Prelle Healthcare

Prelle Healthcare is a domiciliary care agency providing personal care. At the time of our inspection there were 27 people using the service. 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

Since our last inspection the registered manager had improved governance systems. Audits were in place to help identify concerns and the registered manager took actions to address them. We found some gaps in documentation. However, the registered manager knew the service well and staff knew people well and therefore there was no impact on the service people received. We have recommended records are updated to ensure they are clear, concise and include relevant updated information.

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.

Risks associated with people’s care were identified and managed to keep people safe from harm. People were safeguarded from the risk of abuse. People received their medicines as prescribed by staff who were trained and competent to administer medicines.

The registered manager kept a record of accidents and incidents and identified trends and patterns to minimise future incidents. There was a recruitment procedure in place which assisted the management team to recruit suitable staff.

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 requires improvement (published 26 April 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced inspection published 26 April 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good. 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 Prelle Healthcare on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Prelle Healthcare is a domiciliary care agency providing personal care in people’s own homes. At the time of our inspection the service was providing support to 41 people. 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 spoken with told us they felt safe and had no worries or concerns. Staff had undertaken safeguarding training, so they had the knowledge to keep people safe. We made a recommendation to the registered manager about safeguarding.

People had individual risk assessments in place so staff could identify and manage any risks appropriately. However, records did not show some people's risks were being regularly reviewed.

The registered manager told us they understood the requirements to notify CQC. However, they had not informed CQC when the office address and contact details had changed. We also found the contingency plans to cover for senior management absence required improvement to ensure checks were completed on a consistent basis. The registered manager told us they had appointed another senior member of staff to ensure checks were consistently completed.

People told us they were supported with their medication appropriately. However, we found some people being supported with their medicines did not have a medication care plan in place. Training records seen showed staff were provided with training in infection control. All the people and the relative spoken with told us staff were wearing their personal protective equipment.

The service had a process in place for staff to record accidents and untoward occurrences. There was not sufficient evidence to show the action taken or monitoring by the registered manager. There were planned and regular checks completed by the senior managers to assess and improve the quality of the service. However, we found further improvement was required in the auditing of people care plans.

There were robust recruitment procedures in operation to promote people’s safety. There were enough staff employed at the service, so people were supported by regular care workers and experienced continuity of care.

Staff received induction and refresher training to maintain and update their skills. Most care staff spoken with felt well supported. They told us their calls for assistance or guidance from the office based staff were always answered.

All the people spoken with were very satisfied with the quality of care they had received. One person said, “I’ve never had to complain about this company as they look after me very well indeed. Overall, it’s a good service provider and I can’t think of anything to improve.” The relative spoken with made positive comments about the care their family member had received.

People knew who the registered manager was and knew they could ask to speak with them if they had any concerns. People were supported with their health and dietary needs, where this was part of their plan of care.

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.

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 27 February 2020).

Why we inspected

We received concerns in relation to the management and safety of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe, Effective 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 requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 Prelle Healthcare on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the management of the service at this inspection.

Since the last inspection we recognised that the provider had failed to notify of changes. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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 work alongside the provider and 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.

Prelle Healthcare is a domiciliary care agency providing personal care in people’s own homes. At the time of the inspection the service was providing care and support to 27 people.

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

We saw clear evidence of continued improvement at the service and the registered manager was invested in delivering a high-quality and person-centred service. Most feedback from the previous inspection had been acted on by the registered manager; however, other points of feedback such as embedding systems for advanced care planning had not been progressed at all. Audit processes generally supported good service delivery, but further minor improvements were needed to ensure these were effective at promoting consistently good practice across the entire service. Although improvements were identified, we found no evidence to show this impacted on people’s care and the feedback we gathered from people and relatives about the standard of care was very positive.

Staff were trained to identify and report any safeguarding concerns. Risks were assessed, and staff followed guidance to safely support people. Staff were recruited safety and attended calls to people in their own homes on time and stayed for the duration of the call. Medicines were safely managed.

People were supported by staff who were competent and skilled. Staff asked people for their consent before providing them with any care. People who used the service 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. Assessments were carried out to ensure needs could be met. Assessment captured people’s choices, preferences and personal support needs.

People consistently told us staff were kind and they received support from the same core group of staff, which promoted good continuity of care. Staff provided personalised support and actively encouraged people’s independence whilst delivering care. People’s care plans provided clear instructions for staff to follow on how to meet their needs.

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 requires improvement (published 17 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information 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.

Prelle Healthcare is a domiciliary care agency. It provides personal care for people living in their own homes. At the time of the inspection the service was supporting 24 people for around 115 hours per week. 12 out of the 24 people were receiving the regulated activity, personal care. The service is registered to provide services to younger adults or older people living with dementia, learning disability and/or autistic spectrum disorder, mental health needs, physical disabilities or sensory impairment.

