Background to this inspection
Updated
23 June 2017
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.
The inspection commenced on the 2 May 2017 and took place over a number of days as we visited the office and sought the opinion of people who used the service.
The provider was given 24 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be in the office.
The inspection was carried out by two adult social care inspectors and two experts-by-experiences. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at the notifications we had received from the registered provider, we considered questionnaires completed by people who used the service and also other information CQC had received about the registered provider.
We also spoke to both local authorities that commission care from the Registered Provider and also the Safeguarding Unit for Cheshire West and Chester. Both felt that the service had improved.
We gained the opinion of 29 people using the service and 12 relatives.
We spoke with 10 staff to seek their opinion of the service and to talk to them about their roles.
We reviewed records relating to the service such as staff rotas, training records, six recruitment files, staff records, quality audits, complaint logs, policies and procedures.
We also looked at 16 records relating to people who used the service such as care plans, medication administration records and daily logs.
Updated
23 June 2017
We carried out an announced inspection between the 2 and 23 May 2017. We visited the office premises over a number of days. As part of the inspection we also spoke to people who used the service and visited some in their own homes.
Premier Care Limited is a domiciliary care agency which provides support and personal care to people in their own homes. The agency is based in Tarporley but provides support within the surrounding rural areas and up towards Neston and Ellesmere Port.
At the time of the inspection the registered provider told us that they provided around 773 hours per week of the regulated activity of personal care to approximately 99 people.
The service did not have a registered manager but the current manager had applied to CQC for registration. 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.
We had previously carried out a comprehensive inspection of this service on 12 October 2016 and found there to be 10 breaches of legal requirement. The purpose of this inspection was to check if the registered provider now met legal requirements and to ensure that people who receive the service are provided with safe and effective care.
We found a number of improvements on this inspection but the registered provider was still in breach of Regulations 12 and 17 of the Health and Social Care Act 2008.
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.
The registered provider had failed to keep people safe as there had been a delay in staff receiving appropriate training in the administration of eye drops. People had their tablets and creams as prescribed or directed.
Staff understood how people made choices about the care they received, and encouraged people to make decisions about their care. Records, however, did not reflect that care was being delivered within the framework of the Mental Capacity Act 2005.There was a risk that support was not being provided in a manner that protected people's rights. We made a recommendation about the assessment and recording of MCA decisions.
Quality assurance checks on care plans, risk assessments and daily records were ineffective. People had a care plan in place but they were not personalised or accurate. There was a risk that staff may not always deliver safe care in line with a person's needs, wishes and preferences. However, checks carried out on the overall effectiveness of the service delivery were now more robust which meant that concerns could be identified and addressed in a timely manner.
Staff had an understanding of safeguarding and what they needed to do to keep people safe. Accidents and Incidents were reported and investigated appropriately.
People who used the service told us that they were satisfied with the support they received. They said that the staff were caring towards them and they now had a more reliable service. People commented that they mostly knew who was coming to visit and staff were more punctual.
The registered provider ensured that they carried out safe recruitment of new staff. Staff had the required checks prior to the commencement of their employment. This meant that the registered provider ensured that staff were suitably skilled, had the right experience and were of the character to keep people safe.
Training appropriate to their role had been provided to staff and supervisions had been carried out. There were direct observations and competency assessments of staff. This meant that people could be more confident that staff were competent and skilled to carry out their role.
People's complaints were identified and addressed. People's views of the service were recorded if they contacted the office and action was taken when issues were raised. People told us that they were better listened to and action was taken to prevent any unsafe or inappropriate care being reported.
Personal and private information about people was kept secure to ensure confidentiality of information. Access to information was on a “need to know” basis.
The registered provider notified the CQC about key events within the service that impacted on the health and welfare of those being supported. This meant that CQC could monitor the overall risks within the service.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.