Archived: Paramount Care & Safety Ltd

Following the inspection in November 2017, the provider sent us an action plan which confirmed all required actions would be completed by December 2017. This comprehensive inspection was carried out to confirm that all required improvements had been made.

Paramount Care & Safety Ltd specialises in providing support to adults with learning disabilities. This service provides care and support to people living in 'supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of this inspection there were three people supported by the service in two separate properties.

Since the last inspection a manager had successfully registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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 manager was supported in the day to day running of the service by the general manager who was also the Chief Executive Officer (CEO) of the service.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. At this inspection we found the evidence to support the rating of ‘Good’. However, we identified improvements needed to be made to ensure inappropriate restrictions were not placed on people.

Improvements had been made to the arrangements in place to monitor the quality and safety of the service. The managers in the service demonstrated a commitment to ongoing service development.

Staff were safely recruited. Robust processes were in place to make sure all appropriate checks were carried out before staff started working at the service. There were enough staff available to provide the care and support people were assessed as needing. During the inspection, we observed positive and respectful interactions between people who used the service and staff.

Staff were aware of the signs and indicators of abuse and they knew how to report any concerns. Staff had received training on supporting people safely.

Systems were in place to maintain a safe environment for people who used the service and others.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service. Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to deliver support. People had been involved with planning and reviewing their care, using technology and communication tools to do so.

We found people were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People used pictures and photographs to choose the meals they wanted. Staff told us they tried to encourage people to eat a healthy and balanced diet.

People’s privacy, individuality and dignity was respected. They were supported with their hobbies and interests, including activities in the local community and keeping in touch with their relatives and friends.

There were processes in place for dealing with complaints. There was a formal procedure to manage, investigate and respond to people’s complaints and concerns.

People who used the service, staff, relatives and professionals were encouraged to provide feedback about the service. We noted positive comments had been received from a number of people.

Following the inspection in June 2017, the provider sent us an action plan which confirmed all required actions would be completed by 30 September 2017. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Paramount Care & Safety Ltd on our website at www.cqc.org.uk.

Paramount Care & Safety Ltd is a domiciliary care agency, which is registered to provide personal care and support to adults living in their own houses across Lancashire. The agency specialises in providing support to adults with learning disabilities. At the time of this inspection there were three people supported by the service in two separate properties.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been appointed to manage the service after the last inspection. They were in the process of submitting an application to CQC in order to register as manager. They were supported in the day to day running of the service by the office manager.

During this inspection, we found the systems in place to monitor the quality and safety of the service were not sufficiently robust. We also found the provider had failed to act in accordance with the Mental Capacity Act 2005 (MCA). You can see what action we told the provider to take at the back of the full version of the report.

Since the last inspection, a number of quality assurance systems had been introduced in the service. These included audits and provider monitoring visits. However, we found the quality assurance systems were not sufficiently robust to identify the shortfalls we noted during this inspection.

When we reviewed the records for one of the three people who used the service, we found some restrictions were in place in relation to their consumption of some food and drink items. Although staff told us these restrictions were in place to protect the health of the person concerned, there was no evidence that an assessment had been made of the person’s capacity to decide what was best for them to eat and drink. This meant there was a risk their rights had not been upheld.

People were supported to attend appointments with professionals to ensure their health needs were met.

Improvements had been made to the systems to monitor and record training completed by staff. We saw that staff were receiving regular supervision to allow them the opportunity to discuss their training and development needs. Staff told us they enjoyed working in the service and found the managers to be very approachable and supportive.

Paramount Care & Safety Limited is a domiciliary care agency which is registered to provide personal care and support to adults living in their own home across Lancashire. The agency specialises in providing support to adults with learning disabilities. At the time of this inspection there were three people using the service in two separate properties.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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. However the registered manager had not been consistently present in the service for several months. Our findings during the inspection showed this had impacted negatively on the leadership of the service.

During the inspection we found two breaches of Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because there was a lack of robust governance systems in place. In addition the systems to record and monitor the training staff were incomplete and needed to be improved. You can see what action we told the provider to take at the back of the full version of the report. 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 nominated individual was unable to tell us of any systems in place to regularly review the quality of the service people received. Staff reported difficulties in accessing support via the on-call management system. This meant that some staff felt they had been left to make decisions without being able to access advice from a senior manager. In contrast other staff spoke highly of the support they received, particularly from the office manager. Although staff told us they enjoyed working in the service, some staff felt their views on how the service could be improved were not sought by the senior management team.

Improvements needed to be made to the systems to record the training staff had completed. In addition there were no identified timescales by which refresher training needed to be undertaken. Although all but one member of staff told us they had received the training they needed for their role, three staff told us the way training was organised could be improved.

Staff had received training in safeguarding adults from abuse. They were able to demonstrate their understanding of the correct action to take if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff told us they would be confident to use the whistleblowing policy that was in place should they witness poor practice in the service.

We found people were cared for by sufficient numbers of staff who had been safely recruited. Staff told us they worked flexibly to support people to attend activities of their choice. People were enabled to make their own decisions as much as possible. Staff placed emphasis on promoting people to develop their independent living skills and to maintain relationships with their families. During the inspection we observed staff were caring and respectful in their interactions with people who used the service.

Systems were in place to help ensure the safe administration of medicines. Staff had received training in the safe handling of medicines. However there were no systems in place to regularly assess the competence of staff to administer medicines safely.

Care records included detailed risk assessments and risk management plans. These provided information and guidance about how to ensure people who used the service and staff were protected from identified risks.

Regular checks were completed to ensure the safety of the properties occupied by people who used the service. However we noted there was no business continuity plan in place to advise staff of the action to take should there be an emergency at either of the properties occupied by people who used the service or at the registered office.

Staff we spoke with had a good understanding of the principles of the Mental Capacity Act 2005 and DoLS. Community based professionals we spoke with told us processes were in place to ensure applications were made to the Court of Protection in order to protect the rights of people who used the service. Staff were able to tell us how they ensured people who used the service were supported to make their own decisions and choices wherever possible. Staff used pictorial communication systems and electronic devices to enable people to make their needs and wishes known.

Systems were in place to ensure people’s health and nutritional needs were met. People who used the service had health action plans in place. These plans contained personalised information about how professionals should best support individuals when they accessed health care services.

Staff told us how they encouraged people who used the service to review their support plans to ensure they accurately reflected their needs and wishes. External reviews of the care provided by the service had also been undertaken by the two local authorities responsible for commissioning the care people received. Community based professionals we spoke with told us they were confident people who used the service received personalised care which encouraged them to meet their goals.

There was a procedure in place for responding to and managing complaints. We were told there had been no complaints received at the service since the last inspection.