Background to this inspection
Updated
19 September 2020
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 team consisted of three inspectors, a member of the medicines team and an Expert 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. It provides personal care to people living in their own homes.
Notice of inspection
We gave the service 72 hours’ notice of the inspection. This was because due to issues around COVID-19, we needed the service to prepare in advance for the inspection.
Inspection activity started on 27 July 2020 and ended on 13 August 2020. We visited the office location on 5 August 2020.
What we did before the inspection
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 this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who commission from the service.
We used the information the provider sent us in their action plan and subsequent updates. This outlined what they were doing well and improvements they had made or still planned to make. This information helps support our inspections.
We also used the information we had gathered by ways of the Emergency Support Framework which was a supportive conversation we had in regard to the Covid 19 pandemic.
We used all of this information to plan our inspection.
During the inspection
We spoke with 12 people who used the service and 16 relatives about their experience of the care provided. We spoke with five members of staff in addition to the provider, registered manager and the area manager.
We reviewed a range of records. This included sampling aspects of 19 people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including staff rotas, time sheets, audits, policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
19 September 2020
About the service
Premier Care Crewe is a domiciliary care agency providing personal care to 50 people at the time of the inspection.
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.
People’s experience of using this service and what we found
There were processes in place to monitor the quality of the service and a range of audits and checks were undertaken. However, further improvements were required to ensure a better oversight of staff performance and deployment and records relating to medicines.
We have made a recommendation about medicines. Whilst some improvements had been made in the management of medicines the provider needs to take further steps to ensure there is a suitable time interval between doses of medicines. The medicines administration records did not always reflect the directions of medicines and topical preparations as they had been prescribed.
People and their relatives provided positive feedback about the service and said it mostly met their individual needs. They said they felt safe and secure around staff and were treated well. 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.
People said the timing of their visits had improved but there was room for further improvement. People confirmed there had been better continuity in the team of staff who visited. People and their relatives were grateful that they had been able to rely on the staff support throughout the peak of the Covid 19 pandemic.
Safe recruitment practices were followed to help ensure staff were of suitable character to work with vulnerable people. Staff training, support and competency checks had been reviewed. There were now appropriate mechanisms for ensuring staff had the skills, knowledge and competence to care for people safely.
Risks to people's health and safety were assessed and better managed. People were protected from abuse and avoidable harm.
People and staff were asked for their views on how the service operated.
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 inadequate (published 10 December 2019) and there were multiple 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 improvements had been made but the provider remained in breach of regulation 17.
Why we inspected
A decision was made for us to inspect, examine and follow up what improvements had been made since we last visited the service. Due to the Covid 19 pandemic, we undertook a focused inspection to only review the key questions of Safe, Effective and Well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Caring and Responsive key questions were not looked at on this occasion.
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 inadequate to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Crewe 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 monitor the service. 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 continued breach in relation to the overall monitoring and governance of the service.
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 return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.