Premier Care Limited - Wirral Branch

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults. Premier Care Limited - Wirral Branch provides a domiciliary service on the Wirral and was is into three geographic areas. At the time of our visit, the service was providing support for 570 people and provided staff for three extra care schemes. There were 279 staff employed and 22 office staff, including the registered manager. At the time of inspection, a director of Premier Care Limited was also in attendance at the service.

Not everyone using Premier Care Limited - Wirral Branch receives 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 take into account any wider social care provided.

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 service had a registered manager in post.

During our previous inspection in June 2017 there were breaches of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating of the service was ‘requires improvement’. This was because risk assessments did not give specific guidance for staff and the information in the risk assessments was sometimes contradictory and some medication administration records contained misleading information.

At this inspection we found that the service was ‘good’ and was no longer in breach of regulations. This was because improvements had been made to risk assessments, care plans and medication records.

However, we found that records management had improved but further improvements where still needed regarding processes followed for covert medication and daily logs in people’s homes. We were able to see how the service was continually improving regarding the visit times. However, the feedback we received from people was mixed as visits were not always on time. We were also told how people were not always informed of changes to either times or carers.

People's medicines were handled safely by trained staff and were given to them in accordance with their prescriptions. People's GPs and other healthcare professionals were contacted for advice about people's health needs whenever necessary.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults and whistleblowing. Staff received regular training and supervision to enable them to work safely and effectively. There was a complaints policy in place which people felt comfortable using if they had concerns.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. Management and quality assurance systems had been devised and were in place to drive continuous improvement and the service.

Staff understood the need to gain consent and followed legislation designed to protect people's rights and freedoms.

We saw that infection control standards were monitored and managed appropriately. We saw that the provider had an infection control policy in place to minimise the spread of infection, all staff had attended infection control training and were provided with appropriate personal protective equipment such as gloves and aprons.

Premier Care Limited - Wirral Branch provides a domiciliary service on the Wirral and was divided into three geographic areas. At the time of our visit, the service was providing support for 676 people and provided staff for three extra care schemes. There were 296 staff employed including the registered manager, a compliance manager, 10 co-coordinators, seven senior carers, five administrators and care staff. During the inspection a director of Premier Care was also in attendance.

The service is required to have a registered manager. 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 registered manager informed us that he would be moving to another branch in the near future and that the compliance manager intended to apply for registration with CQC as manager of the service.

At our last comprehensive inspection of the service in November 2016 we found breaches of a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care; dignity and respect; safeguarding people who use the service from abuse and improper treatment; meeting nutritional and hydration needs; and staffing.

During this inspection we found that some improvements had been made in all of these areas but further improvements were required. However, in response to the improvements that had been made we took the service out of special measures.

During this inspection, we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our last inspection we found that the provider had no suitable system in place to ensure that risks in relation to people's care were adequately managed. We were able to see that the service had made improvements in this area. This included updating risk assessments in people’s homes. However, we had concerns about some of the risk assessments because they did not give specific guidance for staff and the information in the risk assessments was sometimes contradictory.

During this inspection we saw that improvements had been made in relation to the administration of medication. However, we identified that some records contained misleading information, for example incomplete medication administration records that differed from instructions on the boxes the medications were dispensed in. We also saw daily records that stated staff were administering medication that had not been written into people’s care plans.

During our last inspection we found that daily logs of people’s care had not been adequately completed after each visit. The times reflected in the planned and actual visit records had a lot of anomalies. We also found that the majority of late and missed calls had not been followed up consistently by the provider to ensure people were safe. At this inspection we found that improvements had been made. The provider had an electronic monitoring system that was being used effectively and we saw that improvements had been made to people’s daily logs.

At this inspection we saw improvements had been made to the recruitment procedures at the service. A Disclosure and Barring Service check had been obtained for all staff.

At our last inspection we identified that staff did not have sufficient support to ensure they were delivering care safely. During this inspection we saw that improvements had been made. The provider had implemented supervisions and staff had received training about medication and safeguarding and new staff had a satisfactory induction process.

During our last inspection we identified that the provider did not have an effective system in place to record, handle and respond to people's complaints, and where complaints had been received they had failed to investigate and take proportionate action. At this inspection we saw that improvements had been made and we were able to see that any complaint that had been made to the service had been investigated and an outcome had been logged.

