- Homecare service
Premier Care Limited - Salford Homecare Branch
All Inspections
4 May 2023
During an inspection looking at part of the service
Premier Care – Salford Homecare Branch is a domiciliary care service who provide care and support to over 380 people living in their own accommodation within the Salford area. Premier Care is the main provider for the local authority in 4 of the 5 areas of Salford which are Swinton & Walkden, Little Hulton, Broughton and Ordsall.
Not everyone who used the service received personal care. 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. At the time of inspection, 360 people received personal care and were included in the inspection.
People’s experience of using this service and what we found
We found improvements were required with consistency in the timing and duration of care visits and audit and governance processes. Care staff often arrived earlier or later than planned and did not always remain as long as scheduled. There was also a lack of travel time provided between visits, which also affected staff’s ability to be punctual. There was a lack of audits and monitoring processes being completed within the service. What was in place had not identified a number of the issues we noted during the inspection.
The majority of people we spoke with told us they received safe care, especially when supported by their regular carer. Staff told us they were provided with training in safeguarding. However, records showed training completion rates required improvement. The provider was aware of this, and a plan was in place. New staff had been recruited safely, with all necessary safety checks completed. Risks to people had been assessed, with information in care plans on how these would be minimised as much as possible. Overall, medicines were being managed safely, though some issues we noted had not been identified through the audit process.
We have made a recommendation about medicines auditing.
People and relatives provided mixed feedback about communication with the service and involvement in their care. Some told us communication was good, any concerns were addressed, and they were periodically asked for their views about their care and if they were happy with this. However, others told us they had never been asked for feedback and had not received responses when concerns had been raised.
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 29 June 2021) and there were breaches of 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 we found the provider remained in breach of regulations.
Why we inspected
We carried out a focused inspection of this service in May 2021. Breaches of legal requirement were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection (published December 2017) to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care - Salford Homecare Branch on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to person centred care and the audit and governance process at this inspection.
Please see the action we have told the provider to take at the end of this report.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
6 May 2021
During an inspection looking at part of the service
Premier Care – Salford Homecare Branch is a domiciliary care service who provide care and support to people living in their own accommodation within the Salford area.
Not everyone who used the service received personal care. 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. At the time of inspection 408 people were being supported by the service, however, only 277 received personal care.
People’s experience of using this service and what we found
We found improvements were required with medicines management, management of people’s care visits, governance systems and the timeliness with which actions were addressed.
People provided mixed feedback about the timing and duration of care visits. Concerns were reported with inconsistency of visit times, late visits, staff being rushed and not remaining for the planned duration of each visit. As a result, not all people we spoke with felt safe, however, the majority of people spoke positively about the care staff who visited, telling us they were, “Kind” and “Friendly.” People’s medicines were not managed safely. We identified issues with record keeping, administration and monitoring of people’s medicines. Risks to people had been assessed and included in people’s care plans. Staff had received training in the use of equipment, such as hoists, to ensure they could provide safe care. Staff had access to personal protective equipment and provided with guidance around the management of COVID-19.
The provider used a range of systems and processes to assess the quality and safety of care delivery. However, these had not consistently identified the concerns we found on inspection or where issues had been noted, action had not always been taken timely. People’s views and opinions about their care and support had been gathered through bi-annual surveys, care plan reviews and spot checks. Staff meetings had been put on hold due to the COVID-19 pandemic, instead the provider had used emails, telephone calls and electronic messaging to communicate. Staff told us they were happy with this.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published December 2017).
Why we inspected
We received concerns in relation to medicines management, rota management, late and missed calls and staff competency with using equipment, such as hoists. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.
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 -Salford Homecare Branch 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 a breach in relation to safe care and treatment, specifically the management of medicines.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
13 November 2017
During a routine inspection
At the last inspection on the 04 and 05 August 2015 the service was rated as good. At this inspection we found the service remained good.
The service had a newly appointed 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.
People told us they felt safe in their own homes whilst being supported by staff employed at Premier care. Staff received safeguarding training and knew how to keep people safe and raise concerns if they suspected someone was at risk of harm or abuse.
Individualised risk assessments were in place to identify any assessed possible risk of harm to a person or staff member through areas such as people’s lifestyle choices or items of equipment.
Staffing levels were appropriate and people told us they received calls as agreed with the local authority.
The service had a training matrix to monitor the training requirements of staff. Staff received appropriate training, supervision and appraisal to support them in their role. Appropriate documentation was maintained to confirm when these sessions had taken place.
The management of medicines was safe. Staff received training in medicines administration and the service had detailed policies to guide staff how to ensure a person received safe support in this area.
People were supported in line with the Mental Capacity Act 2005 (MCA).
People's consent to care and treatment was sought prior to care being delivered and they were encouraged to make decisions and choices about their care and had their choices respected.
Care plans were tailored to meet people's individual needs. People were encouraged to be involved in the development of their care plans, which were updated regularly to reflect people's changing needs.
People were encouraged to maintain a nutritionally balanced diet and had access to sufficient amounts to eat and drink, at times that suited them.
People's health care needs were monitored and relevant health and social care professionals were informed when required.
