Prime Care Support Limited

About the service

Prime Care Support Limited is a domiciliary care agency providing personal care to people in their own homes, some of whom may live with dementia, may be autistic or living with a learning disability. At the time of inspection, 93 people were receiving the regulated activity of 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 the wider social care provided.

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

Right Support: Staff did not always retain information from training completed, and the provider did not have a robust process to continually review staff knowledge.

We have made a recommendation for the provider to review how they check staff knowledge following training completed.

Staff mostly communicated in a way people could understand. Trained staff supported people with their medicines, however, some protocols and procedures required improvement. People were involved in planning their care, and their desired outcomes were recorded. Staff promoted people’s independence and encouraged choice.

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.

Right Care: Some people, their representatives and staff told us when care visits were delayed, communication was not always effective.

We have made a recommendation for the provider to review their communication methods with people, representatives and staff to make improvements.

People mostly received their care calls at the expected time, and we found planned care calls were reflective of contractual agreements. Risks to people had been assessed. However, some risk assessments required review to ensure the information was accurate, and reflective of people’s needs. Staff promoted people’s dignity, privacy and human rights.

Right Culture: The quality assurance systems had been reviewed by the provider, since the last inspection, and progress was notable. However, further time and improvements were required to ensure the systems are robust in identifying and addressing shortfalls.

A new manager had been recruited since the last inspection. Staff told us they felt able to approach the management team, and the provider, with concerns. However, feedback received from people, their representatives, and staff, indicated general management communication, and responsiveness, could be improved.

The new manager, provider and care team were passionate to further improve the service. For the most part, staff recognised when people’s needs changed, and the provider made timely referrals to external healthcare professionals to ensure effective care and support was in place. A comprehensive service improvement plan was in use, and the provider was responsive to feedback throughout the inspection process.

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 21 June 2022) and there were breaches of regulation. At this inspection we found improvements had been made, and the provider was no longer in breach of all the regulations found at the last inspection. However, the provider was still found to be in breach of two regulations at this inspection.

At our last inspection we recommended the provider review their renewal process for Disclosure and Barring Service checks of longstanding staff, and their food hygiene procedures. At this inspection we found the provider had acted upon both recommendations made, and reviews had been completed.

This service has been in Special Measures since 01 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified two continued breaches in relation to safe care and treatment, and good governance, at this inspection.

Furthermore, we have made two recommendations to the provider at this inspection. We recommend the provider further reviews their communication methods with people, their representatives and staff. And, we recommend the provider establishes an effective process to confirm training effectiveness and knowledge retention with staff.

We issued two warning notices to the provider in response to breaches of regulation 12 (safe care and treatment) and regulation 17 (good governance). We have imposed a timescale for the required improvements to be completed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Prime Care Support Limited is a domiciliary care agency providing personal care to people in their own homes, some of whom may live with dementia. At the time of the inspection, 205 people were receiving the regulated activity of 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.

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

People were not always protected from the risk of abuse. Care visits were planned with a variable approach, opposed to agreed contractual times. People were at risk of harm due to unsafe medicines management and oversight.

Risks to people were not always identified, nor reassessed, following initial assessment, change in health or following an incident. Infection control procedures were not robust. People considered vulnerable to COVID-19 had not had individual risk assessments completed following our last inspection. Staff were not being supported to follow government guidance for COVID-19 testing. The provider continued to experience staffing difficulties and told us this was due to the pandemic. We found safe recruitment procedures took place, however, a repeat of checks was not completed during employment to ensure staff remained suitable for their roles.

We have made a recommendation for the provider to consider developing policies and risk assessments in relation to ongoing staff safety checks.

Staff training provision had been reviewed; however, not all staff had completed specific training in topics related to people’s needs. The provider had systems and processes in place to ensure the needs of people were assessed, however, we found these were not always followed. Care plans were task focused opposed to detailing the individual needs and preferences of people. People were supported to access healthcare support and appointments. People were supported with meals and drinks, where it was part of their care package. Staff took action to help ensure people had food and drinks available between care visits. However, the risks of leaving food at room temperature had not been explored with people.

We have made a recommendation for the provider to consult with people to consider risk reducing measures where food is left at room temperature for a period of time.

People did not always feel included in all aspects of their care, including the planning and knowledge of care visit timings. People told us this impacted negatively on their day to day lives.

People’s care plans were not personalised and did not evidence thorough assessments which promoted independence. People and relatives knew how to raise a complaint or concern, however, many lacked confidence in the provider’s procedures.

Continued failings were present at this inspection and the provider remained in breach of all regulations identified at the last inspection. The registered manager and provider lacked oversight in key areas which placed people at risk of harm. Clear and effective quality assurance systems were not embedded at the service. We received mixed feedback from people, relatives and staff regarding their communication experiences with the registered manager, provider and office staff. Furthermore, the provider had failed to ensure the locations CQC rating was available to the public.

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 told us visiting staff were caring and supportive. Visiting care staff respected people’s privacy and dignity and were discreet and respectful to the needs of people. People told us information was provided to them in a way which met their communication needs.

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 01 November 2021).

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 the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified continued breaches in relation to protecting people from abuse; staffing; safe care and treatment and good governance at this inspection. We have identified a new breach in relation to person-centred care at this inspection.

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.

You can read the report from our last inspections, by selecting the ‘all reports’ link for Prime Care Support Limited on our website at www.cqc.org.uk.

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. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains 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 timeframe 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 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.

Prime Care Support Limited is a domiciliary care agency providing personal care to older people some of whom may live with dementia.

