This comprehensive rating inspection took place over three days on the 27, 30 September and 2 October 2016, our visit on the 27 September was announced. The provider was given 48 hours’ notice of our visit because the location provides a domiciliary care service and we needed to be sure staff would be available to meet with us. This was the first inspection since the service was registered in December 2013.
Prime Support Service Limited is registered to provide personal care to people living in their own homes in the Stockport and Manchester areas. The service currently provides support to 18 people.
We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, affecting people’s safety, well-being and the quality of service provided to service users. We did not see evidence of good leadership with robust policies, systems and record keeping which would enable the provider to assure themselves they were delivering high quality care. CQC is considering the appropriate regulatory response to resolve the problems we found.
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 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. We may also take other enforcement action proportionate to the seriousness of any shortfalls and breaches at any time, including within the six month timescale of a revisit.
The service had 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. We found evidence during the inspection that the manager was ineffective and not carrying out their legal obligated responsibilities.
The company had a director and a nominated individual in this service. An organisation needs to have a nominated person who acts as the main point of contact for us. They must also be employed as a director, manager or secretary of the organisation, so that they have the authority to speak on behalf of the organisation.
Risk assessments and risk management plans did not provide staff with clear guidance about how to safely manage known risks to people. They were not always up to date, which meant they did not reflect people’s current needs.
Medicines were not safely managed. The provider did not have accurate recording systems in place for medicines, which were administered to people from pre-filled ‘dosette’ boxes. This meant there was no clear record to say what medicines the person had received. In addition to this, medicines risk assessments were not completed in relation to individual’s health conditions.
Care planning documentation was varied. Some were detailed, albeit where care packages were ‘straight forward’ and people being supported did not have complex needs or serious medical conditions, which could leave them vulnerable. Other care plans were generic and task focused, and in two care plans we looked at, the information was inadequate and did not contain sufficient information to provide staff with clear guidance about the care these individuals required. Despite this lack of accurate recording, people told us they received good or satisfactory care overall from the support workers who visited them and that staff knew them well. We received varying comments about the manager and owners of the service.
People told us they felt safe overall. However, the service did not have clear systems in place to report and investigate abuse. Staff understood the types of abuse and were confident in raising concerns with the management team. However, incidents were not always referred to the appropriate agencies, in lieu of the provider carrying out their own investigations. Once investigated, action was not taken as necessary where evidence was found that staff had not carried out the correct procedure or needed to be retrained. Care calls were not always delivered by a consistent staff team, meaning people were visited by different carers. However, people received their care calls on time, or when there were delays they were alerted to this by the service.
We did not consistently see that people had signed to give their consent to care. Where people were unable to consent to care, due to their mental health difficulties or understanding, the service had not completed mental capacity assessments or recorded best interest’s decisions.
The service did not have safe and effective recruitment systems in place. Once recruited, staff completed a two day induction programme, but were not subject to a formal probationary period. The service did not provide adequate training and support to their staff team and did not carry out routine competency checks to ensure staff were delivering effective care.
The service worked with other health and social care professionals but we found that they were not always proactive in liaising with other agencies to maintain a people’s well-being.
People told us care staff were friendly and caring. Some people told us staff provided them with care which promoted their independence. The service had received a number of compliments about the care they provided for people.
The service had an up to date complaints policy and people told us they knew how to raise concerns. At the time of our visit there had been no complaints received by the service so we were unable to establish how they deal with any complaints.
Staff told us they felt supported on a day to day basis by the management team, in particular the nominated individual. Staff meetings had not been held so far this year, except management team meetings. Staff told us they viewed this as a negative, as they had little opportunity to discuss their work practices, training needs and issues affecting the people they supported in collective way.
The service did not have clear management or governance systems in place. The provider had not always made the required notifications to the CQC.
People’s feedback had been sought by the provider in 2016. However there was no analysis of the information and it was unclear if action had been taken to resolve issues or concerns highlighted by people.