9 December 2021
During an inspection looking at part of the service
Prime Care Associates is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of the inspection, 76 people were receiving a service from the agency.
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 happy with their support, but the timing of their visits did not always meet their needs. Some staff did not always stay the full amount of time allocated. People had a care plan, but some of the information was not completed and a person-centred approach was not evident. People’s daily records were also task orientated, and contained little information about the person’s wellbeing.
There was a risk management format in place, but this did not always identify and mitigate the individualised risks people faced. Lack of guidance for staff to manage risks safely was also identified at the last three inspections in 2019, 2018 and 2017.
People’s medicines were not always safely managed. Staff had not documented the time they had assisted a person with their pain relief. This increased the risk of it being given again before the required four hour gap between doses. Some medicine administration records showed handwritten changes to the dosage and timing of the prescription details, without the staff’s signature or countersignature.
There was a quality auditing system in place, but it was not fully effective, as shortfalls found during this inspection had not been identified. This included shortfalls in risk management, care planning and the inconsistency in timing and duration of people’s visits.
Systems were in place to minimise the risk of people experiencing abuse. Staff told us they completed safeguarding training and would report any concerns about people’s wellbeing to the care manager.
People told us they felt safe with staff supporting them. They said staff wore the required personal protective equipment, to minimise the risk of transmitting COVID-19. The care manager gained regular updated government guidance about working safely within the pandemic. This was disseminated to the staff team as required. Staff took part in a regular testing regime to detect if they had the virus at an early stage. This minimised the risk of transmission.
There were enough staff to support existing care packages. The care manager was not accepting any new care packages to avoid staff being spread too thinly. People were supported by a stable staff team, who knew them well. New staff were recruited safely to ensure they were appropriate to work with vulnerable people.
The agency provided end of life care, if needed, to those already being supported.
People and their relatives knew how to make a formal complaint but had not needed to or done so. Two concerns had been raised with CQC just before and at the time of the inspection. The care manager had not substantiated the first concern, and we found there was no evidence to support the second.
The service had a supportive ethos and a clear desire to provide good quality care. Systems were in place to enable people, their relatives and staff to give their views about the service. The care manager told us they worked closely with other agencies such as the GP and community nurses.
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 16 August 2019).
Why we inspected
This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology for gathering information, and phone calls to engage with people using the service as part of this performance review and assessment.
The inspection was prompted in part due to concerns received about people’s support being at an inappropriate time, and staff leaving visits early. There were also concerns about lack of supervision, spot checks and manual handling training for staff. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well-led sections of this full report.
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 requires improvement. This is based on the findings at this inspection.
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 Associates on our website at www.cqc.org.uk.
We have identified breaches in relation to safe care and treatment, person centred care and the management of the service.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.