Prioritising People's Lives Ltd

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people, people with learning and physical disabilities and people who have mental health conditions.

Not everyone using Prioritising People's Lives Ltd receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection there were 75 people who used the service and 63 people were in receipt of the regulated activity personal care.

At our last inspection in August 2017 we rated the service as requires improvement. This was because we found systems and processes for the administration of medicines was not always safe, risk assessments relating to health and safety for people were not always completed, care plans were not sufficiently detailed or updated in a timely manner and quality monitoring processes were ineffective. We asked the provider to make improvements. At this inspection in December 2018 we found the provider had acted and improvements had been made. We rated the service as good.

The service had 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.

People received safe care. Systems were in place to ensure people received their medicine safely and as prescribed. Staff had completed safeguarding training and they knew how to manage risks associated with people's care. Risk management plans provided staff with the information they needed to keep people as safe as possible.

Staff were recruited safely, and enough staff were employed to meet people's needs. People's care and support was provided by consistent workers at the times people expected for the correct length of time.

New staff received an induction when they started work at the service. People told us staff had the skills needed to support them effectively. Staff were supported with regular training, supervision and appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. However, decision specific mental capacity assessments or best interest decisions were not formally recorded. We pointed this out to the registered manager who told us they would take immediate action to address this. After the inspection the registered manager sent us some mental capacity assessments as confirmation that this work had commenced.

Some people received support with their food and nutrition. Where this was the case their nutritional needs and preferences were recorded in their care records. The service worked with external professionals to maintain and promote people's health and wellbeing.

People and their relatives spoke positively about the care they received and told us staff treated people with dignity and respect. Staff helped people to maintain their independence. Policies and procedures were in place to arrange advocates for people should this be needed.

People told us they received personalised care based on their assessed needs and preferences. Care plans were reviewed regularly to ensure they reflected people’s current support needs and preferences. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service and spoke positively about the registered manager. The registered manager and senior staff carried out quality assurance checks to monitor and improve standards at the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications.

Prioritising People's Lives Ltd is a domiciliary care service that provides personal care to older people and people with learning and physical disabilities within their own home. It is based in Stockton-on-Tees and provides care and support to people in the Teesside area. At the time of inspection there were 43 people using the service.

The service was last inspected in April 2017 and rated Requires Improvement.

We issued a formal warning telling the provider that by 19 May 2017 they must improve the following area. Regulation 19: Fit and proper persons employed. The registered provider was employing staff without requesting a Disclosure and Barring Check (DBS). The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults. This helps employers make safer recruiting decisions and minimise the risk of unsuitable people from working with children and vulnerable adults.

We reviewed the action the registered provider had taken to address the above breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also checked what action had been taken to rectify the breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was due to training records being unclear and ineffective at monitoring staff training. People’s care plans did not always contain detail on what support people needed or wanted and quality assurance checks were not always effective at identifying or resolving issues. The provider sent us an action plan stating they would be compliant by 26 May 2017.

At this inspection we found that all staff had a DBS check in place and training records were now updated with evidence of training in place for all staff. We have made a recommendation around recording of decision making in staff files. However, we found issues with the safe administration of medicines and a lack of risk assessments, which quality assurance checks had not highlighted. Therefore we could not evidence that quality assurance checks were always effective.

The service had 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.

Risks to people arising from their health and support needs were not always assessed, and plans were not in place to minimise them. Risk assessments were not specific to the person. Where staff could be at risk arising from the premises or the area of the premises were identified but no risk assessments were in place to mitigate the risk.

We could not evidence medicines were administered or recorded safely.

There were enough staff to meet people's needs. We saw from looking at rotas that people received calls from the same staff each week. There was no evidence of missed or unallocated calls.

Staff understood safeguarding issues, and felt confident to raise any concerns they had in order to keep people safe.

Staff were now receiving training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. The Care Certificate is an identified set of standards that health and social care workers adhere to in their daily working life. Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training, however when asked they could not explain their understanding of the act. Up until and including July 2017 staff received training in up to 14 subjects over one or two days. We have made a recommendation about reviewing the staff's understanding of this training.

Staff received support through supervisions at least five times a year and yearly appraisals. Staff felt confident to raise any issues or support needs they had at these.

The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any concerns they had.

Care plans provided information to guide the care staff on what was needed at each call. However, we found care plans were not updated in a timely manner when people’s needs changed.

Limited feedback was sought from people, relatives, external professionals and staff to assist with assuring the quality of the service.

Staff felt supported by the manager and the provider.