The provider had a complaints procedure in place and we saw examples of people’s complaints being dealt with in line with the services complaints policy.
The registered manager and provider carried out regular audits of the service delivery. We saw areas of improvement were identified and disseminated promptly throughout the staff team to demonstrate action had been taken in a timely manner. Feedback of the service was sought and used to drive continued improvements.
Further information is in the detailed findings below.
04 and 05 August 2015
During a routine inspection
This was an announced inspection carried out on the 04 and 05 August 2015.
Premier Care Limited - Salford Homecare Branch is registered to provide personal care to people living in their own homes. The agency provides a service to people living in the Salford area.
There was a registered manager in place. 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.
At the last inspection carried out in July 2013, we did not identify any concerns with the care and support provided to people by the service.
People who used the service and relatives we spoke with, told us they or their loved ones felt safe when care staff were in their homes and that their possessions were safe. People told us they trusted the care staff who visited their homes.
We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. All staff we spoke to were able to describe the different types of abuse and the action they would take if they had any concerns.
We found the service had robust recruitment procedures in place, which protected people against the risks of abuse. We reviewed a sample of ten recruitment records, which demonstrated that staff had been safely and effectively recruited.
We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service administered medicines safely. People we spoke with who needed help with their medications told us that they thought their medications were administered or supervised appropriately and at the correct times.
We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. On the whole, people we spoke with told us care staff usually stayed the allotted time for their call.
People who used the service and their relatives told us they thought there were enough staff to meet their care needs and that the care workers were well trained and good at their jobs.
We looked at the service’s organisational training and workforce development plan, which emphasised the services commitment to training and continual professional development of staff. We found all new members of staff underwent a comprehensive 12 week induction programme. We found that training requirements for each member of staff was effectively managed by way of an electronic training matrix.
We looked at supervision and annual appraisal records and spoke to staff about the supervision they received from senior care staff and managers. We found that staff received regular supervision, which enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner.
We looked at how the service supported people with their diet. Care plans detailed guidance on the support each person required in respect of food, drink and nutrition. Some people we spoke with told us they had help from care workers with shopping and that they received food they enjoyed, because the care workers knew what they liked.
People who used the service and relatives we spoke with were very complimentary about the care staff and their caring attitude, particularly their regular care workers. One person who used the service told us; “They are always happy to do anything for you, they are very good.”
Other comments from people who used the service included; “I feel very fortunate to have such good carers.” “They’re ever so kind. Such lovely people.” “My care worker is an absolute diamond. I couldn’t do without her.” “I’ve not met one that isn’t kind and patient with me.” “They’re all fabulous and so friendly. You can have a laugh with most of them and that’s great.”
People who used the service told us they were treated with respect and their dignity was upheld. One person said service said “The carers are very friendly and chatty, but they’re very polite too. They do show you respect.”
People told us that staff helped them retain their independence and only provided support with tasks that were agreed. One person who used the service said “I can do a lot of things for myself, so I don’t need help with everything. The carers just help me with the things I can’t do, like getting my stockings on and off.”
A number of people who used the service or their relatives told us that calls were occasionally late or not at the agreed times and were either late or early. Weekend arrangements were highlighted as a particular concern. Comments from people who used the service included; “It’s a problem when my morning call is late because I need help getting to the toilet and that can’t wait.”
The service used a call monitoring system called Road Runner. All care staff were provided with a smart phone, which enabled them to scan an installed bar-code when they arrived at a property and scan the code when they left the property.
We looked at a sample of 15 care files to understand how the service delivered personalised care that was responsive to people’s needs. Before people started using the service, an assessment of need was carried out by the service. This involved the person who used the service, their family and other social health care professionals.
People who had contacted the office told us that they were listened to and that staff were generally helpful and assisted them with their queries. Some people who used the service or their relatives we spoke with could name people they liaised with in the office, including people who came to their homes to do spot checks or review their needs.
We found that the management promoted an open and transparent culture amongst staff. Staff felt valued and supported in their role. Staff told us that the service was well run and that people could be open and honest.
We found that regular reviews of care plans and risk assessments were undertaken. Regular supervision of staff and appraisals were undertaken by the service. We found the service undertook a comprehensive range of checks to monitor the quality service delivery, these include medication audits and ‘spot checks.’
We found the service had been accredited with Investors in People recognition. Investors in People is a management framework for high performance through people.
1 July 2013
During a routine inspection
We looked at how the provider promoted infection prevention and control. We spoke with staff about personal protective equipment (PPE) and they confirmed they always had access to plastic gloves and aprons. We looked at whether staff had received training in relation to infection control. We saw that training was provided and updated annually.
We looked at how the management supported care staff. We saw that staff meetings were held and minutes kept. Regular staff supervisions were taking place and unannounced spot check visits to people's homes were carried out. We saw that training in safe working practices was provided such as: manual handling, basic food hygiene, basic life support and health and safety.
We looked at how the provider monitored the quality of the service they provided. We saw that regular audits of systems were taking place. The agency sought feedback from people who used the service in the form of questionnaires and during the spot checks visits.
24 September 2012
During an inspection looking at part of the service