.

Staff had, in the main, received training to ensure they had the skills and knowledge to be able to meet people's needs and there was a plan in place to extend staff knowledge on people's conditions.

Staff, in the main, understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives.

People and relatives we spoke with told us that staff were friendly, kind, positive and caring.

People using the service or their relatives had been involved in making decisions about how and what personal care was needed to meet their needs.

Care plans were individual to the people using the service to ensure that their individual needs could be met.

People and relatives told us they would tell staff or management if they had any concerns, and they were confident these would be properly followed up.

People and their relatives were satisfied with how the service was run and staff felt they were supported in their work by the senior management of the service.

Management carried out audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service

People were very impressed with the quality of care that was delivered by the provider. Everybody gave us positive comments about the provider. A person told us that the provider was the third care agency that they had used. They said 'They are brilliant. I'm so impressed. I have no intention of changing agencies again. The staff are like an extension of the family'.

The provider has clear safeguarding procedures in place. Staff receive annual safeguarding training and are knowledgable about types of abuse as well as possible signs and symptoms of abuse. People told us that they felt safe when staff from the provider visited to provide care.

The provider has effective recruitment and selection procedures in place and carry out relevant checks when they employ staff.

The provider had appropriate systems in place for gathering, recording and evaluating information about the quality of service of the care, treatment and support provided.

We found people were able to make informed decisions about their care and support. One person told us 'I am in charge of my care. The staff members fully support my needs.'

We found people experienced care and support that met their needs and protected their rights. One person told us 'the carers are professional, but friendly. They do the job properly.' We found peoples' care needs had been thoroughly assessed and care and support was delivered in a way that met peoples' needs and ensured their safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

Although there was a recruitment and selection process in place, we found that gaps in a person's employment history were not fully explained. People using the service were potentially put at risk by absence of a satisfactory written explanation of any gaps in employment histories.

People using the service knew how to make a complaint. The provider kept a record of all complaints made and responded to complaints in a timely manner.