Archived: Princess Homecare

We carried out a comprehensive inspection on 29 September and 5 October 2016, to assess whether the provider had taken action regarding the breaches we found of the Health and Social Care act 2008 (Regulated Activities) Regulations 2014, and to provide an overall quality rating for the service.

The registered provider had made significant improvements around the safety of people’s care and treatment. People and families told us they felt safe with the staff who delivered care and in the way care was given. All staff had received training in the management of medicines and behaviour which may challenge. Staff told us this training had been valuable.

Risk assessments relating to people’s care and treatment had been rewritten and for the most part gave clearer guidance on how to minimise potential risks. However, further development of risk assessments was required. There was a lack of detailed information when recording incidents.

A more robust pricing and invoicing system was in place which assured people of clearer and more accurate billing.

At this inspection we found the provider had made important improvements in their management of medicines. However, improvements were still required in the accurate recording of medicines and more robust auditing of medicines.

The system for staff training and supervision had been updated and staff received training relevant to their role. All staff including the registered provider and deputy manager received on-going support through supervision. Regular team meetings were held and staff told us they felt supported by the management team.

With the exception of one person, where people’s capacity to consent to specific decisions was in question, a mental capacity assessment had been completed. This was in relation to taking their medicine, the use of some types of equipment which may act as a restraint, consenting to their care and treatment and sharing their information with other agencies. Mental Capacity assessments were now reviewed as part of the care review process or when people’s circumstances changed.

The registered provider told us that some people had arrangements in place for their nutritional and hydration needs to be met as part of the provision of care and treatment. Within people’s care plan there was information as to people’s likes and dislikes regarding food and any special dietary requirements. The guidance in place for eating and drinking was not always being followed or potential risks identified.

People received support from health and social care professionals and the registered provider ensured relevant information was shared with staff.

People and their families told us staff were kind, caring and respectful. Staff knew people well and their preferences for the way they wished their care to be delivered. Care records were person centred as they reflected in detail the wishes of the person. The tone and language used in the recording of people’s care was appropriate and the service continued to monitor this.

Care records were person centred and described in detail people’s care routines and their preferences. However, some records such as risk assessments and management plans were unclear and further improvements were required.

Information was available to people about local activities and clubs where they could socialise and meet new people.

The provider’s website and information leaflet had been updated to reflect accurate information about the service. All of the provider’s policies and procedures had been revised. Working practices were being monitored and staff were involved in the future development of the service.

A new addition to the management of the service was a quality assurance manager. The deputy manager and the quality assurance manager had been integral to the changes which the service had made and were working on embedding these improvements. The registered provider told us there was now a clear vision of where the service was going and its future development. One aspect of this was changes which were going to be made organisationally and to the management structure of the service.

In October 2015 the overall rating for this service was ‘Inadequate’ and the service was therefore in ‘Special Measures’. Following the inspection carried out in September and October 2016 we have changed the rating to overall ‘Requires Improvement’. The service is therefore no longer in special measures. You can read the report from this inspection by selecting the ‘all report’ link for Princess Homecare on our website at www.cqc.org.uk.

The service had a registered manager who was responsible for the day to day running of the agency. 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.

The registered manager is also the registered provider of Princess Homecare.

Before the inspection we received concerns about the support people received from the provider with their finances including how they were charged for services. At the inspection we found that the financial systems in place were not transparent and it was unclear what services people were paying for. The provider did not have a pricing list in place as stated on people’s contracts.

The service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA) when people lacked the capacity to give consent to receiving care. The provider had failed to ensure that where decisions were made on behalf of people, this was lawfully authorised.

Staff had not received sufficient training in relation to the MCA and Deprivation of Liberty Safeguards (DoLS). Not all staff had received training in administering medicines and staff did not undertake training which was specific to their role. Staff had meetings with the registered provider to discuss their performance and training needs. However, not all meetings were carried out within a suitable timescale.

Medicine Administration Charts (MARs) did not state how or how often the medicine should be taken. This could increase the risk of people not receiving the right medicines at the right time. Protocols were not in place for medicines prescribed to be administered as and when required. Body application charts were not in place for topical creams.

Records relating to the care and support people received were not person centred and lacked sufficient information. Risk assessments in relation to people’s care and treatment were not fit for purpose. The organisation and standard of record keeping was poor which could impact on the care and support people received.

