Premium Care Solutions Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires improvement. At this assessment the rating has changed to Good.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People and their relatives told us they felt comfortable speaking openly with staff and managers. They were aware of how to make a complaint and were confident to do so. One person told us, "I don't have a problem with picking the phone up and speaking to the manager".

There was a new management team in place who were actively promoting a culture of learning and improvement. Staff mostly told us there had been positive changes with the new management team, particularly in relation to training. Lessons learnt were shared with staff, and regular team meetings were held to support continuous improvement.

There was a system in place for managing incidents and accidents. Staff mainly reported accidents appropriately and understood the process. However, some required further information to evidence all actions that had been taken.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People told us they were involved in planning their care and support. One person told us,"We do meet and greets, and I have input on how I find them. (Relative) gets a voice on how (relative) finds them too." Staff confirmed that they hold meet and greets (if the person chooses) before commencing support, this helps to ensure compatibility.

We saw evidence of the provider working collaboratively with other care professionals to support people. This included joint working with schools to aid safe and effective transitions to independent schooling.

Feedback from external professionals was positive. One person told us “Senior management is visible and approachable and endeavours to work collaboratively with both family and the broader MDT”

We saw evidence of the provider working with another care provider and multi-disciplinary team to support a person transitioning to a new care provider.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us they felt safe. One person told us, “They are trustworthy and experienced." Another said, "they know what they are doing and exactly what to look out for if I am sat wonky or if I am feeling dizzy. They know all the signs if I’m not feeling right." However, we received feedback that one person had previously been cautious to raise concerns, concerned it may result in a reduced staffing level. The issue was reported and resolved appropriately.

Staff had received safeguarding training and told us they were confident to report any concerns. They demonstrated a good understanding. The registered manager was aware of their responsibilities to protect people from abuse and actions they would take regarding an allegation of abuse.

There were policies in place covering safeguarding, whistleblowing, Mental Capacity Act, and equality, staff were able to access these through their electronic system.

There was a system in place for recording and monitoring safeguarding concerns.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the

things that mattered to them.

Relatives were confident risks were managed, and their family members were supported to remain safe. One person told us," They focus on knowing them really well. They know when things are out of the normal. They know how to use the equipment. They make sure medication is given on time and if late, they have to explain why."

Risk assessments were in place which covered various areas including the environment, transfers, medications, and outings where appropriate. However, some of the daily records we reviewed lacked sufficient information regarding how people were being supported with manual handling, this was fed back to the registered manager.

Management told us that no holidays were currently booked, but they were working with a couple of people to facilitate this, with risk assessments planned as part of the process.

People’s risk assessments were available to staff via electronic devices. However, not all staff we spoke to were aware of this, indicating a need for an improvement in communication or training regarding access to digital care records.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

An environmental assessment was completed during the initial set up of new care packages to ensure safety and suitability. Regular audits of smoke and fire alarms were carried out; alongside routine inspections of equipment being used.

We saw evidence of checks identifying equipment required to be serviced, with the provider working with the individual and relevant companies to ensure timely completion.

Processes were in place to assess and monitor environmental risks. These systems supported the delivery of care in a safe setting.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

People and their relatives spoke mainly positive about staff. One person told us, “They are all trained to look after (relative) and do their job well. Another said, "when we get new carers they have to go through training before and when they arrive.”

Staff had received training specific to the people they supported, and their competencies were observed. However, some competencies were not clear what was being assessed as recordings just stated no concerns and contained no evidence of what had been assessed. One staff member told us they have not had any competency checks for over 2 years. Additionally, it had previously been identified that staff had not completed face-to-face training in moving and handling or basic life support. This had been addressed with the registered manager, and at the time of our assessment, 70% of staff had completed the required training, with full compliance expected by November 2025.

The registered manager told us they had already identified the need to strengthen and formalize their wider training approach and had taken proactive steps such as the development of a dedicated team and on-site equipment. The registered manager told us they were committed to ensure their staff are equipped with the skills and knowledge needed to deliver safe, effective and person-centred care.

Our feedback from staff raised concerns regarding the use of slide sheets. In one instance, the registered manager confirmed that a slide sheet was already in place. However, other staff reported being newly instructed to use a slide sheet, suggesting it had not been used previously. Some staff described using a standard sheet to reposition people in bed, which does not align with safe manual handling practices. This carries high risks of skin tears, bruising and pressure ulcers due to friction and shear.

We received mixed feedback from staff. Some staff felt they had received adequate training and noted improvements under the current management team. Others reported they had only received online training.

Nurses were checked monthly against the professional register as part of the HR process, and all 12 were up to date. Disclosure and Barring service (DBS) checks were renewed every 3 years, this supports safe recruitment practice and helps to prevent unsuitable individuals from working within care services.

We reviewed 5 staff files and identified some gaps such as incomplete forms. These were fed back to the registered manager who assured us additional steps have been added to the audits. The gaps did not indicate unsafe recruitment practices.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

People and their relatives told us staff used personal protective equipment (PPE). This helps to prevent the spread of infections. One person told us, “Whenever they do anything they has gloves and aprons on." Another said, "They wear masks when suctioning. They wear gloves when changing the catheter.

Staff had received training in infection prevention and control and told us they have a good supply of PPE, which they can order themselves and it is delivered straight to the person’s home.

There were systems in place to identify and monitor infection rates.

Infection prevention and control policies were in a place which staff could access through their electronic monitoring devices. However, staff told us that some people requiring hoist transfers did not have a toilet sling. They confirmed that the same sling was used for all transfers, this indicated an infection control risk.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People and their relatives felt supported with their medicines. One person told us, “They make sure the staff know what the medications are. They don’t just administer it." Another said,"(relative) takes a lot of medication. There are no problems. They get it on time.”

Staff had received medicines training and had their competencies checked. Staff demonstrated good practice awareness with regards to administering medicines via Percutaneous Endoscopic Gastrostomy (PEG).

A medicines policy was in place. People’s medicines support needs were clearly documented within their care plans. Care staff recorded medicines administrations electronically. We looked at a sample of these which were recorded with the appropriate keys and where medicines had been refused guidance from the GP had been sought.

Care notes did not always evidence that people had their medicines in line with best practice guidelines, for example the times of administration for Levothyroxine were recorded but not times of food/beverages therefore we could not be assured there was always an adequate gap as per guidance.

People had taken when required (PRN) protocols in place however these were not all consistently reviewed and did not always contain information as to how the person expressed pain, this was fed back to the registered manager who showed us evidence of this being updated as well as all peoples PRN protocols being reviewed.