Premium Care Solutions Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and

governance assured high-quality, person-centred care; supported learning and innovation; and

promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has

remained Good.

This service scored 64 (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 did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

Staff spoke mainly positively about working at the service and noted improvement over the past year.

Staff were recruited for the individual person and received person-specific training for that person. However, some gaps were identified in face-to-face manual handling and basic life support training. The provider is addressing this following previous CQC input.

Regular staff meetings were held at both team and management levels.

We reviewed a sample of audits, these generally identified gaps including actions and timescale. However, some audits lacked clarity on who had completed them, with signatures. The action plan audit did specify responsibility.

Some of the audits did not clearly record required actions. The registered manager demonstrated that actions were listed but not always pulled through to the audit report, the

registered manager raised this with their electronic monitoring system provider.

Some actions identified in audits were not completed within the time scale, for example some actions within the care plan audits we reviewed additionally these contained no reason for not being completed within the timescale or any extension given.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

People and their relatives told us they knew their manager. One person told us "The manager is really good, professional and thorough." Another said, "The managers have always been approachable. They have always listened and tried to accommodate. They are very compassionate to (relative) needs.”

Staff mainly spoke positively about the registered manager and provider, noting improved support. While some staff reported occasional delays in communication, others shared examples of the provider being responsive even during leave. Staff told us they were confident they could contact managers when needed.

The registered manger was actively developing their leadership skills and is currently undertaking a governance course which is being funded by the provider. They had identified differing needs across the teams and were working to address these.

There were systems in place to assess, monitor and improve the quality and safety of the service. The registered manager demonstrated a proactive approach to addressing concerns identified during the assessment.

People did not always feel they could speak up and that their voice would be heard.

Staff told us they knew how to speak up if they had any concerns, they mainly felt supported.

Staff were able to discuss any issues at team meetings and at their one-to-one meetings. However, some staff told us when concerns had been raised during team meetings this had been fed back to the person they were supporting, they had addressed this with their management team but where unclear how this had been managed. We discussed this with the registered manager.

Systems were in place for staff to raise concerns, but not anonymously as the provider was concerned this could conflict with employment law. Consideration of ways to further protect confidentiality when staff raised concerns would benefit the service.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had an equality, diversity and inclusion policy in place and staff had completed relevant training. We received mixed feedback from staff, some staff felt unsupported when requesting to reduce their hours or going part time, while others reported feeling supported.

Staff had raised concerns concerning their treatment from a person they are supporting. This was discussed with the manager who assured us of the actions they were taking to address this.

Some staff told us they felt pressurized to cover for sickness, with one person telling us, “I was once called whilst on annual leave at 06:30am”. Another told us," We are often asked to cover

shifts, but I never feel pressurized." One person told us the longest they had worked was 72 hours in a row.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

People and their relatives told us they felt the service was well run and managed. One person told us, "Yes when we have a carer it feels well managed. When there is no carer, it doesn’t feel good as they should fulfil the package." Another said, " It is running smoothly. I haven’t really had any problems."

Staff told us there had been a lot of changes within the management team, one staff member told us, "We have had so many managers, it is not very organized." The registered manager was newly appointed within the last year, having been promoted from within the team.

There were systems in place to help promote effective governance. Audits and checks were carried out to monitor the efficiency of the service to help identify areas of concern and drive improvements. Audits and checks were carried out by the management team, these included checks on the recording of people’s medicine management, care plans and daily care notes. However, as the audits did not identify all the areas raised within our assessment, this might indicate the need to increase from the current percentage being audited, this was fed back to the registered manager who acknowledged our feedback and told us they will explore whether any refinements were needed.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Referrals were made to external health and social care professionals when required, and any advice or actions to be taken provided by health care professionals and commissioners were followed. They shared information and learning with partners and collaborated for improvement.

The service was open to feedback from other professionals. We received good feedback from external professionals. One professional told us, "They escalate clinical concerns to relevant clinical teams, timeously and appropriately." They also told us," They also reached out to the Integrated Care Board (ICB) for mediation when conflicts in the care package were compromising patient safety."

The service worked with the Brain Injury Association and with people who are experts through experience to gain diverse perspectives. This demonstrated a commitment to continuous improvement through shared learning.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The registered manager told us they were committed to the continuous improvement of the service and wanted to promote a culture of learning and development. They told us they had identified gaps in learning and development, and steps had already been taken to address this, including establishing a dedicated department with 3 staff and training equipment.

The management team undertook a range of audits to monitor the quality of care and support provided by the service. The registered manager was very positive and proactive to our findings during the assessment. The processes they had in place enabled them to use the information from their audits, feedback and care plans to make positive changes. This all demonstrated proactive leadership, an effective use of audits and commitment to continuous learning.