New Direction Support

Updated 1 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection. The inspection took place on 17December 2018 and was announced. We gave the service 48 hours notice of the inspection visit because the location provides a domiciliary care service. We needed to ensure the registered manager would be available during our inspection to enable us to look at records they are required to maintain. We also wanted to give them enough time to seek agreement with people using the service to allow us to visit them in their homes and telephone some people.

The inspection was carried out by two adult social care inspectors. An expert by experience also telephoned five people using the service and five relatives during the week of the inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we asked the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We also looked at information we had received about the service since the last inspection, such as notifications about significant incidents, and information from people who use the service, staff, relatives and other professionals.

Before the inspection we sent out questionnaires to people who used the service, relatives and staff and their responses helped us to reach our judgements about the service. We also received a response from a community health professional.

We visited the agency office where we met with the registered manager, the DCA manager, training manager and four care workers. We looked at three recruitment files, staff training records, staff supervision and monitoring records, staff weekly rotas and four individual’s care plans. We also visited two people in their supported living home.

Updated 1 February 2019

We carried out an announced comprehensive inspection on 17 December 2018. Premier Care (Plymouth) is a domiciliary care service. They provide assistance to older people, and people living with disabilities who require support with personal care and daily living tasks.

The service has two separate departments, one managed the domiciliary care and the other managed the supported living service. As both services are registered at one location this inspection covers both departments. The agency is based in Plymouth and provides a service to people living in Plymouth and the surrounding area. At the time of this inspection they provided personal care to 43 people using the domiciliary care service and 31 people in supported living receiving support with personal care tasks. Supported living is where people live either on their own or with a small group of others, and have their own tenancy agreement. Care and support is provided in order to promote their independence. The care people receive in supported living settings is regulated by CQC, but the accommodation is not.

We checked the service was working in line with ‘Registering the Right Support’ which makes sure services for people with a learning disability and/or autism receive services that are developed in line with national policy. For example, how the service ensures people care is personalised, maintains their independence and supports links with people’s community.

At our last inspection we rated the service as Good overall. The evidence continued to support the rating of Good overall and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

There was a registered manager in post. 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 had overall responsibility for both services but there was another manager who ran the domiciliary care service (DCA) on a day to day basis. (The report refers to the registered manager- for supported living and overall responsibility and the manager for the DCA).

People told us they felt safe. Care was taken to recruit and select the right staff for the job. Recruitment processes helped the provider choose applicants with the right values and caring qualities for the job. Staff had received training on safeguarding and knew how to identify and report any concerns about potential abuse.

Risks to people's health and safety had been assessed and staff had been given information and training about these as well. Staff understood specific health conditions and knew how to recognise signs of illness and when to seek medical intervention. People were supported to manage their medicines safely.

People told us the service was effective. Comments included, "I think they have enough training they are very skilled”, “They make sure she’s got her shoes and socks on and that she’s warm and cared for, brilliant!” and “Very satisfying, I have no complaints.” People received a reliable service from small teams of staff who knew them well and understood their needs. Staff were well trained and well supported. Staff had the skills and information they needed to ensure people's needs were fully met. People said, “They always come on time and we have a chat and they make me smile which is good”, “All the girls do a fantastic job” and “I get regular carers, they’re really good, do anything I want. They always make sure I’m ok, they are friendly and kind to me. Sometimes it’s a bit of company, they will sit and chat with me and that makes me feel good.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Consent to care and treatment was always sought in line with legislation and guidance. The service understood their legal responsibility to ensure they complied with the Mental Capacity Act. People receive support from staff who respected and promoted equality and diversity.

People told us the staff were always caring. Comments from people included "No worries, they are really friendly”, “Get on well with them all, no problems happy with care”, “They know how to protect my Mum’s dignity, they are very good that way, always taking time and chatting so she understands” and “It’s the little personal things that they do that make a difference.”

Staff were compassionate and understood the things that mattered to people. We heard examples of how they had made a positive difference to people's lives and how the staff sometimes went above and beyond their regular duties to make sure people were happy and safe.

People received a service that was responsive to their changing needs. People received personalised and responsive care from staff who knew and understood their needs. For example, the manager said, “They may want a cup of tea but we know they would like it in a particular cup. Everybody is different. Some people are very specific, I want to capture everything.” Support plans were drawn up and agreed with people before the service began. The plans were regularly reviewed and updated to ensure staff always had access to up-to-date information about all aspects of the person's needs. People were given information about the service, including a copy of their support plan.

People told us the service was well managed. The provider was very involved in the service, visiting the office regularly and had quality monitoring processes in place to ensure the service was constantly improving. Spot checks were carried out regularly by a member of the management team to check the quality of the care staff provided to people. This also meant the management team were very knowledgeable about people’s needs.

The provider's electronic care system enabled the management team to monitor the service throughout each working day. For example, to see which ‘run’ staff were doing and which people they were supporting as well as where vacancies were available.

The views of people who used the service, relatives and staff had been sought in various ways and these were acted upon. Concerns and complaints, however small, were responded and listened to and used to improve the quality of care. For example, a recent survey had noted that sometimes care workers did not always put the bin bags in the bin and this had been dealt with immediately.

Further information is in the detailed findings below.