Archived: Privilege Care Limited

Privilege Care Limited has one registered location. The office is situated within walking distance of Slough’s High Street, railway station and transport links. At the time of our inspection, 17 people were supported with personal care.

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:

During this inspection, we checked to see if the provider had addressed the concerns found at our previous visit on 28 January 2019. We found the provider did not make the improvements it told us it would, and there were multiple repeated breaches of the regulations. There were systemic failures in the provider’s quality and assurance systems, and records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. This compromised the quality and safety of the service provided.

Systems in place to protect people from abuse were ineffective. Although staff had attended relevant training, some staff were unable to demonstrate how they would safeguard people if alleged abused was disclosed. People could not be assured staff would recognise or respond appropriately to abuse. We have made a recommendation about the review of safeguarding systems. Risks to people’s welfare and safety were not managed appropriately.

The provider did not have enough qualified, competent, skilled staff and recruitment and selection procedures, did not ensure people were only supported by staff who were suitable to do so.

Although some improvements had been made in relation to the safe management of medicines, further improvements were needed to ensure medicines were managed safely at all times. This placed people at risk of potential harm. We have made a recommendation about medicines management and medicines management policies and procedures.

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; as the policies and systems in the service did not support this practice.

The provider failed to ensure staff had the appropriate knowledge and skills to meet people's needs effectively. The delivery of care and support was not personalised to meet people’s specific needs. People’s rights under protected characteristics, were not always protected as staff did not understand their responsibilities.

The registered manager failed to document meetings with people and their relatives therefore, we were unable to determine whether the care delivered still met their care and support needs. The provider did not meet the requirements of the Accessible Information Standard as, there had not been an assessment of people's communication needs to ensure these were met. Systems in place to handle, record and deal with complaints were not effective.

People and relatives felt staff were caring and respectful. People said staff supported them to live healthier lives, access healthcare services and to eat well balanced meals. People were protected from the risk of infection. The provider sought the views of people and relatives about their experiences of using the service. However, at the time of our visit the provider had not taken any action to analyse and respond to the feedback received.

Rating at last inspection and update: The last rating for this service was inadequate (published 20 July 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the full report.

Enforcement

We have identified breaches in relation to person-centred care, obtaining consent from people to receive care and support, receiving and acting on complaints, ensuring staff are well supported and trained to provide effective care, recruiting staff that are suitable for the role and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

This is the single location within the provider’s current registration. The office is in a residential area of Slough. At the time of our inspection, 24 people used the service and there were 11 staff. For more details, please see the full report which is on our website at www.cqc.org.uk

People’s experience of using this service:

People and relatives described the support received as caring, however stated there were numerous areas that the service needed to improve. Insufficient action was taken by the provider since our last inspection. People’s risks were assessed however sufficient information was not in place which demonstrated how risks were reduced. There was consistent feedback that staff were late, there were not enough staff or that the same staff members were not deployed to provide people’s care. Recruitment processes remained unsatisfactory. Staff did not appropriately complete induction, training and performance appraisals. Spot checks by the registered manager were completed. The documentation and management of complaints was insufficient. Systems and processes to monitor the quality of the service were still not in place. Formal feedback was not sought, although forms were available to enable this. There was inadequate management oversight of the service which led to repeated and new breaches of the regulations.

Rating at last inspection:

At our last inspection the service was rated “requires improvement ”. Our last report was published on 27 March 2018.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. We inspect services previously rated “requires improvement” within 12 months after the last published inspection report.

Enforcement:

There were eight breaches of the regulations at this inspection.

The overall rating for this service is inadequate and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and a rating of inadequate remains for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The service has a registered manager. 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.

This is the first inspection under Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives spoke positively about the caring nature of staff. A person commented, “They (staff) know I have problems with my shoulders and provide care in a gentle way. They always say what they’re going to do and ask me if I am okay.”

People and their relatives said staff treated them with respect and dignity. Personal information was kept securely and password protected in the office.

People and their relatives felt safe when receiving care and support from staff. Staff were aware of their responsibilities to protect people from abuse and had attended the relevant training. However; staff did not have access to Local Authorities specific procedures for reporting and managing safeguarding matters. We have made a recommendation for the service to seek current guidance and best practice to make sure national and local safeguarding arrangements are reflected in their safeguarding policy and procedures.

Staff were aware of people’s risks but there were no measures to reduce or remove the risks within a timescale that reflected the level of risks and impact on people. Safe recruitment practices were not always in place. We have made a recommendation for the service to seek current guidance in relation to staffing provision in the event of unforeseen circumstances.

Medicines were administered safely. However; the service had not made sure met staff met the acceptable levels of competence to support people with medicines. We have made a recommendation for the service to seek current guidance and best practice on conducting medicine competency assessments. People were kept safe from infection.

People felt they were supported to have maximum choice and control of their lives. However; there were no records to demonstrate staff had supported them in the least restrictive way possible. We have made a recommendation for the service to seek current guidance and best practice on maintaining documents in line with the MCA requirements and the registered manager to attend a MCA course specific to their job role.

People and their relatives felt the care delivered was responsive and met their specific needs. We found assessment of peoples’ needs were not consistently undertaken by the service. We have a made a recommendation for the service to seek current guidance and best practice on how to carry out assessment of peoples’ needs. Staff were not appropriately inducted; trained and supervised. Staff worked within the principles of the Equality Act 2010 to make sure their work practice did not discriminate against people. People and their relatives felt their nutritional and health needs were met.

The registered manager was not aware of their legal duty under the Accessible Information Standard, to make sure people with a disability or sensory loss can access and understand information they are given. We have a made a recommendation for the service to seek current guidance and best practice in order to be compliant with the Accessible Information Standard. This meant the service did not implement the systems they had in place when complaints were received.

People and their relatives felt the service was well-led and staff spoke about the supportive work culture.

Although the registered manager was actively involved in providing hands on care to people, this affected the operation of the service. This was because systems in place to assess; monitor and improve the quality and safety of the services provided were ineffective. The service did not always notify us of certain incidents which had occurred during, or as a result of, the provision of care and support to people.

There were no records of to show how the service responded to feedback received and how information sought was used to drive improvements to the quality and safety of the services provided. We have made a recommendation for the service to seek current guidance and best practice on how to evaluate the service provided.

We found breaches of regulations as a result of this inspection. You can see what action we told the provider to take at the back of the full version of the report.