The Care Quality Commission
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Archived: Palmerstone Homecare

Overall: Requires improvement read more about inspection ratings

8th Floor, North Suite, Terminus House, Terminus Street, Harlow, Essex, CM20 1XA (01279) 437923

Provided and run by:
Palmerstone Homecare Ltd

Important: This service is now registered at a different address - see new profile
Important: This service was previously registered at a different address - see old profile

All Inspections

12 July 2016

During a routine inspection

This was an announced inspection carried out on the 12 and 13 July 2016. At the last comprehensive inspection in September 2015, we rated the service as requires improvement. At that inspection we found two breaches of regulation; people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines and people who use the service were not protected from the risks of unsafe care because the recruitment procedures were not adequate.

After the inspection in September 2015, the provider wrote to us to say what they would do to meet the regulations in relation to each breach. They told us they would complete all actions by the end of January 2016. At this inspection, in July 2016, we found that the provider had not completed their plan of action and legal requirements were still not met. We also found additional breaches.

You can see what actions we told the provider to take at the back of the full version of the report

Palmerstone homecare provides personal care and support to adults who live in their own homes. At the time of inspection up to 197 people were using the service and some people were vulnerable due to their age and frailty, and in some cases had specific and complex health care needs.

We completed this inspection after receiving concerns about missed and late visits and people being left without care and support. Concerns included people’s personal care needs not being met and people not receiving their medicines at the prescribed times. We found the local authority had temporarily suspended new placements to the service because they had concerns about the service being provided.

The service has a 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 2008 and associated Regulations about how the service is run.

Medicines were not managed safely. Safe medicine administration practices were not followed so people were not protected against the risks of unsafe management of medicines. Although some staff had received training in managing medicines, this had not given staff the required competency to manage medicines safely.

Sufficient recruitment checks had not been carried out before staff started work to ensure that they were suitable to work in a care setting. Staff were not always supported to carry out their work and had not received regular support and training.

The provider's systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not always implemented and the provider's quality monitoring systems had failed to identify significant concerns. People did not always receive their care and support as planned as staff had missed some people's calls and did not always spend the agreed time on the calls.

There were not always effective systems in place to respond appropriately to complaints and comments made by people who used the service or people acting on their behalf. People who used the service were not confident that their comments and complaints were always listened to and dealt with effectively.

People were receiving the support they needed to eat and drink sufficient amounts to help meet their nutritional needs. Staff knew who to speak with if they had any concerns around people's nutrition.

Risk assessments identified specific risks to people and hazards in their home environment.

Staff had a good knowledge of safeguarding procedures and were clear about the actions they would take to help protect people. Risk assessments had been completed to help staff to support people with everyday risks and help to keep them safe.

People were supported by staff to maintain good healthcare and were assisted to gain access to healthcare providers where possible.

17 and 23 September 2015

During a routine inspection

We carried out our inspection on the 17 and 23 September 2015 and the inspection was announced.

Palmerstone Homecare provides personal care services to people in their own home. At the time of our visit the service was supporting 166 people. This was the first inspection since the service was registered at this location.

Palmerstone Home care has a registered manager who was also a company director. 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.

Recruitment procedures were not sufficiently robust; staff had started work before the results of all the checks were complete. This placed people at risk of receiving unsafe care.

Medicines were not always safely managed and we found that there was a lack of clarity about the agency’s responsibilities and who should administer what medication. This lack of clarity could people at risk

There were sufficient staff available to meet people needs and people told us that they liked having consistent carers.

Risks to people were well managed through a risk assessment process which looked at both environmental and individual risks. Staff were clear about safeguarding procedures and the actions should they take should a concern be identified.

Training was provided to staff but the systems in place to monitor and oversee it did not operate effectively. It was not clear if staff had the required knowledge or undertaken relevant training. We identified gaps in staff knowledge and understanding of the Mental Capacity Act 2005 (MCA).

Support was available to support people to maintain a balanced diet and to access health services.

People told us that the majority of staff were very caring and went the extra mile but this was not always consistent. Communication was identified as an issue as misunderstandings could occur which impacted on care.

People were involved in developing their care plan but there were occasions when the agency had not been able to consistently meet people’s preferences. Communication about the reasons for this and the management of concerns was an area that was identified as problematic. People did not always feel listened to.

Formal complaints were investigated and some were well managed with a clear outcome.

There were systems in place to monitor the quality and safety of the service which included seeking the views of people who used the service and welfare checks. However the systems had not been effective at identifying the lack of consistency across the service.

During this inspection we identified 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.