Background to this inspection
Updated
27 February 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency, which provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 26/11/2020 and ended on 08/12/2020. We visited the office location on 26/11/2020 and 30/11/2020.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took into account that we did not ask for the PIR when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with 18 people who used the service and 20 relatives about their experience of the care provided. We spoke with 13 members of staff including the, registered manager area manager, head of governance, care co-ordinators, senior care workers and care workers.
We reviewed a range of records. This included nine people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and care records.
Updated
27 February 2021
About the service
Premier Care Limited - Wigan is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger and older adults with various needs including, people with learning disabilities, sensory impairments and dementia. At the time of this inspection 144 people using the service received personal care. Not everyone who used the service received personal care. The Care Quality Commission (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 told us they did not always feel safe receiving support from the service. Relatives told us, “It is so stressful I am constantly on edge and constantly worried about [relatives].” Medicines were not always managed safely or administered accurately. Risks to people had not always been assessed and risk management plans were not always completed. Infection and prevention control measures were not robust.
Appropriate training was not provided to staff. Staff were providing care before they were assessed as competent to complete their job role. The feedback from people and relatives was that staff were poorly trained and often did not know how to support people with specific needs.
Electronic care monitoring reports showed staff were regularly late for visits and some visits were up to two hours late. People told us they were not informed when staff were running late.
People and relatives told us they did not receive continuity in care workers.
People were not treated with dignity and respect. People and relatives told us, “[Relative] hates them [staff] coming in because of how they are with [relative],” and, “I don’t trust them, and we can’t rely on them.” People's right to privacy was not always respected.
We received negative feedback about how the service was led. People told us, “The communication is poor,” and “I wouldn't recommend them to anybody.” The management of staff rotas was poor. Rotas had back to back visits with no travel time between a lot of the visits. On call systems to support people and staff during out of office hours were poorly managed.
Some people informed us they were not confident in raising their concerns on the telephone. We have made a recommendation about the provider reviewing their processes in obtaining feedback from people.
Staff felt the registered manager was approachable. Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults.
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 and update
The last rating for this service was requires improvement (published 27 June 2019) and there was a breach of a regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to staffing and training. As a result, we undertook a focused inspection to review the key questions of safe, effective, caring and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect it. Ratings from previous comprehensive inspections for that key question were used in calculating the overall rating at this inspection.
The overall rating for the service remains as 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 Premier Care Limited – Wigan on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, staffing, dignity and respect, and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
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.
Follow up
We will request an action plan from 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.