Background to this inspection
Updated
26 January 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: The inspection was carried out by one adult social care inspector.
Service and service type: Premier Healthcare Solutions is a Domiciliary Care Agency that provides care and support to adults in their own homes. Not everyone using Premier Healthcare Solutions receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
The manager was in the process of applying to be registered with the Care Quality Commission. A registered manager, 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 notice of the inspection site visit because it is small and the manager and senior staff were often out of the office supervising staff or providing care. We needed to be sure someone would be available to support the inspection.
What we did: Before the inspection we reviewed the action plan provided following the previous inspection and other information we held about the service. We used this information to plan our inspection.
During the inspection we spoke with the office manager and a senior care worker. We looked at training records, call monitoring records, four staff recruitment files, records of supervisions and spot checks and completed surveys from people using the service and staff.
After the inspection we spoke with two people who used the service and two relatives. We also spoke with the director of the service and an external professional with knowledge of the service.
Updated
26 January 2019
About the service: Premier Healthcare Solutions is a Domiciliary Care Agency that provides care and support to adults of all ages, in their own homes. The service covers Hayle, Redruth, Camborne, Penzance and surrounding areas. At the time of the inspection 26 people were using the service. At our previous inspection in November 2018 we found five breaches of the regulations in relation to risk management, safeguarding, recruitment, staffing and governance. We issued a warning notice in respect of the breach of regulation 17, good governance.
The concerns identified were in respect of the management of complaints and gathering people’s views of the service, recruitment checks and inductions were not always completed before staff worked at the service, poor organisation of annual leave resulting in staff shortages at certain time of year, no system to effectively monitor that care visits were provided as planned and a lack of oversight of the service.
Why we inspected: Following the previous inspection the provider sent us an action plan which included the actions being taken to meet the requirements of the warning notice. This was a focused inspection to check the service had made the necessary changes. At this inspection we only looked at the well-led question. This was because the concerns leading to the warning notice were in respect of how the service was managed.
People’s experience of using this service:
¿ The manager and a senior care worker had been off work for several weeks. No alternative arrangements had been put in place by the provider to make sure the service continued to run smoothly. The office manager and a senior carer had been running the service on a day to day basis. They were both enthusiastic and committed but admitted they did not always know the correct processes to follow. For example, they were not aware of the need to notify the Care Quality Commission (CQC) of allegations of abuse.
¿ There had been a lack of oversight due to these absences. This was beginning to have an effect on how the service was organised. Observational checks on care workers practice were less frequent than planned, policies and procedures were not available for reference and the results of a staff survey had not been collated and analysed. This placed people at risk.
¿ An on-call system was operated seven days a week so people were able to contact someone for support at all times. On-call cover was normally provided by the manager, office manager and senior care workers. Due to the absence of the manager and one senior care worker the workload for the office manager and second senior care worker had increased. The office manager was not trained to provide personal care. Although another member of staff was able to support the on-call system on two weekends during December 2018 the senior care worker was normally solely responsible for covering unexpected gaps in the rota. If they were required to do this while they were on-call, there was a risk people needing support from on-call would not be able to contact anyone.
¿ Improvements to systems had been made to enable the management team to more effectively check how care was delivered. Visits were closely monitored so any missed or late visits would be quickly identified. The system also identified if visits were being cut short and people were not receiving care as planned.
¿ Complaints and concerns were recorded and there was a clear audit trail of actions taken in response. People were asked for their opinion of the quality of the service. When negative feedback had been received, changes to the way care was implemented had been introduced.
¿ Systems to check new staff were suitable and competent had been put in place. Recruitment checks and an induction were completed before new staff started work. A training matrix had been developed to highlight when training had been completed and when it was due to be refreshed.
¿ There were robust processes to ensure staff annual leave arrangements did not impact on the care provided.
Rating at last inspection: Requires Improvement (report published 7 November 2018)
Enforcement: See the end of this report for details of the action the provider needs to take.
Follow up: We will carry out a further inspection, in line with our inspection programme, to check improvements have been made to ensure the service is meeting the regulations. We will continue to monitor intelligence we receive about the service. If any concerning information is received we may inspect sooner.
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.