Premier Care - Bradford Branch

Premier Care Bradford is a domiciliary care agency providing support and personal care to people living in their own homes. At the time of our inspection the service was supporting 67 people. Not everyone who used the service received personal care. The Care Quality Commission (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

Medicines were not always managed safely. Whilst some systems had improved, we found gaps and shortfalls in people’s medicine records. This meant we were not assured people were receiving their medication as prescribed.

A range of audits and checks were undertaken to assess, monitor and improve the service. They had not been effective in identifying shortfalls in the management of medicines. Other quality checks were effective in identifying issues and driving improvements. The registered manager responded promptly to our feedback about concerns and took action to address the shortfalls. The registered manager was approachable and supportive and provided leadership to the team. Staff received regular supervision and support.

Recruitment was managed safely and there were enough staff to support people.

People and relatives gave positive feedback about staff and the support they received. They said they felt safe and staff were kind and respectful. We received mixed feedback about the consistency and timing of calls. Risks to people’s health and safety were assessed and regularly reviewed. Staff knew people well and supported them based on their needs, choices and preferences.

People and staff’ feedback was sought, listened to, and used to improve the service.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 requires improvement (Published 13 November 2019). At this inspection we found the provider remained in breach of regulations. The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 9 and 14 October 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Bradford on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of medication and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect

About the service

Premier Care (Bradford) is a domiciliary care service providing a service for adults of various ages. At the time of the inspection it was providing personal care to 70 people. 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

We found the service had improved a number of key areas since the last inspection. People said they felt safe and secure using the service and said staff cared for them safely. However, medicine management systems needed improving as they did not always provide a clear record of the support people had received. Overall there were enough staff to ensure safe care and support, although some rotas needed reviewing to ensure staff had enough travel time. Safe recruitment procedures were in place.

People said they received effective care and achieved good outcomes. Staff received a range of training and support to enable to them to do their duties to a high standard. People received appropriate support with eating and drinking. The service assessed people’s healthcare needs and worked with healthcare professionals where required.

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.

People said staff were kind and caring and treated them well. People and staff had developed good relationships. People were listened to and their views used to improve the service.

People’s care needs were assessed and clear information on their likes and preferences was recorded to aid staff deliver person-centred care. Some care plans needed updating to ensure they reflected people’s current needs. A system was in place to log, investigate and respond to complaints.

People said they were satisfied with the overall care experience although some people said they thought communication from the office could be improved. Checks on the medicine management system needed to be more robust to ensure a high performing service. However, the service was committed to continuous improvement and demonstrated it was taking action to address areas that required improvement, for example medicines management.

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 requires improvement (published 13 April 2019).

At this inspection we found improvements had been made in a number of areas with the service able to demonstrate it was now effective, caring and responsive. However, we identified a further breach of regulation which meant the service was still rated requires improvement overall.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to safe care and treatment due to risks associated with the medicines management system.

Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

Premier Care – Bradford is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to adults and older adults. CQC only inspects the service being received by people provided with 'personal care.' At the time of the inspection the service was providing support to a total of 95 people, 30 of whom were receiving personal care.

This was the first inspection of the service since it was registered in August 2017.

There was a registered manager 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.

Although staff could tell us about safeguarding procedures, we found incidents were not always being reported to the local authority safeguarding team. This left people at risk of receiving unsafe care.

Safe staff recruitment procedures were in place. Staff were given training, however, checks to make sure they were applying this to their practice were not always sufficient. This led to people not always receiving the care they wanted or needed. We made a recommendation about checks on staff practice being more robust.

Staff rotas were not always well managed and some people were dissatisfied with the times of their calls as care workers were often late. We have made a recommendation about reviewing staff rota’s to make sure calls are made at the right times.

Medicines were not always managed safely. We made a recommendation about making sure the new medicines procedure was implemented and checks made to make sure it was being adhered to.

People had care plans in place, however, these were not always up to date or being followed by care staff. We made a recommendation about care plans being kept up to date and about staff needing to follow the care plans.

People who used the service and relatives told us the names of some staff they felt were good.

Three out of the five people who used the service and five out of the six relatives we spoke with raised concerns about the service. We found people's complaints were not always responded to. We made a recommendation about staff who are dealing with complaints having additional training to make sure complaints are documented and responded to.

There was a lack of leadership and direction for staff, with no oversight of risks or key issues regarding people's care. Systems and processes for monitoring the quality of the care provision needed to be improved.

Feedback from people who used the service was being sought by the provider.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.