Prime Care Support Limited

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

At our last inspection we identified breaches in relation to people’s safe care and treatment. At this assessment improvements had been made and the service is no longer in breach of regulations. People gave us mixed feedback about how safe they felt being supported by staff and staff consistency. We also found some inconsistencies related to safety where staff did not always effectively record how people had been supported. However, for the most part people were supported safely at the service and staff knew how to keep people safe. Staff followed safe medicines administration and infection prevention control (IPC) practices.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people about how well staff learned lessons when things went wrong. For example, one person said, ‘‘I keep telling [staff] how I like things to be done and how they are supposed to help me when they support me with [equipment], but nothing seems to change. I do wonder if they are listening to me or not.’’ We fed this back to the registered manager who explained they would be meeting with people and also be looking at how people’s preferences are recorded across care plans and daily records to support consistency. It was sometimes unclear how staff were reporting incidents and accidents. Sometimes staff would report these on daily care records and other times they would ring the office to report concerns. This made it unclear how some incidents were being reported and what follow up actions were taken to promote learning. This had the potential to have an impact on people’s experiences. The registered manager took this feedback seriously and started taking action to review how incidents were recorded to support lessons being learned. They sent us evidence assuring us this was now going to be improved. We also received positive feedback from people and their relatives I relation to how staff learnt lessons. One relative said, ‘‘When things happen, and we raise it with [staff] they seem to change how they are doing things pretty quickly.’’

Staff told us they were supported to learn lessons when things went wrong. They explained the various ways in which lessons were shared such as in meetings and also via e-mail. Staff explained how they had regular communication with each other about the best ways to support people to help lessons be learned and best practice to be shared. The registered manager and provider were keen to learn and improve. They had several methods in place to learn lessons such as reviewing daily records and incidents reported and sharing these with the staff team. They also had a running log of lessons learned so they could embed these into everyday practice at the service. The registered manager and provider took our feedback during the assessment seriously and sent us evidence they were starting to implement lessons learned as a result of this.

Processes were in place to learn lessons when things went wrong. For example, the registered manager and management team reviewed incidents and accidents when they happened to see if any lessons could be learned. They shared these with the staff team. The registered manager also kept a running log of lessons learned and reviewed this regularly to help ensure similar incidents were avoided as far as possible.

People told us staff supported them with any support they needed as a result of advice from other services such as hospitals or GPs. One relative said, ‘‘[Family member] went to the hospital and now requires a lot more care. After a few discussions [staff] were able to accommodate this no problem at all.’’ People also told us staff knew what to do if they felt a person needed support from another service and supported them as best as possible with this. For example, a person told us, ‘‘I remember once I had a fall and was in a lot of pain. [Staff] arrived for my call, and they sorted an ambulance out for me and even rearranged everything so they could stay with me and make sure I got where I needed to go.’’

Staff told us how they supported people if they had used another service. They told us any changes to people’s care needs as a result were shared with them clearly by the management team. People’s care plans were updated based on any changes to their needs. The management team spoke with us about how they ensured staff were available to support people if they needed to visit another service such as a doctor’s appointment. They worked with relatives to discuss where extra support might be needed. The management team also showed us how they recorded changes to people’s support needs in care plans and shared these changes with the staff team.

Professionals spoke with us about how staff and the management team worked with them if they felt people needed specific or different support. They told us staff followed their instructions to help keep people safe. One professional said, ‘‘I have supported several [people using service] and have had no concerns with how the staff follow our instructions.’’

There were processes in place to help ensure changes to people’s support needs as a result of using other services were recorded in care plans and shared with the staff team. The registered manager also spoke with us about how staff would record any changes to people’s care needs or any visits from professionals working with other services in their care records. However, when we reviewed care records, we found staff did not always record visits from health professionals in these records. The registered manager took action and sent us evidence they would address this issue.

We received mixed feedback from people about how safe they felt being supported by staff. One person said, ‘‘I sometimes feel like some of the staff rush things. They are far too quick and sometimes I worry this makes them a bit rough when they help me.’’ Another person said, ‘‘I do not feel safe as I do not know who is coming every day. I ask the carer who visits me in the morning who is coming in the rest of the day, and they don’t know. Feels like strangers coming into my home which is unnerving.’’ We also received some positive feedback about how safe people felt. People told us, ‘‘I feel very safe with the carers I see regularly.’’ and, ‘‘I am perfectly safe with the carers, and they all know exactly how to keep me safe when they help me.’’ The registered manager told us they would discuss the feedback people gave to us in relation to safeguarding with them to see if any improvements could be made.

Staff had training in safeguarding and knew what different signs may indicate people were not safe. They knew how to report concerns to both at the service and externally to partners such as the local authority safeguarding team or CQC. The provider notified the safeguarding team and CQC of safeguarding incidents if this was required.

The provider had policies and processes in place to help ensure safeguarding concerns were dealt with appropriately. These were effective in making sure safeguarding concerns were considered carefully by the provider and measures taken where possible to help improve safety for people using the service.