The service had quality assurance systems in place. However, these had not recognised the concerns we raised.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Prioritising People’s Lives Ltd is a domiciliary care service that provides personal care to older people and people with learning and physical disabilities within their own home. It is based in Stockton-on-Tees and provides care and support to people in the Teesside area. At the time of the inspection 23 people received personal care from the service.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident was subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of the service. This inspection examined those risks.

The service had 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.

The registered provider’s recruitment process did not always check to ensure staff were suitable to work in a care service as Disclosure and Barring Service (DBS) checks were not always carried out. Staff received a wide range of training, but training records were unclear and ineffective at monitoring this. People’s care plans did not always contain detail about the support they wanted or needed. The registered manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service, but these were not always effective at identifying or resolving issues. CQC had not always received required notifications from the service.

Procedures were in place to safeguard people from abuse. People’s medicines were managed safely, and people told us they were supported to access their medicines when needed. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Procedures were in place to monitor and respond to accidents and incidents. Plans were in place to provide a continuity of care to people in emergency situations. People told us they were supported by a stable staffing team who were usually on time. The registered manager said they continuously monitored staffing levels and people’s levels of dependency to ensure enough staff were employed to support them.

Staff we spoke with said they did receive training and that it was useful in equipping them with the skills needed to support people effectively. Staff were supported through regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) were protected. People were supported with food and nutrition and to access external professionals to maintain and promote their health.

People spoke positively about the support they received from the service, describing staff as kind and caring. Relatives also spoke positively about staff at the service and the support they provided. Staff we spoke with were enthusiastic about their roles and said they enjoyed getting to know the people they supported. Staff were knowledgeable about the people they supported and were able to tell us about their interests, families and people liked to be supported. The service had received a number of written compliments about the care and support provided by staff. People were supported to access advocacy services where required.

Staff we spoke with said they had all of the information they needed to support people effectively. There was a complaints policy in place, and people were made aware of this when they started using the service.

Staff spoke positively about the culture and values of the service. People and their relatives also spoke positively about the management of the service.

We found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to recruitment checks, submitting required notifications and good governance. Detail on the action we took is contained in the main body of this report.

Prioritising People’s Lives Ltd is a domiciliary care service which provides personal care to people within their own home. It is based in Stockton on Tees and provides care and support to people in the Stockton area. At the time of the inspection 12 people received personal care from the service.

The service had 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.

Risks to people arising out of their support needs and environment were assessed and reviewed, and steps were taken to minimise the chances of them occurring.

People were supported to access their medicines. Where issues with medicine administration were identified, remedial action was quickly taken.

Staff understood the safeguarding issues and felt confident to raise any concerns they had. Staff and the people they supported thought that there were enough staff employed to support people safely and at people’s own pace. Pre-employment checks were carried out to minimise the risk of unsuitable staff being employed.

Plans were in place to provide a continuity of care in emergency situations. Staff had access to the personal protective equipment (PPE) they needed to support people safely.

Staff received a wide range of training, and felt they could request additional or specialist training if they wanted it. The registered manager and registered provider were committed to providing staff with any training that might be relevant to the people they supported.

Staff were supported through regular supervisions and appraisals, which allowed them to raise any issues or support needs with management.

Staff had a working knowledge of the principles of the Mental Capacity Act 2005, and could describe how they obtained people’s consent to deliver care and support.

Where people were supported with food and nutrition they told us they always had a choice over what they wanted to eat and that staff understood their preferences.

The service worked with other professionals to support and promote people’s health and wellbeing, including receiving specialist training where needed.

People told us that staff maintained their dignity and treated them with respect. Staff told us how they encouraged people to maintain their independence whilst always ensuring they had support when needed.

People and their relatives said that staff were kind and caring. Staff said they had time to talk with people and get to know them.

Where necessary, the service had procedures in place for organising advocates to support people and to arrange end of life care.

Care plans reflected people’s preferences on how they wanted their care delivered. They were reviewed to ensure they met people’s current needs. People said they received the care they wanted and that they knew how to request changes to their care plan.

Procedures were in place to investigate complaints, and people were informed of the outcomes. People were provided with the complaints policy when they started using the service.

The service’s culture and values were well-known to staff, who acted on them when delivering support to people.

Staff felt supported by the registered manager and registered provider, both of whom were familiar to staff and people using the service and both of whom were described as approachable.

The registered manager and registered provider worked together closely to monitor and improve standards at the service. Feedback was sought from people and staff on what they thought of the service.

The registered manager understood their role and responsibilities, and was able to describe the notifications they were required to make to the Commission.