Prime 4 Care Ltd

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

People were safe. Records of people’s referrals and healthcare appointments were made at times people needed. Rotas demonstrated staff supported the same people and people told us, staff stayed for the required times. Staff had the necessary skills to support people, and new staff were introduced to people to build up trust and knowledge. People felt safe supported by staff in their own homes and staff respected people’s homes. Processes to manage risks were assessed but some risk management information and care records required more personalised information to ensure staff provided the care people needed. Managers supported families to ensure continuity of care if people needed support from other health service.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they were pleased with the service. One relative said Prime 4 Care was the best service they had received. Where feedback had been given to the provider, improvements were made. One relative said, “This is the best care team [Relative] has had in over 20 years. I know the managers, they help us with our care, even over the telephone."

During our visit the manager and director were open and honest in what needed improvement. The manager told us they had identified where improvements were needed. They acknowledged checks were completed, but not recorded so this was to be a priority for them to improve. Staff told us the service and culture had improved and staff felt they worked well as a team. Staff told us they felt supported and were confident to raise any concerns.

The process to learn from lessons did not always support the improvements needed through a lack of evidence. However, learning from events was taken through feedback from people, relatives and staff. People’s feedback was sought which informed how they received their service.

People and a relative told us they felt their service worked well with other health professionals such as the doctor and multi-disciplinary teams. People told us they received continuity in the staff who provided their care. One relative said, “ [Relative] has a number of appointments and they help take them to appointments”

The manager and provider said they had positive professional relationships with external professionals to ensure people’s needs were met. Staff told us of examples when they could request GP support when needed, via office staff. Staff knew if there was an emergency, who to contact and what to record. Staff said they had a care plan which directed them from the start, how to support people.

We asked health professionals for their feedback. We did not receive any feedback, however, conversations with a relative and the provider, showed health partners had been involved, consulted with and in some cases, the provider supported families at meetings. A relative we spoke with told us how important this was to them and how this was appreciated. This showed health professionals were involved when required.

The manager had limited records to show us, how they shared information with health and social care professionals. The providers processes needed some improvement to demonstrate and provide external health professionals, with important information in case they needed to be transferred between other services.

People were positive about the way their safety was considered. People and a relative felt safe with staff in their home. One person told us,” I do feel safe, I like them” and a relative said, “[Relative] is safe and well looked after.” This relative said staff recognised changes in mood and took appropriate steps to support them.”

Staff told us they were trained in how to recognise and report abuse. Staff knew how to raise concerns. Staff were confident if they reported concerns they would be taken seriously. One staff member said, “If I saw anything, I would make the person safe and report it.”. Staff knew which agencies to refer to if poor practice was suspected. Management team knew how to respond to any concerns and who to involve.

Safe systems included a review of reported incidents, observed practice and supervisions of staff to check they supported people safely. Regular training sessions on safeguarding and safety, as well as people’s feedback was sought to ensure they continued to feel safe.

People were pleased with the support they received. People and relatives said risks were managed related to medicines, moving and handling and people felt safe when staff supported them, at times they required. A relative was confident staff knew what signs to look out for so appropriate steps could be taken to protect their family members welfare. This relative said, “I know we have talked at length about risks with Prime 4 Care.” They were confident risks were well managed.

Staff knew how to manage risks. Staff told us they relied on verbal handovers from staff, and care records in the person’s home. The provider used consistent staff teams to support people which meant staff knew people well and risks were known. Observed practices helped make sure staff managed known risks. However, management whilst confident staff provided safe care, they had not ensured, people’s health conditions and support needs were accurately documented. This had potential to put people at risk.

The provider had limited processes to manage and monitor risks across the service. We found some processes required better management and oversight. Daily records we saw required more detail. Care plans and risk assessments needed to be reviewed to ensure they continued to meet people’s needs. In some cases, care records were not person centred. The manager agreed to review all care records. The provider recognised improvements were required to improve processes to better manage risks.

People and relatives felt staff respected their home environment. Where risks of the environment could impact on people, such as any trips or hazards, these were known by staff and where practical, improved.

A field supervisor responsible for carrying out assessments of people’s needs explained the importance of ensuring risks in people’s homes were identified and actions taken to mitigate those risks. Care staff said they considered fire risks, such as clothing on or near a source of heat. They said they would remind people and remove clothing if it caused a safety issue.

The manager told us environmental risks within people’s homes were identified prior to care beginning. Information was included in people’s support plans about any actions staff should take to keep themselves and people safe. Where equipment was required to support people, there was guidance informing staff how they should support people.

People's experience was positive. People told us they got on well with staff and they received the same staff at the times they wanted. People and relatives said where staff changes took place, staff shadowed so when they took over, they knew what was needed. One relative told us, “ They know how to treat them. Staff take them out to get them socialising more. The staff are wonderful, safety is a priority and I would be lost without them.”

The manager said they had enough care staff to allocate all the calls people required. They explained how care calls were allocated geographically to ensure people received care from a consistent staff team, with minimal delays. Care staff told us they had travel time between calls and were not rushed. In some cases, care staff had an allocated driver to take them to calls. Staff had time to support people for the duration of the calls.

The provider used an electronic system to allocate people’s care calls. However, more learning was needed to ensure staff logged in and out on time. We found examples where staff had not with no reasons why. Calls were grouped geographically to minimise travel time and limit late calls. Office staff monitored the care calls ‘live’ on the system so could intervene if calls were running later than planned. There were effective processes to ensure staff were recruited safely.

People had no concerns with overall cleanliness. One relative told us staff wore the required personal protective equipment (PPE) and the used PPE was discarded safely. Feedback from staff and leaders

Staff said they had enough stocks of personal protective equipment (PPE) and demonstrated an understanding of what they would wear in the event of an outbreak. One staff member said they would wear all PPE, gloves apron and masks unless a person wants us to wear a mask then they did. Staff told us they always cleaned up after they had supported people.

Observed practice was completed to ensure staff had and used appropriate PPE and when required, the provider reminded staff of any government guidance regarding a pandemic or outbreak. People's feedback helped ensure staff supported people safely.

People received their medicines from trained staff and if people could administer their own medicines, this was encouraged.

Staff told us they gave people medicines and recorded this on individual medicine administration record (MAR). One staff member described how they made sure, one person had a cup of tea 30 mins before they gave a certain medicine. The manager told us they did not keep records of people’s prescriptions or a list their medicines in people’s care plans. During and following our onsite visit, we asked the provider to send us a MAR for a person who required staff to apply a prescribed cream. We were not sent this information, and we know this detail was not in the person’s care plan. This made it difficult to be confident, staff had the right information.

Processes needed improvement. The providers systems included staff training and competency assessments on staff. However, the manager did not record any medicine or audit checks. In one case, we found staff applied a prescribed cream yet this was not recorded on the person’s care plan. We asked to check this person’s MAR but we were not given a copy. Because the provider’s audits were not recorded, we could not be confident the provider was aware of the issues we found.