Archived: Prestigious Homecare

Prestigious Homecare is a domiciliary care service based in Wigston, Leicestershire. It provides care and support to people living in their own homes. At the time of our inspection there were 82 people using the service who received personal care.

The Care Quality Commission (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

The service did not have a system in place to assess, monitor and improve the quality and safety of the service provided. This meant shortfalls within the service had not always been identified.

The service had not notified CQC in a timely manner of significant changes to the way the service was organised. This meant the service continued to provide regulated activities when they were not registered to do so.

Improvements were needed to way risk was assessed at the service. Staff did not always have the information they needed to protect people from risk.

People’s medicines were not always managed safely. Some records were incomplete, and there was no audit system to check if medicines had been correctly administered.

Not all staff had had the training they needed to prevent and control infection. The service had a good supply of personal protective equipment including gloves, masks and aprons but staff hadn’t always worn this in accordance with government guidance.

The registered manager was working to an action plan with a view to improving the quality of the service. Staff competency checks had been carried out, staff training booked, and staff files improved.

People and relatives thought the service was safe and the staff caring and kind. The registered manager was supportive of the staff and dedicated to the well-being of the people using the service.

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

Why we inspected

This was a focused inspection based on concerns we had received about the service. These were in relation to people's safety and the governance of the service. As a result, we undertook this focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed. This is based on the findings at this inspection.

Rating at last inspection

The last rating for this service was Good (published 1 November 2018). At this inspection the provider was in breach of a regulation and the overall rating for the service is now Inadequate. This is based on the findings at this inspection.

You can see what action we have asked the service to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Prestigious Homecare on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to good governance at this inspection. 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 request an action plan from the service to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Not everyone using Prestigious Homecare received the regulated activity; personal care. CQC only inspects the service received by people provided with personal care, help with tasks related to personal hygiene and eating. Where they did we also took into account any wider social care provided. Of the 72 people using the service, 69 were receiving the regulated activity, personal care.

At our last inspection in August 2017, we found one breach of the regulations. The service was rated overall ‘Requires Improvement’ with a ‘Requires Improvement’ rating in the Well Led domain. We asked the provider to complete an action plan to show what they would do and by when to improve the key question, Is the service well led, to at least good. We found formal monitoring systems had not been established and accurate complete and contemporaneous records had not been kept.

At this inspection carried out on 9, 10 and 11 October 2018, we found the provider/registered manager had implemented the necessary improvements and we found evidence to demonstrate and support the overall rating of ‘Good’.

The service's provider is also the registered manager and as such is a 'registered person'. 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.

There were systems in place to regularly assess and monitor the quality and safety of the service being provided.

People told us they felt safe with the staff team who supported them. Their relatives agreed with what they told us. The staff team had received training on the safeguarding of adults. They were aware of their responsibilities for keeping people safe from avoidable harm and knew the actions to take should they be concerned for anyone.

People’s care and support needs had been assessed prior to them receiving their care and support and the associated risks had been reviewed and managed. Checks had been carried out on both the environment in which people's care and support were carried out and on equipment used to ensure it was safe.

Appropriate checks had been carried out when new members of staff had been employed to make sure they were suitable to work at the service. Staff members had received an induction into the service and relevant training had been provided to enable them to meet people’s needs.

The staff team had received training in the management of medicines. Where people required support with their medicines, they were supported in line with the provider's medicines policy.

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.

People told us there were enough staff members to meet their current needs. They told us they had regular members of staff who always turned up, never missed a visit and always stayed the correct length of time.

People were protected by the prevention and control of infection. The staff team had received training in infection control and understood their responsibilities around this.

People were supported by a staff team that was kind and caring and who treated them with dignity and respect. People were supported to make choices about their care and support on a daily basis.

Plans of care had been developed with the people using the service and with people who knew them well. The staff team understood people's needs and preferences because they had read their plans of care.

A complaints procedure was in place and people knew who to contact if they had a concern or issue of any kind.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong and a business continuity plan was available to be used in the event of an emergency or untoward event.

People had the opportunity to be involved in how the service was run. They were asked for their opinions of the service on a regular basis. This was through visits to people's homes and through the use of surveys.

The management team were aware of their registration responsibilities including notifying CQC of significant incidents that occurred at the service.

Further information is in the detailed findings below.

The service’s provider is also the manager and as such is a 'registered person'. 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 told us they felt safe using Prestigious Homecare and felt safe with the support workers who supported them. Relatives we spoke with agreed with what they told us. Support workers had received training on the safeguarding of adults. They knew what to look out for and the procedure to follow if they felt that someone was at risk of avoidable harm or abuse. The provider was aware of their responsibilities for keeping people safe and knew to refer any concerns on to the local authority and Care Quality Commission (CQC).

The provider had assessed people’s care and support needs and risks presented to either the people using the service or the staff team had been assessed and managed.

People using the service had plans of care in place. These had been developed prior to their care package commencing and showed the staff team the tasks they were required to perform. The staff team were aware of people’s individual needs, their likes and dislikes and their preferences.

Checks had been carried out for people wishing to join the staff team. Once employed, support workers had been provided with an induction into the service and training had been completed.

People told us there were enough staff members to meet their current needs. They told us they had regular support workers who always turned up. However, some people told us that not all of them were always on time and not all of them stayed for the agreed length of time.

Support workers felt supported by the provider and felt able to contact them for support or advice at any time.

Support workers had received training in the management of medicines.

People's consent was always obtained to make sure that they were happy with the support they were to receive. Support workers had a basic understanding of the Mental Capacity Act 2005 (MCA) and training had been arranged so they would be clear of its principles. The provider understood their responsibilities around MCA.

People were supported with their nutritional needs and were assisted to access health services when they needed them.

People told us the staff team were kind and they were treated in a caring and respectful manner. They told us their care and support was provided in a way they preferred and choices were always offered.

People using the service and their relatives told us they knew what to do if they were unhappy with the service they received. People had received a copy of the provider’s complaints process when they had first started using the service.

Management monitored the service being provided to make sure people received the care and support they required, though this was on an informal basis. Following our visit a number of auditing processes were developed to assist the formal monitoring process moving forward. A business continuity plan was in place for emergencies or untoward events.

The provider was aware of their registration responsibilities including notifying CQC of significant incidents that occurred at the service.

We found the service was in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of

the report.