Archived: Promedica24 UK Ltd

Promedica24 UK Limited provides live in care staff for people living in their own homes throughout the country. Staff are recruited in Poland and come to the UK to live in people’s homes and provide care and support for a contract period of usually six or seven weeks at a time.

Not everyone who used the service received personal care. 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. At the time of our inspection 115 people were receiving live in support in their own homes.

People’s experience of using this service and what we found

CQC had received increased numbers of notifications about how people using the service were being kept safe. This included issues around staff training and support, moving and handling practice, accident and incident management, and staff behaviours. A decision was made for us to inspect and examine those risks.

During the inspection the registered manager advised that the volume of care packages managed by the Watford office had increased from 55 at the previous inspection in January 2020 to 115 currently. This increase was as a result of one of the provider’s offices closing and the administrative tasks merging. This helped to explain the increase in notifications from this service.

We explored the outcomes of complaint investigations, safeguarding investigations and incident reporting and found that the provider had a good oversight of these matters and provided support to the registered manager as and when needed.

The service took action to help reduce the transmission of Covid 19 and other infections. Staff reported that personal protective equipment (PPE) was readily available to them and that they had received appropriate training. Staff were knowledgeable about any current Covid 19 restrictions in their local area and what this meant for them and the person they supported.

We explored staff knowledge of safeguarding vulnerable adults and reporting concerns to external bodies for investigation. Staff were very clear about internal reporting processes and how to report concerns externally if needed. Staff received training, supervision and competency assessments to help ensure they had the right skills and knowledge to support people safely.

The registered manager and provider had good oversight of the service and the management of any concerns, complaints or safeguarding matters. There were clear reporting systems that were understood by the entire staff team.

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

Rating at last inspection

The last rating for this service was Good (published 08 August 2020).

Why we inspected

We undertook this targeted inspection to review specific concerns around increased numbers of notifications and complaints. CQC have introduced targeted inspections to follow up on enforcement notices or breaches or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Please see the safe and well-led section of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Promedica24 UK Limited provides live in care staff to people living in their own homes throughout the country. Care staff are recruited in Poland and then come to the UK to live in people’s home and provide care for a period of usually seven weeks.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. At the time of our inspection 55 people were receiving live in support in their own homes.

People’s experience of using this service and what we found

People and their relatives were happy with the support they received. They regarded staff as an extended part of their family and were happy with the care and support they received which enabled them to remain in their own homes.

People felt safe with staff and had their needs met. Staff developed good relationships with people and were respectful of people’s privacy. Relatives felt their family members were cared for safely by well-trained staff, who were kind and respectful. Staff received the training and support they needed to enable them to support people effectively.

There were enough staff to meet people’s needs. Recruitment processes were robust and personalised to help ensure the right candidates were selected for the right people.

People received their medicines safely from trained staff. Accidents and incidents were analysed, and lessons were learnt and shared with the staff team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff supported people to eat and drink enough and people were involved in making decisions about their care where possible. Relatives assisted when appropriate. Staff gave and respected people's choices. Their preferences on how staff delivered their care were recorded in care records for staff to follow.

The provider had effective governance in place. There were systems to audit, monitor and drive improvement.

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

Rating at last inspection and update:

The last rating for this service was good (published 21 June September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected Cassiobury House on 3 May 2017. We then made telephone calls to people who used the service and staff on 8, 9 and 10 May 2017. The inspection was announced.

At our last inspection on 5 October 2016, the service was found not to be meeting the required standards in the areas we looked at. They were rated inadequate and placed in to special measures. The service was found to have several breaches of regulation relating to. Accidents and incidents were documented by staff but no follow up or risk assessments were completed to help keep people safe. There were no systems in place to monitor risks to people’s health and well- being. There were not sufficient staff resources to always cover staff when required. There were no systems in place that enabled staff to identify trends and patterns emerging to prevent risks and improve the service. The provider did not have effective governance in place and there were no systems to audit, monitor and drive improvement. There were no effective and accessible systems for identifying, receiving, handling and responding to complaints from people who used the service. Training did not cover all areas of people’s needs People were not always involved with reviews of their care and support. Not all people received personalised care and support that met their changing needs and took account of their preferences. Safeguarding incidents had not been reviewed to determine any action needed to keep people safe. The review of accidents and incidents was not robust. The provider had failed to notify the Care Quality Commission of incidents which had taken place, which under the terms of their registration they had a duty to report.

