Premier Community

Premier Community is a domiciliary care agency providing personal care to people in their own homes. They support older adults with a range of physical and mental health needs. At the time of our inspection there were 393 people using the service.

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.

The service is split into 3 areas, each individually managed. The areas are Nottinghamshire, Derbyshire North West and Derbyshire North East.

People’s experience of using this service and what we found

Feedback we received for Derbyshire North West and Nottinghamshire raised several concerns. However, feedback about Derbyshire North East was more positive.

People did not always receive their calls at their preferred or even scheduled times. Calls were often condensed or cut due to staffing demands and people’s needs were not always all met as a result.

People did not always receive care in a person-centred way and care plans were not always being kept up to date to reflect people’s current needs and requirements.

People were supported to take their medicines although not always in a timely way and recording was not always in line with best practice.

We have made a recommendation around medicines management.

People experienced a lack of communication from management. Staff also felt they were not being supported. The provider did have systems and processes in place to monitor the quality and care delivery of the service, however these had not proved effective in improving the service. The provider was aware of some of the concerns and had taken measures to ensure people’s experiences improved.

People told us the carers were kind and treated them well. People felt safe whilst being supported by them and staff knew how to protect people from risks and abuse.

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 31 May 2019).

Why we inspected

We received concerns in relation to call timings, missed calls and a lack of response to raise concerns. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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 Community on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, delivering personalised care and governance. We also made a recommendation about medicines management and documentation.

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.

People’s experience of using this service: People and staff told us they felt safe at the service. People received support to take their medicines safely. Risks to people's well-being were recorded and updated when their circumstances changed. Staffing was provided at safe levels and people told us at the times they preferred.

People's rights to make their own decisions were respected. People were supported to access healthcare services. Staff were skilled and knowledgeable in the care and support people required.

People received caring and compassionate support from the staff. Staff referred to people in a respectful way. People were complimentary about staff and the positive relationships they had with them. Staff respected people's privacy and dignity and people were supported to be as independent as possible.

People knew how to complain.

The service had recently experienced change in relation to the management team and implementing new electronic systems. Work to continuously improve was noted and the management team were keen to make changes that would impact positively on people’s lives. Quality checking systems were in place and the service had a robust plan to address any areas for improvement. The service worked well with other community partners.

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

Rating at last inspection: Good (report published November 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

Premier Care provides support and personal care to adults across Nottinghamshire and Derbyshire. The service is managed from an office in Pleasley near Mansfield, Nottingham. On the day of our inspection 301 people were using the service each week.

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

People told us that they felt safe while receiving care from their care staff, although repeatedly people commented on the lack of regular staff which made them feel more at risk. However, there were enough staff to ensure that people received their calls at the planned time and meet their care needs.

Staff took the necessary steps to keep people safe and understood their responsibilities to protect people from the risk of abuse. Potential hazards were identified and detailed plans were in place to enable staff to support people safely. Where required, people received the support they needed to safely manage their medicines.

Staff were provided with support and training but people felt that they did not always have the knowledge and skills they needed to care for them effectively. Staff received supervision of their work.

The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The provider was aware of the principles of the MCA and how this might affect the care they provided to people. Where people had the capacity they were asked to provide their consent to the care being provided.

Where people required support to eat and drink enough, this support was provided. Staff made sure that people had access to their GP and other health care professionals when needed and would have no hesitation in ringing 999 for an ambulance, if they felt that this was required at any time.

Positive and caring relationships had been developed between staff and people who used the service. People were involved in the planning and reviewing of their care and making decisions about what care they wanted. People were treated with dignity and respect by staff who understood the importance of this.

People’s care plans were written in a way that focused on people’s choices and preferences. A complaints procedure was in place and people felt comfortable to speak up if they were unhappy about any aspect of the service they received

The culture of the service was open. People were supported by staff who were clear about what was expected of them and staff had confidence that they would get the support they needed from the registered manager, both during and outside of office hours. The registered manager undertook audits and observed practice to ensure that the care provided met people’s needs.

We found that people's views were taken into account and their independence and dignity were respected. One person who used the service told us,'I have choices and the care plan is personalised, I have help to go to bed, and with making tea and lunch.'

People felt they were safe, had their needs met and were well cared for. One person who used the service told us,'The service I get is first class and I feel safe when I am cared for.'

People were protected from the risks of unsafe or unsuitable equipment. One staff member we spoke with told us, 'Premier Care have given us training on how to use hoists, slings and how to move people safely. I am very confident in using all of the equipment. Having the training has helped.'

Staff were supported in their role and encouraged to obtain further qualifications to develop their expertise.

People's views, comments and complaints were encouraged and acted upon. "The office people visit me and ask for feedback. They set up the necessary changes.'

We found people gave consent to their care and treatment and received care and support that met their needs. A relative told us, 'We have got a care plan which I have read and it is right. I was asked to sign it to agree to it, which I did.' A person who used the service told us, 'I am more than happy with the carers, I am proud of them. They come on time all the time and get on with the job straight way. They respect us in our home. '

We found there were suitable arrangements for the management of medicines and there were sufficient and suitable staff available.

We found people's comments and complaints were acted upon. A person who used the service told us, 'It is a very good service, I cannot fault any of them. I can talk to them. I have been told how I could make a complaint if I want to.' Another person told us, 'I know about making complaints. I have not ever needed to in the three years I have used them.'