Premier Care - Halton Branch

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.
The service was in breach of legal regulation in relation to the way records were presented and maintained at the service.
 

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.
Incidents and accidents were recorded and generally reviewed; however, processes to embed learning and implement appropriate follow-up actions were not always effective. For example, after a person sustained a head injury during a fall, records did not demonstrate that post-fall observations or monitoring had been completed to ensure their safety and wellbeing. This meant opportunities to learn from incidents and reduce future risks were not always fully realised.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.
People and relatives described the service as responsive and reported good communication with staff who understood their needs. There was evidence of partnership working with district nurses, social workers, reablement services and other healthcare professionals to support people’s ongoing care and wellbeing. Relatives provided examples of positive outcomes following hospital discharge and rehabilitation, with one relative explaining that, “[Person] is back to her old self, more disabled than previously but involved in conversations and the activities that are provided where [they] live”. Another relative told us, “Doctors have commented on the improvement they have seen.”
 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff focused on protecting people’s right to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider had safeguarding and whistleblowing procedures, and staff understood their responsibility to recognise, record and report concerns. People and relatives consistently said they felt safe. One relative said, “I feel [person] is very well protected and I’ve always felt [they] are safe in their care.” Another person said, “The standard of care never varies. I’ve never felt unsafe.” Managers took action following incidents, including contacting social workers and other professionals, reviewing care plans and supporting staff.

The provider did not always work well with people to understand and manage risks. Staff did provide care to meet people’s needs, but this required improvement to ensure it as effective.
Some risk management processes were not always effective. For example, a person’s fire risk assessment had not been updated to reflect a change in their prescribed cream, despite the change being recommended by the fire service following 2 fires in the person’s home.
Risk assessments were in place to support people with identified risks relating to skin integrity, including the need for regular repositioning and the application of prescribed creams. However, records did not consistently demonstrate that these interventions had been carried out, reducing assurance that people were receiving the support required to manage risks to their skin health.
Records relating to a person's pressure area care contained conflicting information. Their pressure area risk assessment stated they had no pressure sores and were not receiving support from district nurses, whereas their care plan recorded the presence of a pressure sore and involvement from the district nursing team. This inconsistency increased the risk of staff working from inaccurate information and not providing appropriate support.
 

The provider detected and controlled potential risks in the environments where people received care. Staff identified environmental hazards during visits and took action, including reporting concerns, updating support plans and involving relevant professionals. Following fire and smoking incidents, the provider contacted the fire service, introduced additional smoke alarms and metal bins, replaced unsafe equipment and sought further risk assessment and best-interest discussions. However, repeated fire incidents showed that some controls had not always been effective. For one person, fire service recommendations and the risks associated with an emollient cream were not clearly reflected in their care plan. The provider needed to ensure environmental risk assessments, care plans and staff guidance consistently included all agreed fire precautions and that managers checked these measures remained effective.

The provider made sure there were enough skilled and experienced staff who received training, supervision and support. People mostly described a reliable service and valued continuity of care. Staff said they had enough time to support people, had completed medicines competency assessments and received supervision and spot checks. The training matrix covered all topics deemed mandatory by the provider, and staff were in date with these. Recruitment records demonstrated safe recruitment practices.

The provider assessed and managed the risk of infection and had systems to reduce the risk of it spreading. Staff induction information set clear expectations about personal hygiene, uniform and the appropriate use of personal protective equipment. People and relatives gave positive feedback about infection prevention practices.

The provider made sure medicines and treatments were managed safely and met people’s needs, capacities and preferences. People gave positive feedback about the support they received with medicines. Staff had completed medicines training and competency assessments, and the provider carried out medicines audits.