We received mixed feedback from people about how staff supported them to manage their known risks. One relative said, ‘‘[Family member] is living with [support need] and I am just not sure the carers fully understand how to support them with it. It does not help that we have a lot of different carers, so they do not have the chance to help them with [support need] regularly.’’ A person told us, ‘‘I have had changes to how I need supporting but I do not think staff support me the right way [with support need].’’ However, we also received some positive feedback. A person said, ‘‘[Staff] know how to help me with everything I need. Never had an issue.’’ A relative told us, ‘‘[Staff] are very competent using the equipment [family member] needs.’’ We also received mixed feedback about whether people and relatives were asked to be involved in care planning and reviewing risk assessments. Some people and relatives told us they had done this, and some told us they had not seen care plans and risk assessments. We fed this back to the registered manager who assured us they would address this and make sure people, and their relatives were involved in this area of their support if they wished to be.

Staff were confident about how to support people and spoke with us about the potential risks people faced and the measures they took to help mitigate these. The registered manager and senior staff had a good oversight of the risks people faced and updated people’s risk assessments regularly or when the staff team told them a change was needed.

Risk assessments in place for people were of a good quality and gave staff detailed information and guidance about how to support people to mitigate risks. Processes were in place to engage with people and relatives and involve them in planning risk assessments.

People and relatives told us staff supported them safely in their homes and treated them with respect. One person said, ‘‘[Staff] know how to use all the equipment in my home and always tidy up and put things away when they are done.’’ A relative told us, ‘‘The carers are very respectful. They know they are working in [family members] home and treat it with a lot of respect.’’

Staff told us they had guidance and risk assessments to follow about working in people’s homes and using equipment to support people. They were confident in how to do this. The registered manager and management team assessed any risks in people’s home environments and shared these with the staff team, so these risks were mitigated.

Processes were in place to monitor the environment staff were supporting people in, at their homes. Staff reported any concerns, and these were used to update and inform risk assessments where necessary.

People and relatives gave us mixed feedback about staff getting to visits on time and staying for the correct duration. People’s comments included, ‘‘My care visits are supposed to be at certain times, but [staff] can be very late or very early. Sometimes I just finish my breakfast then staff come in to help with lunch. The visits are all over the place.’’ and, ‘‘I am allocated [times for care visit] but staff don’t always turn up on time or if they do they rush and don’t stay the full length of time.’’ A relative said, ‘‘[Staff] do not seem to have set times for when they visit [family member]. This is frustrating as they really would prefer their support at the times they have asked for. It can be quite inconvenient.’’ We shared this feedback with the registered manager who showed us evidence they would address concerns and monitor this. People also gave us positive feedback about staffing. One person said, ‘‘I see the same carers and they are more or less on time. The office staff will always let me know if they are running overly late.’’ A relative told us, ‘‘Never had a problem with staff arriving on time. We know we can trust them.’’

Staff told us there were enough of them to cover care visits and explained how they worked flexibly to make sure all care visits were covered. They also told us, most of the time, they had adequate time to travel between different care visits. The registered manager and provider explained how they monitored care visits and took action if they noted improvements needed to be made. Staff were positive about their training and were knowledgeable about what they had learned. They told us they had regular supervisions and management staff also observed them supporting people and gave them feedback to help them continually improve. The registered manager and provider explained how they listened to staff and sourced additional training if staff felt they needed this.

Processes were in place to monitor staff visit times to help ensure they were happening at the right times and for the right duration. The registered manager showed us how action was taken if there were discrepancies but were also open and honest about where the system could be improved. They told us how they would implement these improvements and sent us evidence of this. The registered manager and management team monitored staff training and competency on a regular basis to help ensure they could support people in the best way possible. Staff were recruited safely in line with current legislation.

People told us staff followed good IPC practices and used personal protective equipment (PPE) when supporting them. One person said, ‘‘[Staff] always have their gloves and aprons on and clean up the bathroom and kitchen. It always looks great.’’

Staff told us they had training in IPC and how they implemented this training when they supported people. Staff told us they had access to any PPE they may need to use.

Processes were in place to monitor staff training and competency in IPC such as the management team visiting people in their homes to ensure staff were following good practice.

People told us they were supported safely with their medicines. One person said, ‘‘My medicines need to be taken at very specific times and staff make sure this happens. Not sure what I would do without them.’’ A relative told us, ‘‘[Family member] needs a lot of medicines so it is reassuring staff are so well trained to administer them.’’

Staff had training in medicines administration and had their competency to administer medicines checked regularly. They spoke with us confidently about what they would do in circumstances such as medicines running out or people choosing not to take their medicines. The registered manager ensured staff training and competency to administer medicines was up to date.

Processes were in place to help ensure medicines were administered safely. Staff recorded medicines administered on daily records for people. However, when we reviewed these records, we noted several gaps indicating people may not have had medicines administered or staff had not recorded these had been given. However these were picked up by the providers processes. The registered manager told us how they would monitor this more closely and put measures in place to improve this. Medication policies were detailed and understood and followed by the staff team. People’s care plans made it clear how they were to be supported with their medicines.