We saw improvements had been made in some of the care files we saw in people’s homes. However, we saw that some people’s care files had only been reviewed and updated when staff were aware that CQC inspectors would be visiting the person as part of this inspection.

At our last inspection we found that the provider did not have effective systems and processes in place to assess and monitor the quality and safety of the service provided. During this inspection we found that improvements had been made and the provider was aware that further improvements were needed. The administrators carried out weekly compliance monitoring and people were asked for their views about the service they were receiving.

The majority of the feedback from people we spoke with was positive and people told us they felt safe with the staff visiting them. People using the service and the relatives we spoke with told us that although the service had improved there were aspects of the service from both the carers and the office staff that needed further improvement.

Prior to our visit, we had received information of concern about the quality and safety of the service provided. This information prompted our visit. We gave the provider of the service 24 hours’ notice before our visit to ensure they would be available to participate in the inspection. We carried out the inspection on the 24, 25, 28, 29 and 30 November 2016.

There was a registered manager in post who participated in the inspection visit. 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’.

On the day of our visit the registered manager, compliance manager and one of the three directors of the service (the provider) in relation to how the service was managed were present during the inspection and were involved in the day to day running of the service also. We liaised with all three for the majority of our inspection.

During this inspection, we found breaches of Regulations 9, 10, 12, 13, 14, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the care files belonging to 14 people who used the service. 11 at the office and 3 in people’s homes. We found they did not adequately cover people’s needs and risks. They failed to provide clear information or guidance to staff in the provision of safe and appropriate care. This placed the person at risk of harm. Care plans were not personalised to people’s individual needs and preferences and staff lacked sufficient guidance on how to provide people with person centred care.

We found that some people had mental health conditions which may have impacted on their ability to understand about the importance of their care in relation to nutrition. Staff had no guidance on how to support people with mental health needs and appropriate action had not been taken by staff to report the day to day outcomes of their visits.

Due to the irregularity of visits, some people did not receive their medication at regular times. People’s medication administration charts showed gaps in the administration of medication that were unexplained and did not demonstrate that people always received the medication they needed or in a safe way. In some instances there were no medication administration record sheets (MAR’s) in people’s homes.

There was no evidence that the provider had checked on people’s welfare or reviewed their care to ensure that the support people received continued to be suitable for their needs. Where people’s support needs had changed, people’s care plans had not been updated. This placed people at risk of inappropriate or unsafe care.

The staffing arrangements in place at the service was in disarray due to the amalgamation of three new contracts commissioned from July 2016 to October 2016 taking staffing up from 40 to over 430. The information provided to us was not a true reflection of the service provision at this time as the system ‘Care Free’ did not contain all of the data required as yet about all of the people using their service the impact meaning the provider could not be confident that people’s needs would be met. The provider was aware of the staffing levels not being sufficient due to new contracts for being in place. Actions to review people’s care to ensure that the number of staff employed could safely deliver the care required was taking place, however visits were being missed and the time agreed in care plans was not being provided.

There were gaps in the training of staff members and some training had not been updated since 2012 which meant it would have been out of date. This was due to staff transferring to the service without training records and the service not being aware of the staff competencies. Staff lacked appropriate supervision in their job role and their skills and abilities had not been regularly evaluated by the provider to ensure they were competent to deliver care to people to an appropriate standard.

People we spoke with told us that the staff who delivered the care were mostly kind and caring and did their best.

We saw that the provider did have a satisfactory complaint policy in place. However the provider’s procedure was not effective in dealing with complaints made to them.

People’s views about the quality of the service had not been sought by the provider. Four people we spoke with and three relatives told us that they had complained to the provider many times about the quality of the service and the care they received. One person said “They don’t listen”. Another said “I don’t bother complaining anymore, they take no notice”.

There were no effective audits in place to check the quality and safety of the service at this present time. The provider had failed to ensure the registered manager and staff followed policies and procedures, and had failed to take any action to protect people from risk.

During our visit on the 24, 25, 28, 29 and 30 November 2016, we raised serious concerns with the provider about the safety of the service and asked them to refer the care of some of the people whose care file we looked at to the local authority safeguarding team to protect them from further risk. We also asked them to take appropriate action to mitigate any further risks to people’s health, safety and welfare. We asked the registered manager had they contacted the people we reported to them and they told us at a meeting they had not.

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.