Archived: Premier Care Crewe Branch

Premier Care Crewe is a domiciliary care agency providing personal care to 50 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

There were processes in place to monitor the quality of the service and a range of audits and checks were undertaken. However, further improvements were required to ensure a better oversight of staff performance and deployment and records relating to medicines.

We have made a recommendation about medicines. Whilst some improvements had been made in the management of medicines the provider needs to take further steps to ensure there is a suitable time interval between doses of medicines. The medicines administration records did not always reflect the directions of medicines and topical preparations as they had been prescribed.

People and their relatives provided positive feedback about the service and said it mostly met their individual needs. They said they felt safe and secure around staff and were treated well. 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 said the timing of their visits had improved but there was room for further improvement. People confirmed there had been better continuity in the team of staff who visited. People and their relatives were grateful that they had been able to rely on the staff support throughout the peak of the Covid 19 pandemic.

Safe recruitment practices were followed to help ensure staff were of suitable character to work with vulnerable people. Staff training, support and competency checks had been reviewed. There were now appropriate mechanisms for ensuring staff had the skills, knowledge and competence to care for people safely.

Risks to people's health and safety were assessed and better managed. People were protected from abuse and avoidable harm.

People and staff were asked for their views on how the service operated.

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 inadequate (published 10 December 2019) and there were multiple breaches 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 but the provider remained in breach of regulation 17.

Why we inspected

A decision was made for us to inspect, examine and follow up what improvements had been made since we last visited the service. Due to the Covid 19 pandemic, we undertook a focused inspection to only review the key questions of Safe, Effective and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Caring and Responsive key questions were not looked at on this occasion.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to requires improvement. 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 Crewe Branch on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to the overall monitoring and governance of the service.

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 work alongside the provider and local authority to monitor progress. We will return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Premier Care Crewe is a domiciliary care agency providing personal care to 89 adults 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, relatives and staff felt the service was not well led. They described the systems being in place to ensure that calls times or staff were consistent across any given week as ineffective. This caused anxiety for people as support was not always provided at the time it was expected or required.

Our examination of the rota and time sheets confirmed this to be the case.

Risks to people and details around their health conditions were not appropriately recorded, monitored or addressed. The management and administration of medicines was inadequate and unsafe.

Safeguarding concerns were not always identified or reported to the relevant authorities. Where there had been concerns the provider did not ensure that they were fully investigated. They had not implemented measures to protect people from future risk of abuse.

Care plans were not personalised and did not accurately reflect people's needs and wishes. They did not include information on how to support people with their medical conditions. People with life limiting conditions were being supported but care plans did not include people's end of life wishes.

People's rights were not always protected in line with the principles of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not 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.

People and relatives felt that staff were not always well trained or experienced. Staff had completed an induction and received ongoing training, however, there were inadequate checks to ensure staff understood what they had learned and were able to implement this in practice. The service did not follow national guidance and best practice to ensure effective care. .

Complaints were not dealt in line with the provider's policy. Not all complaints had been logged and there was no learning or actions evident as a result of the complaints that had been made.

The area manager had completed monthly audits, but not all issues identified over the course of this inspection had been highlighted. Where concerns had been found, they had not been thoroughly investigated or resolved. Some daily logs had been recently reviewed but these had failed to identify the concerns we found in regard to people’s day to day health and care.

Records such as MAR charts and daily logs had not been returned to the office on a monthly basis so that the information and accuracy of information could be checked without delay. Some of these records could not be provided or found. This raised further concern in regard to the confidentiality of records and their safe keeping.

People and relatives gave very positive feedback about the staff themselves and told us that they were treated with kindness. They told us their dignity and privacy were respected. People firmly believed that any short-falls in their care were the failings of the management and organisation and not the care staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This service was registered with us on 25 April 2019 and this is the first inspection.

The planned inspection was brought forward due to concerns received about medicines, staffing levels and the competency of staff. A decision was made for us to inspect early and examine those risks.

Follow up

We will request an action plan and meet with the provider following this report being published to discuss how they will make changes to ensure they improve the standards of quality and safety. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.