This inspection took place on 27 and 28 November 2018 and was announced. At the last comprehensive inspection on 18 and 19 October 2016 the service was rated as Good. At this inspection we found the service was rated as Requires Improvement.Premier Care Services Ltd is registered as a domiciliary care agency. The service provides personal care to people living in their own homes. The Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'. For example, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 72 people living in the London Borough of Croydon were using the service.
The service had a registered manager in post who was available during both days of our inspection. 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.
The provider did not always properly assess risks relating to people's care, such as risks relating to medicines management, pressure ulcers and nutritional risk. There were no robust management plans in place for staff to follow in reducing the risks.
The provider did not always manage people's medicines well. For example, the provider did not ensure staff made records of medicine administration accurately and did not ensure staff were sufficiently trained in the specialist skills they needed.
The provider did not keep an overview of staff training so we could not be sure all staff had received the training they needed, when they needed it. We were concerned the training provided was out of date and did not include current best practice and guidance.
Some parts of people's care plans lacked detail to inform staff about the people they were caring for. For example, a person's care plan did not set out the communication difficulties a person experienced or the best ways for staff to communicate with them.
The provider did not have effective systems in place to monitor, assess and improve the service. The provider had not identified the issues we found during our inspection and so had not made the necessary improvements to meet the fundamental standards.
The provider did not always submit statutory notifications to CQC as required by law which meant they did not support us to carry out our role in monitoring services to make sure the appropriate action was taken to protect people’s health, safety and welfare.
People’s ability to make decisions was not always recorded in line with the Mental Capacity Act (MCA) 2005.
People knew how to complain and believed the registered manager would investigate any concerns they raised properly. The complaints policy needed to be amended and the way complaints were recorded needed to be improved.
Staff told us and records indicated they received appropriate supervision to support them in their role. The service followed safe recruitment practices.
Systems were in place to involve people in developing and reviewing their care and to gather their feedback about the service they received. Although sometimes the information recorded was poor.
People were safeguarded from abuse and neglect. Office staff were confident in the reporting procedures they should use and staff knew when they should notify the office if they suspected people may be being abused to keep them safe.
People were supported in relation to eating, drinking and their healthcare needs when this was part of their agreed package of care. However, record keeping around the type of support people required was sometimes poor.
Staff were kind and knew the people they were caring for. Staff supported people to maintain their privacy and dignity and treated people with respect.
We found breaches of the regulations relating to safe care and treatment, staffing, person centred care, good governance and notifications. You can see what action we have asked the provider to take to address these breaches at the back of this report.
We have made a recommendation to follow the current best practice guidelines for the MCA.
Further information is in the detailed findings below.