At this inspection we found that the provider had made the improvements required. However, there were some areas that required further improvement. These have been addressed in the report.

There was a manager in post who was not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The registered manager had resigned and their last working day was 26 August 2016. There was a new manager in place who had made an application to CQC to register.

Accidents and incidents were recorded by staff and risk assessments were completed to help keep people safe. There were systems in place to monitor risks to people’s health and well- being. However, further improvements for the monitoring of these incidents to monitor emerging trends or patterns.

Care plans had been reviewed and updated since the last inspection. The plans were now person centred and contained guidance for staff. However, we found some examples where care records required further updating to ensure they were accurate. People told us that they felt safe in their homes. Staff had received training in how to safeguard people from abuse. Staff knew how to report concerns. There were now systems in place to ensure that agency resources were available to cover staff when required.

We found that capacity assessments did not always consider each separate decision as required.

The provider had effective governance in place, there were systems to audit, monitor and drive improvement.

People knew how to complain and there were effective and accessible systems for identifying, receiving, handling and responding to complaints from people who used the service.

Relatives and people were positive about the skills, experience and abilities of staff who worked in their homes. Staff received training in Poland and monthly internet training supported by competency checks from care managers. The provider ensured that relevant training to meet specific needs were in place. Staff had received supervision to discuss and review their development and performance.

Staff had developed caring relationships with the people they supported and knew them well. People were involved with reviews of their care and support.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their changing needs and took account of their preferences.

People were supported to maintain good health and had access to health and social care professionals when necessary.

We inspected Cassiobury House on 5 October 2016. We then made telephone calls to people who use the service and staff on 6, 7, 10, 11 and 17 October 2016. The inspection was unannounced. At our last inspection on 02 March 2016, the service was found not to be meeting the required standards in the areas we looked at. The service was found to have breaches in regulation’s 9, 11, 12, 13, 16, 17 and 18. At this inspection we found that the provider had not made the improvements required. Cassiobury House provides ‘living in’ carers to support people in their own homes. At the time of our inspection 84 people were receiving live in support in their own homes.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. 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 are 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.

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

There was a manager in post who was not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run. The registered manager had resigned and their last working day was 26 August 2016. There was a new manager in place who had made an application to CQC to register.

Accidents and incidents were recorded by staff but no follow up or risk assessments were completed to help keep people safe. There were no systems in place to monitor risks to people’s health and well- being.

People told us that they felt safe in their homes. Staff had received training in how to safeguard people from abuse. Staff knew how to report concerns. There were not sufficient staff resources to always cover staff when required.

There were no systems in place that enabled staff to identify trends and patterns emerging to prevent risks and improve the service. The provider did not have effective governance in place. There were no systems to audit, monitor and drive improvement.

People knew how to complain. However there were no effective and accessible systems for identifying, receiving, handling and responding to complaints from people who used the service.

Relatives and people were not always positive about the skills, experience and abilities of staff who worked in their homes. Staff received five days training in Poland, however the training did not cover all areas of people’s needs and we saw no evidence of additional training for staff to enable them to support people’s needs. Staff had received supervision to discuss and review their development and performance.

Staff had developed caring relationships with the people they cared for and knew them well. People were not always involved with reviews of their care and support.

Care was provided in a way that promoted people’s dignity and respected their privacy. However not all people received personalised care and support that met their changing needs and took account of their preferences.

People were supported to maintain good health and had access to health and social care professionals when necessary.