Archived: Premier Healthcare Solutions SW Ltd

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.

Premier Healthcare Solutions is a Domiciliary Care Agency that provides care and support to adults of all ages, in their own homes. The service provides help with people’s personal care needs in Hayle, Redruth, Camborne, Penzance and surrounding areas. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals. 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.

At the time of our inspection 31 people were receiving a personal care service. People’s needs varied with some people only requiring short visits and others having visits of an hour or more or overnight care and support. Some people needed support from two members of staff due to their mobility needs.

The service requires a registered manager and at the time of our inspection there was no 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 and associated Regulations about how the service is run. The manager had started work at the service very recently and told us they were intending to apply for registration.

We identified concerns about recruitment practices within the service. We found not all staff had relevant pre-employment checks in place before they started supporting people with personal care. Planned staff absence had been poorly organised resulting in a period of time when the service had been short staffed. To compensate for this the manager had recruited casual workers without any recruitment checks and no knowledge of people’s needs. Some staff had provided care without the appropriate training.

Staff were able to describe how to raise safeguarding concerns. However, we found one occasion when staff had raised concerns which had not been reported to either the local authority or CQC. There was no evidence any action had been taken as a result.

Risk assessments lacked detail and did not clearly guide staff on the action they should take to mitigate risk. Some people were at risk due to their specific health conditions but no risk assessments had been developed in respect of this.

Staff were administering medicines for people who were unable to take them independently. This was not clearly documented in their care plan and we have made a recommendation about this in the report.

There was a lack of oversight and leadership of the service. The director of the company had failed to complete pre-employment checks of the manager before they started work. They had not recognised that there was a lack of monitoring systems in place to ensure the smooth running of the service. For example, there were no systems in place to review training needs and complaints.

People told us they felt safe when being supported by staff from Premier Healthcare Solutions and staff were friendly and relaxed in their approach. Comments included, “The staff make me feel so relaxed”, “The staff are so easy to talk to”, “I have very caring people [staff] that come round” and “The staff are very friendly.”

Staff supported people to make decisions and choices. However, there was no evidence people’s capacity to consent to care was appropriately assessed or decisions taken on their behalf made in their best interest in line with guidance contained in the Mental Capacity Act (2005). We have made a recommendation about this in the report.

Care plans provided staff with information about how to support people with personal care routines according to their wishes. However, we identified some care plans where information had not been included to guide staff on how they could meet people's specific needs. Systems for recording when care plans were reviewed were inconsistent and we were not always able to ascertain how up to date the information was.

Staff were positive about recent changes to the management of the service and told us improvements were already being made. The manager had met with most of the people using the service and half the staff team had received one to one supervision. The manager had used this as an opportunity to collate staff satisfaction and identify any areas of concern.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

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.