Archived: Premier Care Limited - Cheshire West & East Branch

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.

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 1240 hours of the regulated activity of personal care to approximately 140 people.

The service did not have 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 2008 and associated Regulations about how the service is run.

We had previously carried out an unannounced comprehensive inspection of this service on 24 February 2016 and found breaches of legal requirements. 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.

The registered provider had submitted an action plan telling us they would be compliant by September 2016. However, we found that the registered provider was still not meeting legal requirements and we identified a number of on-going and new breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.

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.

People who used the service told us that they were not satisfied with the care that they received. They said that the care staff were polite and caring towards them but that the overall service was unreliable, inconsistent and as a result they did not feel safe. People commented that they never knew who was coming to provide the service, there were many occasions when care staff were late and it was not unusual for no one to turn up at all.

People were supported with their medication but we found that this was not done in a safe way. People did not always get their medication as prescribed or directed. This placed their health and wellbeing at risk.

An assessment of people’s needs was not always evident prior to people using the service and people told us they had not really been involved in formulating their care plans. Not everyone had a personalised care plan in place and as a result, staff did not always deliver safe care in line with a person’s wishes and preferences. This meant that people did not get care that afforded them privacy, dignity and respect.

The registered provider did not ensure that their own policies and procedures were adhered to in regards to recruiting staff. Not all staff had the required checks prior to the commencement of their employment. This meant that the registered provider did not ensure that staff were suitably skilled, had the right experience or were of the character to keep people safe.

Training provided to staff was inconsistent and supervisions were not regularly carried out. There was no direct observation or assessment of care staff therefore people could not be confident that care staff were competent and skilled to carry out their role. People told us that new staff needed more training and support in order to support them more effectively.

People’s complaints were not identified as such and addressed. People’s views of the service were not always formally recorded and we found no action was taken when issues were raised. People told us that they were not listened to and action was not taken to prevent any unsafe or inappropriate care that was being reported.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. Staff gained consent from people prior to providing care or services, however where people lacked capacity we saw that arrangements were not in place for staff to act in their best interests. Staff were not knowledgeable about the MCA and had not received training. This meant that there was a risk that support was not being provided in a manner that protected people’s rights.

We found that personal and private information about people was not kept securely and there were occasions where there were other breaches of confidentiality. This meant that privacy and dignity were not maintained.

Quality assurance checks on care plans and care delivery were ineffective. Audits had not been carried out .This meant that the risks to people’s health, safety and welfare had not been identified or addressed in a timely manner. The registered provider had also failed to notify the CQC about key events within the service that impacted on the health and welfare of those being supported. Due to the many concerns that we found, we did not have confidence that the registered provider had oversight of quality and risk within the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC.

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 so that there is still a rating of inadequate 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 within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

This was the first inspection since the service was registered. The service provides personal care and support for over 200 people living in their own homes. They deliver nearly 1800 care hours to people per week. The service provided care and support for older people, people living with dementia, end of life care, long term conditions, respite care and night care.

There was no registered manager in post. 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.

We found that the registered provider was not meeting legal requirements and there were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We checked medicines management. We found that clear and accurate records were not being kept of medicines administered by care workers. Details of the strengths and dosages of some medicines were not accurately recorded. Care plans and risk assessments did not support the safe handling of some people’s medicines. This breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is being followed up and we will report on any action when it is complete.

The service had not followed the principles of the Mental Capacity Act 2005 (MCA). The MCA governs decision-making on behalf of adults who may not be able to make particular decisions for themselves. The requirements of the MCA were not being followed which meant that people’s rights may not be protected. This breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is being followed up and we will report on any action when it is complete.

There were systems in place to monitor many aspects of the service this had not been fully implemented. There were a number of areas not monitored such as management of medicines daily records and care plans. This breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is being followed up and we will report on any action when it is complete.

There were safeguarding policies and procedures in place. Staff were knowledgeable about what actions they would take if abuse was suspected. However they were unaware of social services accountability in dealing with safeguarding concerns. A safeguarding concern was identified at the inspection that had not been discovered by the service.

Safe recruitment procedures were followed. The service had received a number of staff and service users recently who were transferred to them from another service. The provider had identified that a number of these had gaps in their recruitment that needed to be addressed.

Staff said that they undertook an induction programme which included shadowing an experienced member of staff. Staff were appropriately trained and told us they had completed training in safe working practices and were trained to meet the specific needs of people who used the service.

People and relatives were extremely complimentary about the caring nature of staff. Staff were knowledgeable about people’s needs and we were told that care was provided with patience and kindness. People’s privacy and dignity was respected.