There were no systems of audits in place and therefore the registered provider could not be assured that people were receiving safe and effective care and support. The registered provider did not demonstrate sufficient understanding of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as required by their registration.

People and relatives told us the staff were very kind and caring and we observed that staff treated people with respect and dignity. However, entries in one person’s daily records evidenced that this was not always the case.

There was a complaints procedure in place and people told us they would talk with the registered provider if they had a complaint.

We found breaches of the Care Quality Commission (Registration) Regulations 2009 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report. The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff were aware of local safeguarding procedures and knew the correct action to take if they had any concerns. Staff said that they would feel comfortable raising concerns with the provider if they had any, and that they were 'well supported'.

People using the service and their families/next of kin, had been given written information, which clearly detailed the options that were available to them if they had any concerns. They had also been given the contact details for CQC and the local authority helpdesk. Families /next of kin that spoke to us said they would feel able to raise concerns if they had any, and commented that "we would just ring Audrey [the provider]".

People described how they were able to 'switch off' when staff from the agency arrived, and commented 'things run very smoothly'.

Is the service effective?

People's needs were assessed and care plans were in place, which documented the care and service to be provided.

Families/next of kin described the positive outcomes that had been achieved for people using the service. These included people 'putting on weight'; 'being a lot happier now'; and 'being calmer and more content'.

The provider supported people to access equipment and benefits that they might be entitled to. Families/next of kin said "They are just excellent at dealing with things' and 'They are very good a problem solving'.

Is the service caring?

We spoke with two people using the service, and three families/next of kin. People described how the care team 'have a lovely manner', and said, 'They treat mum beautifully'. Another person said, 'Staff are very kind and respectful and do everything they can'.

We observed a member of staff supporting a person using the service with a calm and friendly manner: The person using the service described the staff member as 'a good girl', which was clearly intended as a term of endearment.

The provider was very aware of the needs of people using the service, and their families described the care team as being 'part of the family'.

Is the service responsive?

Families/next of kin told us that communication with the agency was 'excellent'; staff 'communicate immediately if there is an issue": and 'They keep me informed'.

People gave examples of how the provider 'goes the extra mile' and said that the care team 'go far beyond the basics'.

The provider identified people's needs and liaised with other agencies appropriately to ensure that they could be met. A report from a local GP surgery described 'excellent carers', and records showed that staff worked in partnership with other healthcare professionals to promote the health and wellbeing of people using the service.

Families/next of kin described how the agency was 'very flexible with what they do', and said that they were 'very happy with the service'.

Is the service well led?

The provider had detailed knowledge of people's needs and preferences, and ensured that resources were in place to meet them. Staff said that they had sufficient equipment and allocated care hours, to be able to meet peoples needs. One member of staff described how it was 'nice to be able to spend time with people and do things properly`'.

Staff said that they were 'well supported' and that they 'can just pick up the phone' if they need anything. The provider described how she valued staff, and that they were supported to attend training and development opportunities.

Feedback was sought from people using the service, families/next of kin and the care team. The provider described how they valued people's views and were appreciative of the positive feedback that had been given.

Family members we spoke with told us that their relatives were well cared for in their own homes and their care plans reflected their care needs.

People who used the service were protected from abuse and neglect. We saw that the provider maintained systems to keep people free from harm.

The agency had a long standing staff team with an average of nine years' experience within the care industry. One member of staff told us, 'I enjoy my job, looking after people and providing help to their families'.

People and their representatives were given the opportunity to provide feedback on the provision of care we saw that the responses were positive.

People received information about the service and were involved in the planning of their care. People told us they had never had a missed call, staff always arrived at the time they should and stayed for the duration of the call.

There were good arrangements in place to support staff. We spoke with two staff by telephone. They told us they enjoyed their work and said they felt supported. One of them said they knew they could contact the office at any time if there was a problem and the other told us there was 'always assistance if needed'.

Staff told us they felt equipped to do their job and that they had the training they needed. They said this included training in safeguarding vulnerable adults and described how they would respond if they suspected a person was being abused. One member of staff told us they were particularly enjoying the new mental health awareness training they had started.

The service had a clear statement of purpose and quality assurance arrangements were in place. The records required for the running of the business were comprehensive, up to date and safely stored.