Archived: Premier Care Limited - Wigan

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.

This service is a domiciliary care agency that provides support to people in their own homes. It provides a service to younger and older adults, people with physical disabilities, sensory impairments, learning disabilities or dementia. The provider has 16 agencies registered with the Care Quality Commission (CQC). The service's office is based in Hindley, and personal care is provided to people in surrounding areas. At the time of the inspection it was providing a service to 288 people.

People’s experience of using this service:

We found the governance systems used did not provide effective oversight and monitoring of the service.

Holistic care plans were in place. However, regular reviews of care plans were not undertaken, and the people we spoke with confirmed this. Care records contained information about people's needs and risks. However, we found people’s ongoing risk assessments were not reviewed on a regular basis.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). However, we made a recommendation about the depth of information recorded in the capacity assessments.

Medicines systems were organised and people were receiving their medicines when they should. The service was following safe protocols for the administration of medicines.

People we spoke with told us they had choices and were involved in making day to day decisions. People told us staff managed their needs well. One person said, “I feel safe in their hands.”

Staff worked in partnership with the community, other services and organisations.

People told us the staff knew them well and responded to their needs in a person-centred way.

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to good governance. Details of action we have asked the provider to take can be found at the end of this report.

The service did not meet the characteristics of Good in some areas; more information is in the full report.

Rating at last inspection:

At the last inspection the service was rated Good (report published 03 November 2016). Following this inspection, the service is rated as Requires Improvement overall, and in the well-led domain. The ratings for the safe, effective, caring and responsive domains remain unchanged.

Why we inspected:

This was a planned inspection based on the rating at the last inspection

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality care and support is provided to people. We will re-inspect in line with our inspection timescales for Requires Improvement services, where we will also follow up on recommendations made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Premier Care Limited - Wigan is a large agency that provides home care services to people in the Wigan, Leigh, Atherton, Horwich and Westhoughton areas. The service is managed from an office in Hindley town centre. At the time of the inspection a total of 318 people used the service.

At the time of the inspection there was a registered manger in post. A registered manager is a person who has registered with the Care Quality Commission (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.

All the people we spoke to told us they felt safe. We saw the service had suitable safeguarding policies and procedures in place. Staff had all received training in safeguarding vulnerable adults and were able to demonstrate a good understanding of how to report both safeguarding and whistleblowing concerns.

We saw the service utilised a dependency screening tool, which was reviewed on a monthly basis, to ensure that sufficient staff were employed to meet people’s needs. Some staff reported feeling rushed and not having enough time between calls, but all agreed that the service was still able to meet all calls and that people received the support they required.

We saw that robust recruitment procedures were in place to ensure staff working for the service met the required standards. This involved all staff having a DBS (Disclosure and Baring Service) check, at least two references and work history documented.

Staff reported that they received an appropriate level of training to carry out their role. We saw all staff completed a comprehensive induction training programme, followed by a flexible period of time shadowing experienced care staff, before being allowed to work with people who used the service. We saw the service had systems in place to ensure that staff received regular refresher training to ensure their skills and knowledge remained up to date.

We saw there was both a policy and systems in place to ensure safe medicines management was maintained. People we spoke with confirmed they received appropriate support to ensure medicines were taken when required and as prescribed. We saw the service carried out regular audits to ensure medicines had been administered correctly.

People spoke highly of the standard of care received and the caring nature of the staff. People told us that staff treated them kindly, with dignity and respect whilst also promoting their independence wherever possible.

We looked at 16 care plans, which contained detailed and personalised information about the people who used the service. The care plans also contained individual risk assessments, which helped to ensure people’s safety was maintained. We saw that people or their representatives had been involved in planning the care provided and were asked for their feedback through completion of reviews, spot checks and questionnaires.

We saw that there were a range of systems and procedures in place to monitor the quality of the service. Audits were carried out both internally by the in-house compliance officer and registered manager and externally by the company’s compliance officer and the three company directors, which included a comprehensive monthly audit of the entire service provision. We saw that action points generated through the auditing process had been carried through and documented.

The records that we checked included appropriate information and helped to ensure that the person was cared for safely. The people we spoke with told us they had no concerns about their safety and we found that there were systems in place to ensure that people were protected from the risks of abuse.

We spoke with four members of staff who told us that they liked working for the agency and they felt well supported in their roles. Staff told us that they received appropriate training and we saw records to confirm that appropriate training had been completed. The staff we spoke with did not express any concerns about the agency.

We found that the provider had effective systems in place to monitor and improve the quality of the service that was provided.