The service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Our last inspection at Prelle Healthcare took place on 30 May 2018. The service was rated Inadequate overall. We found the service was in breach of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. There were breaches in Regulation 12: safe care and treatment, Regulation 17: good governance, Regulation 18: staffing, Regulation 19: fit and proper persons employed. We also found the service was in breach of the Health and Social Care Act 2008, Section 33, failure to comply with conditions of registration and Care Quality Commission (Registration) Regulations 2009, Regulation 14, notice of absence.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we found sufficient improvements had been made to meet the requirements of regulations. However, further improvements are expected and we have made three recommendations to the provider.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the CQC 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.

During the inspection we received very positive feedback from people who used the service. They said the service was well-run and the management team were approachable and friendly. Since the previous inspection the provider had introduced new systems to evaluate and improve the quality and safety of the services provided. Through our checks of the provider’s audits we saw the provider could question poor practice, respond to areas of risk and make improvements to the service. However, as many of the quality assurances systems were relatively new or in development, they needed to be tested over time.

People who used the service told us they felt safe. We found there were sufficient numbers of staff to meet people’s needs and it was evident that staff had been safely recruited. There had been two recorded safeguarding concerns since we last inspected, in each case the service had notified the safeguarding authority and taken all appropriate action mitigate the potential risk of harm. We have made a recommendation about notifying the CQC of certain incidents.

Systems were in place to manage medicines in a safe way. We saw records were kept when medicines support was provided. However, when medicines support was not required, such as when people were staying in hospital, this was not always appropriately recorded in people’s administration record so that gaps were clearly explained or accounted for. People who used the service had no concerns with the support they received for medicines.

People told us the service was very reliable and staff stayed as long as they should. We found people received support from the same staff which promoted good continuity of care. People told us staff were caring and kind and as a result of the emotional support they had received from staff, they felt safe and more confident. We saw the service promoted people’s independence by supporting people to manage their own routines, such as cooking, cleaning and washing.

We saw evidence of a collaborative approach to planning people’s care and support. People who received a service told us they were provided with a copy of their care plans which was reflective of their needs. We have made two recommendations about people’s care records so they are reviewed more regularly and start including information about people’s wishes for advanced care planning.

The service encouraged people to maintain a healthy diet and worked collaboratively with external services to promote people's wellbeing. Staff told us they enjoyed working at the service and had received support, training and supervision to help them to carry out their roles effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

This was the first inspection of the service.

Prelle Healthcare is a domiciliary care agency. It provides personal care for people living in their own homes. At the time of the inspection the service was supporting 23 people for around 160 hours per week. When the service registered with the Care Quality Commission (CQC) they told us they would be providing services to younger adults or older people living with dementia, learning disability and/or autistic spectrum disorder, mental health needs, physical disabilities or sensory impairment. However, the registered provider was currently providing a service to older people with physical or sensory impairment or living with dementia.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

The leadership and management of the service lacked understanding about meeting their responsibilities as a registered provider and manager. For example, the registered provider was operating in breach of their conditions of registration. This was because the registered provider was operating from a location address that was different to the address they had registered. They had not notified us of this, so the inspection was carried out at a different address than that identified on this inspection report. In addition, the provider had not notified CQC, as required by law, of any incidents which may potentially affect the safety and wellbeing of people using the service.

The registered provider did not have effective governance systems in place to continually assess, monitor and review the service so that required improvements could be identified and acted upon, including mitigating risks to people who used the service.

Despite concerns about the registered providers knowledge and effective governance systems most people told us they received good care and support.

We have made recommendations about care records so that staff had the information about how to best support the person and to reduce or eliminate the risks associated with their care and support. This included risks associated with the health, safety or wellbeing of the person.

The registered provider did not have effective recruitment processes in place. When staff were recruited, the system in place had not ensured all the relevant information and documents required were obtained before the staff member began working with people.

There was an insufficient number of staff to provide people with safe care and treatment and protect them from harm. The registered provider acknowledged the current staff team was insufficient to enable people to receive calls at regular times. This meant the registered provider was carrying out some of those calls to ensure calls were covered, but this had meant some of their other responsibilities as a registered provider had not been established or effective in practice.

Currently, the service was relying on training staff had received in previous roles so that they had the skills, knowledge and experience to deliver effective care and support. This meant that staff may not be aware of best practice or current guidance in care. Regular supervision for those staff was not established for the service to assure themselves staff were delivering effective care and support in accordance with their own vision and values and policies and procedures.

People who used the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, care records did not always contain information about people who had the legal authority to make decisions on behalf of the person where they lacked capacity.

There was a system in place to manage complaints, however, one person was not confident the registered provider listened and dealt with their concerns. We found a record was not made of the concern either as a complaint or incident. Other people and relatives said they had no cause to complain.

Staff were familiar with people’s individual needs and were able to describe how they maintained people’s privacy and dignity, which was confirmed by people who used the service and their relatives.

The inspection found one breach of the Health and Social Care Act 2008 Section 33 Failure to comply with conditions of registration, one breach of the Care Quality Commission (Registration) Regulations 2009 Notice of absence and four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review, and if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.