Prime Care Associates

Updated 16 March 2022

The inspection

We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and phone calls to engage with people using the service and staff.

Inspection team

This inspection was undertaken by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 9 December 2021 and ended on 7 January 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We sought feedback from professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

This performance review and assessment was carried out without a visit to the location’s office. We used phone calls to enable us to engage with people using the service and staff. We reviewed documentation which was sent to us on request.

We spoke with seven people who used the service and nine relatives about their experience of the care provided. We spoke with 12 members of staff including the care manager.

We reviewed a range of records. This included five people’s care records and medicine records. We looked at staff training data, quality assurance records and a variety of records relating to the management of the service, including policies and procedures. We received feedback from two professionals who have contact with the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 16 March 2022

About the service

Prime Care Associates is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of the inspection, 76 people were receiving a service from the agency.

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.

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

People were happy with their support, but the timing of their visits did not always meet their needs. Some staff did not always stay the full amount of time allocated. People had a care plan, but some of the information was not completed and a person-centred approach was not evident. People’s daily records were also task orientated, and contained little information about the person’s wellbeing.

There was a risk management format in place, but this did not always identify and mitigate the individualised risks people faced. Lack of guidance for staff to manage risks safely was also identified at the last three inspections in 2019, 2018 and 2017.

People’s medicines were not always safely managed. Staff had not documented the time they had assisted a person with their pain relief. This increased the risk of it being given again before the required four hour gap between doses. Some medicine administration records showed handwritten changes to the dosage and timing of the prescription details, without the staff’s signature or countersignature.

There was a quality auditing system in place, but it was not fully effective, as shortfalls found during this inspection had not been identified. This included shortfalls in risk management, care planning and the inconsistency in timing and duration of people’s visits.

Systems were in place to minimise the risk of people experiencing abuse. Staff told us they completed safeguarding training and would report any concerns about people’s wellbeing to the care manager.

People told us they felt safe with staff supporting them. They said staff wore the required personal protective equipment, to minimise the risk of transmitting COVID-19. The care manager gained regular updated government guidance about working safely within the pandemic. This was disseminated to the staff team as required. Staff took part in a regular testing regime to detect if they had the virus at an early stage. This minimised the risk of transmission.

There were enough staff to support existing care packages. The care manager was not accepting any new care packages to avoid staff being spread too thinly. People were supported by a stable staff team, who knew them well. New staff were recruited safely to ensure they were appropriate to work with vulnerable people.

The agency provided end of life care, if needed, to those already being supported.

People and their relatives knew how to make a formal complaint but had not needed to or done so. Two concerns had been raised with CQC just before and at the time of the inspection. The care manager had not substantiated the first concern, and we found there was no evidence to support the second.

The service had a supportive ethos and a clear desire to provide good quality care. Systems were in place to enable people, their relatives and staff to give their views about the service. The care manager told us they worked closely with other agencies such as the GP and community nurses.

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 16 August 2019).

Why we inspected

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology for gathering information, and phone calls to engage with people using the service as part of this performance review and assessment.

The inspection was prompted in part due to concerns received about people’s support being at an inappropriate time, and staff leaving visits early. There were also concerns about lack of supervision, spot checks and manual handling training for staff. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.

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 from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider 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 Prime Care Associates on our website at www.cqc.org.uk.

We have identified breaches in relation to safe care and treatment, person centred care and the management of the service.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.