Primavera Domiciliary Care Services Limited

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

People and their relatives told us that the support workers who supported their family member were kind and caring. However, despite this feedback we identified areas of concern similar to those identified at the previous inspection which had not been addressed.

Risks associated with people’s health and care needs had been assessed, however, we found examples where information contained within care plans and related risk assessments was not always consistent. This meant that clear guidance and direction was not always available to staff on how to manage risks to keep people safe. Staff recruitment processes had not been robustly completed and verified to ensure that staff employed were suitable to work with vulnerable adults.

Management oversight processes were ineffective and did not identify the issues we identified as part of the inspection process.

People received their medicines safely and as prescribed. Staff were aware of their responsibilities to raise concerns if they felt a person was being abused. The service understood the importance of infection prevention and control and had measures in place to help keep people safe from risk of infection.

People were supported by support workers who had been trained and were skilled in their role. Support workers told us they felt supported in their role. People were supported to eat and drink enough. The service supported people to lead healthy lives and supported them to access relevant health care services 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 and their relatives were happy with the support they received from their support workers and the registered manager. People and relatives had been involved in the planning and delivery of care.

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 good (published 15 February 2020).

Why we inspected

We received concerns in relation to recruitment and management oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to recruitment of staff and management oversight of the service. Please see the action we have told the provider to take at the end of this report.

We made one recommendation about improving the care plan and risk assessment practice.

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.

Primavera Domiciliary Care Services Limited is a domiciliary care service providing the regulated activity of personal care to older people aged 65 and over in their own home, some of whom were living with dementia. At the time of the inspection the service was supporting 20 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

People and relatives feedback about the service that they received from Primavera Domiciliary Care Services Limited was positive. People told us that they felt safe and received care and support from a regular team of care staff.

People and relatives told us that care staff were kind, caring and respectful and that they received care and support that upheld their privacy and dignity.

Management oversight systems in place enabled the registered manager to identify issues and improve the quality of care people received. However, completion of these and oversight to ensure required improvements were made, needed to be further improved upon.

Staff knew who to report their concerns to if they suspected people were subject to any form of abuse. The registered manager had systems in process to escalate and investigate concerns raised.

Risks associated with people’s health and care needs were identified and assessed so that care staff had clear guidance on how to support people safely.

People received their medicines safely and as prescribed.

Staff recruitment processes ensured that only those staff assessed as safe to work with vulnerable adults were recruited.

People were supported by a team of care staff that were appropriately trained and skilled to do so.

People’s nutrition and hydration needs were assessed and appropriate support provided where required.

Care staff were observant when supporting people and where concerns were identified with people’s health and medical needs these were reported and appropriate assistance sought to address these.

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/ did not support this practice.

People and relatives knew who to speak with if they had any concerns and were confident their concerns would be addressed and resolved.

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 7 January 2019). We found breaches of Regulations 9, 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Since the last inspection we recognised that the provider had failed to display their CQC ratings on their website as required. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted the fixed penalty and paid this in full.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Primavera Domiciliary Care Services Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and people with a range of physical and sensory disabilities as well as people living with dementia.

Not everyone using Primavera Domiciliary Care Services Limited receives 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 the inspection the service was providing care and support to 22 people.

There was a registered manager in post at the time of this inspection. 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 care plans identified people’s risks associated with their health and social care needs, the service did not always carry out risk assessments so that care staff were provided with direction and guidance on how to minimise the identified risk to keep people safe and free from harm.

Medicine management and administration processes were not always safely adhered to. Gaps in recording, incomplete information about medicines and lack of instruction and authorisation on how to administer medicines safely, meant that people may not always have been receiving their medicines safely and as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the service did not always complete mental capacity assessments to establish people’s capacity and where people lacked capacity, decisions made in people’s best interest were not clearly documented.

Care plans were not person centred and did not detail people, likes, dislikes, preferences, cultural and religious requirements and background history to enable care staff to provide care and support that was responsive to their needs.

Care plans were not always current and reflective of people’s needs. Care plans had not been reviewed since the package of care had commenced. Where people’s needs had changed care plans had not been updated to reflect this.

Management oversight processes did not identify the issues and concerns that we found especially around medicine administration and recording. In the absence of checks and audits of care plans, the service had no insight or awareness of the issues that we found.

People and their relatives confirmed that they felt safe with the care staff that supported them. The registered manager and care staff demonstrated a good understanding of safeguarding and were able to describe the steps they would take to protect people from abuse.

The service carried out a variety of checks to ensure that only those staff identified as safe to work with vulnerable adults were recruited. There was enough staff available to meet people's care and support needs.

Assessments of people's care and support needs were carried out before they started using the service to confirm that the service could meet their needs effectively.

Care staff received appropriate and relevant training to enable them to deliver their role effectively.

People were also supported with their nutritional and hydration requirements where this had been identified as an assessed need.

People had consented to their care and support and where people were unable to consent, relatives had been involved in the care planning process where appropriate.

People and their relatives told us that they were happy with the care and support that they received and that care staff were caring and kind with whom they had developed positive relationships with.

People and their relatives knew who to speak with if they had any concerns or complaints to raise and were confident that these would be dealt with appropriately.

People, their relatives and staff spoke positively of the leadership and management of the service.

At this inspection we found the provider to be in breach of Regulations 9, 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.