Prime Care Associates

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.

Prime Care Associates provide personal care and support to people living in their own homes. 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 told us they felt safe when staff were delivering personal care. The staff had attended training in safeguarding adults and had access to the procedures for reference. This ensured appropriate action was taken where there were concerns of abuse. There were no open safeguarding referrals at this time.

Systems were in place to manage risk. Some risk assessments needed more detail on how staff were to monitor and assess potential harm. While environmental risk assessments were in place, more information was needed for people who smoked in their home and for people with a key safe entry.

Where people needs had changed identified risks were reviewed and risk assessments updated accordingly. The management team had an overview of the people at greatest risk of potential harm.

Medicine systems had improved. Medicines were audited regularly and where there were persistent errors action was taken which ensured the number of errors had reduced. We recommend the provider follows that NICE guidance in relation to paraffin-based emollients.

Staffing levels for people whose care was commissioned was determined by the local authority. People told us staff did not rush their personal care, arrived on time and stayed for the allocated time agreed.

People needs were assessed before the agency agreed to deliver personal care.

The training set by the provider ensured people's needs were met. New staff had an induction when they started work at the agency. The induction training was in line with skills for care standards.

The staff were supported with their performance and development. Performance was monitored through one to one supervision, spot checks and annual appraisals.

The manager told us how they ensured the staff were kind and caring towards people. People told us the staff were caring and compassionate.

There were aspects of the care plans that were person centred and the quality of the care plans had improved since the last inspection. Daily notes showed people were supported with their meals. Where health and social care visits had taken place, staff recorded the nature of the visits and their outcome.

Complaints were investigated and resolved to a satisfactory level.

The manager had a good oversight of the agency. There was a wide range of audits undertaken and action taken where there were shortfalls.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had capacity to consent to their care and treatment. Where people agreed for staff to administer medicines, using sensors and key safe access their consent must be documented.

Rating at last inspection

The last rating for this service was Requires Improvement (published 17 July 2018) and we found a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

This inspection took place on 24 May 2018 and ended on 31 May 2018. The agency was given short notice of this inspection visit. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults.

A registered manager was 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.’

The people we spoke with and who replied through questionnaires said they felt safe with the staff. The staff we spoke with said they had attended safeguarding of abuse training. Although two staff were not clear on the types of abuse they knew to report their concerns. The care manager said that at the next staff meeting refresher safeguarding training will take. Where staff suspected abuse by other staff they felt confident to report their concerns.

Risks were assessed and action plans were developed on minimising the risk. Individual risks to people included mobility needs and prevention of pressure sores. However, for one person the action plan on how to transfer was unclear as adequate equipment was not provided by the appropriate healthcare professionals. When the person then became frustrated guidance was not provided to staff on how to manage these situations.

Members of staff described how they managed situations when people became anxious during personal care and resisted their support. Guidance was not in place on how staff were to manage one person’s level of anxiety when they became frustrated. The care manager told us during feedback that this guidance was now in place.

Where people were at risk from pressure ulcers their care plans listed the preventative measures. Daily reports were not detailed on the repositioning changes that took place on each visit. This meant risks were not assessed and monitored to ensure preventative measures were followed. The care manager said repositioning charts had been reinstated as staff had discontinued recording position changes.

Moving and handling risk assessments were detailed on each movement, the aids and equipment used and the number of staff needed. The staff we spoke with had attended training in moving and handling.

Environmental risk assessments were in place to ensure staff were able to deliver personal care in safe surroundings.

Incident and accidents reports were completed and analysed for patterns and trends. At the time of the inspection there were no accidents logged.

Audits were used to assess the quality of care were in place. The audit log listed the areas assessed and monitored each week which included audits of records, complaints and people at high risks. Action plans were then developed on shortfalls identified. However, the findings of this inspection in relation to the areas identified for improvement were not consistent with audit log. The care manager told us they were going to consider improving the process for auditing the quality of care. For example, care planning. The care manager told us clear auditing process were being developed.

The arrangements for medicines were unclear. Staff that administered medicines had attended appropriate training. Completed medicine administration records (MAR) were not always returned to the agency office which meant they were not always audited. Some medicines particularly topical creams were labelled “as directed”. This meant staff were not given guidance on their application. The care manager told us during feedback that this information was now included in the MAR.

