Premier Care - Halton Branch

Premier Care Halton is a domiciliary care service providing personal care to 414 people at the time of the inspection.

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's experience of using the service was mostly positive. People were happy with the staff who visited them and felt safe with the support they provided. People received visits from regular staff most of the time. However, some people were unhappy about the different staff who visited them. Some did not have a regular care worker.

People spoke positively about the staff. Their comments included, "They are all nice; kind, caring and good hearted", and "They do a good job and are friendly; they treat [name]well” and “We’ve had our ups and downs but the staff do the care how [name] wants it”.

Staff had received additional training for infection control because of the COVID-19 pandemic. They had a regular supply of personal protective equipment (PPE) such as masks, aprons and people told us staff always wore this.

People using the service and staff were involved in the development of their care through regular reviews meetings and surveys. The latest survey showed that people were mostly satisfied with their care, with dissatisfaction being about the lack of regular staff they saw.

Staff had been recruited safely. There were sufficient numbers of staff employed to support people. Staff received regular training and support.

Staff told us they enjoyed working for the service. The management team completed regular quality audits and where actions were identified these were addressed to bring about improvements. The service worked effectively with the local authority and healthcare commissioners.

Rating at last inspection and update: The last rating for this service was Requires Improvement (published 24 April 2020) and there were multiple breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 10 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, effective care and good governance.

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, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. 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 - Halton on our website at www.cqc.org.uk.

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.

Premier Care Halton is a domiciliary care agency providing care to people living in their own homes, so they can live as independently as possible. At the time of our inspection the service was supporting 345 people with personal care.

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.

The service is contracted to provide personal care by Halton Borough Council. Premier Care – Halton Branch then sub-contracts approximately 140 people's care packages to another service in the area. For the purposes of this inspection, care packages that were being fulfilled by the sub-contracting company were not looked at.

People’s experience of using this service and what we found

Medicines were not always well managed. There were concerns with the recording of administration and audits had not always been effective at identifying concerns. Risks to people’s health and well being were not always assessed appropriately. Risk assessments relating to bed rails and specific health conditions were either missing or not completed sufficiently. The provider had addressed some of the concerns before the end of the inspection.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments had not always been completed when appropriate and best interest meetings had not always been recorded. People were supported by a well trained staff team who felt supported by management.

There were systems in place to monitor the quality and safety of the service through auditing, however these were not always effective at identifying concerns found at this inspection. There were not always clear actions in place to address concerns that had been identified. The provider and manager were responsive to concerns raised during the inspection.

People told us they had good relationships with the staff that supported them. People were treated with dignity and respect. Staff supported people to express their views about the service and their care. People were supported by a consistent staff team who knew them well.

People and relatives told us the service was person-centred. There was a complaints procedure and any received were investigated and responded to. Staff and people told us that when they had raised concerns with the management team they had been responded to appropriately. People’s communication needs were recorded, and staff supported people day to day in ways that met their needs. However, information about the service had not always been made available to people in a way that was suitable for their communication needs. We made a recommendation about this.

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 February 2019) and there was a breach of regulation. 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, however we found other areas of concern and the provider remains in breach of regulations

Why we inspected

This was a planned inspection based on the previous rating

Enforcement

At this inspection we have identified breaches in relation to the safe management of medicines, risk assessments, consent and good governance.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will arrange to meet with the provider to seek assurances about concerns raised at this inspection. 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.

People’s experience of using this service: People we spoke with told us they were happy with the care they received. Every person we spoke with said care staff were kind and caring. Most people we spoke with told us that they receive care from the same regular staff and they always arrive on time.

People told us they were supported to maintain their dignity and independence.

The service was the only provider that the local authority commissioned care to. In order to meet the needs in the local area, the registered provider sub-contracted some care packages to an external company. We found that the registered provider was not completing comprehensive quality assurance or monitoring of the sub-contractor, this is a breach of Regulation 17: Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were protected against the risk of avoidable harm, there were up to date risk assessments recorded in care files.

Medicines were safely managed, people who required time critical medication had an electronic alert set up on the care co-ordinators system to flag up if care staff were 15 minutes late arriving at their home.

The registered provider had a robust policy for the prevention and control of infection. Some people told us that care staff did not use the required personal protective equipment when assisting them with personal care.

People told us they were cared for by staff who were well trained. New care staff were safely recruited and received an induction before working unsupervised.

The registered manager completed three monthly service user surveys to gather the opinions of the people using the service.

Rating at last inspection: This was the first time this service has been inspected since they registered with CQC in February 2018.

Why we inspected: This was a planned comprehensive inspection.

Follow up: This inspection has identified a breach of Regulation 17: Good Governance of the Health and Social Care Act (2008). The service is required to submit an action plan detailing what they have put in place to mitigate this breach.