Prime 4 Care Ltd

Prime for Care Ltd is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection there were 7 people using the service.

People's experience of using the service and what we found

Although risks to people’s health and safety were identified, those risks were not routinely assessed or reviewed following changes to people’s health. Medicine administration records (MARs) were not always clear and or follow best practice guidance. All staff who worked at Prime 4 Care Ltd were agency. The provider was recruiting permanent staff which included some of the agency staff who currently worked at the service. Staff recognised the importance of keeping people safe from the risk of abuse and avoidable harm. Staff were provided with Personal Protective Equipment (PPE) to promote good infection control. The provider was committed to improving the service at Prime 4 Care Ltd and learning from the inspection.

Improvements were needed to ensure that people’s assessments were reviewed following changes in their health, to ensure they remained relevant and up to date. 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 manager recognised when people’s ability to make decisions for themselves was compromised. However, improvements were needed to ensure statements regarding people’s mental capacity were supported by mental capacity assessments. The provider was committed to ensuring staff were well trained and had invested in a new training provider, and system to monitor when staff training was completed, or due. When people needed help with their eating and drinking, or assistance to prepare meals, this information was recorded in their care plan. The provider, manager and staff worked in partnership with other healthcare professionals to meet people’s needs and in response to changes or concerns about people’s health.

Audits and governance processes to maintain oversight of the safety and quality of care were either not in place or operating effectively. We received positive feedback about the care provided, and staff felt happy and well supported working at Prime 4 Care Ltd. The provider and manager had an understanding of some of the types of events and incidents that needed to be reported to CQC. Since joining Prime 4 Care Ltd, the new manager had visited people in their homes to check they were happy with their care and whether any changes were needed. Both the provider and the registered manager were committed to improving the service, and recognised that further work was needed to develop and embed good governance systems. The provider and staff worked closely with other health professionals to improve outcomes for people's health and social care needs.

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 2022). 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. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an announced inspection of this service on 3 May 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve 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, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Prime 4 Care Ltd on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to Safe Care and Treatment and Good Governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Prime 4 Care provides personal care for people living in their own homes. At the time of our inspection visit eight people were receiving personal care.

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

Risk assessments and care plans for known health conditions including epilepsy were not always in place. One person supported to take their medication had no medicine administration records. Some gaps in medicine records had not been identified because there was no formal system to audit records. Daily records did not always evidence when action was taken in response to health concerns.

Systems to ensure a consistent and thorough approach to risk assessment, monitoring and review were not effective. Staff spoke positively about their training and told us they were observed in practice. However, there were no records available to evidence the training staff had undertaken or observations of their practice. There was no system to review risk assessments after medical intervention. Improvements were needed to ensure a suitable recruitment system operated to obtain authentic references.

People told us they felt safe and well looked after by the care staff. Staff had knowledge of the risks to people's health and could describe how they would spot signs of infection linked to catheters and deterioration in people's skin. People were supported by staff who understood their responsibilities to safeguard people from abuse and harm. There were enough staff to meet people's needs safely by a consistent staff team. The provider maintained regular contact with people through weekly telephone calls to gather feedback, and whether there were any concerns or complaints. Staff wore Personal Protective Equipment (PPE) and carried out regular lateral flow testing.

People and their relatives gave positive feedback about their experiences of care and staff gave positive feedback about working for Prime 4 Care Ltd. The provider used regular telephone conversations and face to face discussions to gather feedback on people's experiences of care and whether any changes needed to be made. The provider was committed to improving the quality and safety of care for people, and was open and accepting of feedback from our inspection. There was a complaints process but no active complaints or concerns at the time of our inspection. The provider worked closely with the local G.P surgery and other health professionals including district nurses, to improve outcomes for people's care and health.

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

Rating at the last inspection and update

The last rating for this service was requires improvement (published 25 July 2019). 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 were still needed and the service remained in breach of the regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 27 June 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the key question Well Led.

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 inspection to calculate the overall rating. The overall rating for the service remains 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 Prime 4 Care Ltd 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 and will take further action if needed.

We have identified breaches in relation to Regulation 17 good governance 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 meet with the provider to monitor progress and continue to monitor information we receive about the service, which will help inform when we next inspect.

Prime 4 Care provides personal care for people living in their own homes. At the time of our inspection visit two people were receiving personal care.

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

Recruitment systems did not demonstrate that adequate checks were in place to ensure potential new staff were suitable to work with vulnerable people.

The provider did not have a system to ensure staff had the appropriate levels of training and their knowledge was refreshed regularly.

There were systems to protect people from the risk of abuse and harm. Medicines were managed safely.

People were treated with dignity and respect and staff spoke fondly of the people they supported.

The care and support people received reflected their personal needs and preferences.

People were supported to access appropriate professionals and services to ensure care remained responsive to their individual needs.

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 service was too small to be rated at the last inspection(published 24 September 2018). At this inspection we found the service to be rated as requires improvement and in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

Why we inspected

This was a planned inspection based on our methodology for services we have previously been unable to rate.

Follow up:

We will request an action plan for 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.

Prime 4 Care is a domiciliary care agency which is registered to provide personal care support to people in their own homes. The service was registered in September 2017 and had not previously been inspected. Due to the limited service being provided at the time of our inspection, we could not answer all the key lines of enquiry (KLOEs) against the regulated activity. We have therefore not been able to award a rating for the service.

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 provider and registered manager understood their responsibility to keep people safe by minimising risks associated with people’s support needs and reporting any safeguarding concerns to the local safeguarding authority and to CQC.

People’s needs were assessed when they started using the service to ensure they could be met effectively. People and those closest to them were involved in the assessments which were used to develop a care plan. People’s support needs were met in accordance with their care plan and care workers arrived when expected and stayed for the time arranged with them.

The provider’s vision was for a domiciliary care service where care workers had time to build trusting relationships with people. Care was delivered in accordance with this vision and care workers gave people time to understand information and communicate their choices for how they wanted their care to be delivered. People were given information about how to raise any concerns or complaints and felt confident the service was responsive if any changes were required.

The provider had plans to recruit new staff as the service developed and grew. They had arranged an external provider to deliver training and intended that staff new to care completed the Care Certificate.

As the service had only recently started supporting people, checks as to the quality of the service had been limited. The provider told us they planned to develop their quality assurance system so they could remain responsive to people’s needs and identify any areas that required improvements.