The people we spoke with said staff arrived on time and stayed for the allocated time. However people responding to questionnaire contradicted these comments. The people we spoke with told us they occasionally received late calls, but these were in a time frame of no more than thirty minutes. Staff said they mainly arrived on time and stayed for the allocated time. The care manager told us people were made aware that there was an acceptable half an hour each way for visit times. They said some people had expectations that staff arrive at the time they specified but this was not always possible.

People told us their care was delivered by the same carers. They told us the staff were caring and built relationships with them which made them feel they mattered. The staff we spoke with said people received continuity of care because regular staff visited.

New staff had an induction to ensure they were confident to perform their role. Staff were supported to maintain their skills and improving their performance. There were spot checks, one to one supervision and annual appraisals.

The people we spoke with told us they made their own decisions in relation to their health and welfare. Staff knew how to support people with the day to day decisions. Where people lacked capacity to make decisions clear documentation was not in place on who made the best interest decisions. We made a recommendation for the care manager to gain from a reputable source guidance on how to ensure the principles of the Mental Capacity Act 2015 were followed.

Where necessary office staff made GP appointments. Staff said they were kept informed about visits from healthcare professionals.

Some care plans had aspects of person centred care in relation to tasks. However care plans were not in place for needs associated to the area of personal care to be delivered. For example, where people did not communicate verbally guidance was not provided on how to communicate with the person. The care manager said this guidance was now in place. People told us they participated in the development of their care plan. We made a recommendation for the care manager to gain guidance of developing person centred care plans that reflects people’s physical and emotional care needs.

People told us the staff were caring and felt able to express their views about their care. The staff respected their rights. There were no complaints received. People knew who to approach with concerns.

We found a breach of Regulation 12 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.

This inspection took place on the 15 and 16 February 2017 and the provider was given short notice of the inspection. We gave notice to make sure the staff and or registered manager was at the office. This was the first rated inspection for this service as there were changes in their registration.

Prime Care Associates provide personal care and support to people living in their own homes.

There was a registered manager in post who was responsible for the day to day running of the service. 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.

Staff told us the staffing levels were appropriate although they were “busy” throughout the day. However, the deployments of staff as shown within the rota did not provide sufficient detail on how staff were to provide the allocated time, as well as arrive at the next visit within the same time frame.

Medicine Administration Records (MAR) charts were used to record the medicines administered but some lacked information. Protocols on when required medicines (PRN) medicines and creams were missing and where they were in place, lacked guidance on administration.

People told us they felt safe with their carers. Members of staff told us they had attended training on safeguarding of vulnerable adults procedures. Staff were able to identify potential abuse and knew their responsibility to report alleged abuse. Two community professionals told us the people that they had regular contact with and who used the agency were safe with the staff.

Staff said the induction included shadowing more experienced staff which helped them to perform the role they were employed for. Staff attended mandatory training, which the provider set as mandatory included safeguarding vulnerable adults from abuse, medicine competency and moving and handling. However, staff were not given the opportunity to discuss their personal development with their line manager.

Members of staff were knowledgeable about the actions in place to minimise risk. Where risks were identified actions plans were based on the advice given. However, some assessments lacked guidance on the staff actions to keep people safe from potential harm.

Care plans were updated and included information about people’s mental capacity as well as their ability to make decisions. However, some action plans we saw lacked person centred care, background history, and guidance on meeting people’s needs in their preferred manner. Members of staff had some understanding of the principles of the MCA. DoLS applications needed to be made to the supervisory authority to ensure where people lacked capacity and bedsides were used to ensure these restrictions were lawful

Staff said where appropriate the office staff organised healthcare appointments. A record of the visits and the outcome were maintained electronically. Staff said they were kept informed about changes in people’s needs before their visits to the person’s home.

Member of staff knew the importance of developing relationships with people. Two community professionals said the staff were caring and gave examples on when staff had shown great kindness and compassion to an individual.

Members of staff said the team worked well together and the team was stable. Team meetings and newsletters were used to inform staff of housekeeping issues, policy changes and training. Spot checks to monitor staff’s performance was undertaken annually by line managers. Staff were not able to benefit from formal structures where their personal development and goals was set. Spot checks were annual.

Overall quality assurance systems ensured the service provided was assessed and where shortfalls were identified action was taken to meet standards. The views of people were gathered using surveys and their feedback was that the level of care delivered was good.