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. At the time of the inspection 100 people were receiving the regulated activity of personal care.

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

People told us the level of care they received varied. This was due to visits to people not being carried out, cut short or at times earlier or later than agreed. This meant people received personal care, food and drink or medicines late or at times not agreed. Where people had care needs that required a visit at a specific time, this did not always happen.

People and relatives told us there were not enough staff to provide timely care. The provider told us they were facing recruitment challenges which had recently impacted on staffing.

Safeguarding systems and processes were not effectively operated. People were not protected from the risks of financial harm or abuse by the provider. Staff were aware of how to identify when people were at risk and reported concerns appropriately. The manager and the provider failed to take appropriate action, and when concerns were substantiated did not ensure lessons were learned to mitigate future risks. Where referrals were required to be made to the local authority these were not always carried out.

People told us that regular staff knew how to support their health and wellbeing. However, risk assessments and care plans to guide staff were not in place for everyone. Staff had not received specific training to prepare them for supporting people in areas such as skin integrity, dementia and diabetes.

The registered manager had not risk assessed how staff could mitigate the risks of contracting or spreading COVID-19 to vulnerable people.

The registered manager and provider had not established systems and processes resulting in the issues found at this inspection. We found systems were not effectively operated to identify and implement improvements. The provider had not implemented lessons learned from another of their services which had also been rated inadequate due to similar concerns.

People and relatives told us the service was not well managed. They told us they were not communicated with when things went wrong and that their visits were poorly planned. They told us they had raised issues but no improvements were made.

The manager and the provider took some immediate actions following our first day of inspection to keep people safe. For example, they recognised the impact late and missed calls were having on people and put in place a temporary suspension of new referrals.

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 told us staff followed infection prevention procedures when providing personal care and wore their personal protective equipment [PPE]. Staff had received training in relation to COVID-19 and how to safely wear and dispose of their PPE.

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

Rating at last inspection

The last rating for this service was good (Published 03 July 2019).

Why we inspected

We received concerns in relation to people receiving unsafe care due to missed and late visits, medicines management and poor leadership. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. 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 good to inadequate. This is based on the findings at this inspection.

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have found breaches of regulations in relation to insufficient staff, lack of training and keeping people safe from harm, also in relation to management of the service. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Special Measures

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 timeframe, 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 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.

Primecare Support Ltd is a domiciliary service providing personal care to 293 people at the time of the inspection.

Not everyone using Primecare Support Ltd 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 consider any wider social care provided.

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

Most people we spoke with had a concern about the call times not being as per their agreed plan of care. People told us calls were often late and they were not sure what time staff would attend. Some people told us this resulted in them feeling rushed.

During the course of the inspection process a concern was raised in relation to medicines and the quality of care provided. The registered manager liaised with the CQC and the local authority and took appropriate action to address and the concerns raised.

Other people felt supported well by staff in relation to their medicines. They told us staff always checked the medicines, administered them correctly and ensured people had a good supply.

Some people told us they struggled to understand staff where there were language differences.

People said that they did not feel confident that complaints were well managed and they often did not get a response when trying to call the office.

Relatives did not feel all staff were well trained in relation to supporting people with more complex needs and felt this needed to be improved.

People told us staff involved them with assessing their needs, writing up clear plans of care and regularly reviewing these.

People felt safe and well cared for and told us staff were caring, kind and gentle.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice.

We have made a recommendation about ensuring records show clear assessment and guidance of people’s risks. We have also made a recommendation in relation to recording and auditing of medicines.

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

Rating at last inspection:

At the last inspection the service was rated Good (published 14 September 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence 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.

The service provides personal care to over 200 adults in their own homes. Some of the people being supported by the service were living with a variety of care needs including dementia. The service also supported seven children and young people.

There was a 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 2008 and associated Regulations about how the service is run.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm. When required, suitable equipment was in place so that people were supported safely.

The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely. Staff had received regular supervision and had been effectively trained to meet people’s individual needs. However, the provider needed to improve how they supported staff, particularly those from other countries.

Staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. However, newer staff needed more training to understand the principles of the Mental Capacity Act 2005 (MCA).

People were supported by caring, friendly and respectful staff. They were enabled to make choices about how they wanted to be supported.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. They were supported to eat and drink well, and to access other health and social care services when required.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continuously improve the quality of the service.

The provider had effective quality monitoring processes in place and these had been used effectively to drive continuous improvements. Most people described the service as ‘very good’. They had no concerns about how care was provided and how the service was managed, but some felt that communication between office staff and care staff needed to be improved.

We found that the provider was meeting the regulations by gaining consent from people both written and verbally when required. People were cared for by staff who had received the appropriate training and staff treated people with dignity and respect. The provider had a robust quality control system in place and the service was also monitored by the local authority and acted on any recommendations that were made. We noted the provider had a detailed complaints procedure in place and that people who used the service told us they had the confidence in the provider to act on any complaints or issues that they had.

We noted from the six care files that we looked at, that people were offered support at a level which encouraged independence and ensured that their individual needs were met. People told us that the staff were friendly and courteous in their approach and were knowledgeable and confident in their roles. One person told us, "The staff are fantastic, they're just like my friends now". Someone else said "They are exceptional, I wouldn't want to change them".

We could see from records that people were encouraged to express their views and were involved in planning their care and making decisions about their care and support. The provider welcomed suggestions from people which could improve the service they provided. People told us that they felt able to approach the manager to discuss anything, and they were confident that swift action would be taken to resolve any issues they had.