About the service:

Premier Care Limited – Specialised services is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided support to people with a learning disability, or who required support in relation to their mental health. The service was provided through both a domiciliary care service and care to people living in supported living arrangements.

The part of this service providing support to people with a learning disability and/or autism has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. People lived in their own, or small shared houses that were ordinary residential homes. Part of the service had recently been registered as a care home, and the provider was continuing to consider how best to continue to change the way the service was provided to ensure it was person-centred in its approach.

People’s experience of using this service:

• People received support from consistent teams of staff who knew them and understood their needs and preferences.

• Staff supported people to take part in activities and occupation that were meaningful to them. This included supporting people to access services that would allow them to explore employment opportunities.

• People and relevant representatives were involved in planning and reviewing their care and goals.

• There was evidence that the service learned from past issues such as safeguarding and complaints. However, the service was more reactive than pro-active in identifying ways to improve the quality and safety of the service.

• People had health action plans in place. However, we found staff had not given full consideration as to how they could meet recommendations made in relation to one person’s health care needs.

• There were systems and processes in place to help the registered manager monitor the quality and safety of the service, which had improved since our last inspection. However, we identified further improvements could be made in this area.

• Safe practice was generally followed in relation to the management of medicines. However, we found that in two instances, a person had not received their medicines in a timely way due to running out of stocks of medicines kept at their home. The provider reviewed their procedures during the inspection to help prevent this recurring.

• Staff felt supported, listened to and told us they received adequate training. The registered manager encouraged an open culture where staff could challenge things they thought ‘were not right’.

• We received positive feedback from two social care professionals. They told us the service had worked in partnership with them, and others involved in people’s care to help design services that met their needs effectively.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways: promotion of choice and control, independence, and inclusion. The provider recognised the need to continue to review and make the service more person-centred. This was particularly the case for people who were living in the homes that were previously registered as a care home.

Rating at last inspection:

The overall rating at our last inspection of this service was requires improvement (published 04 April 2018).

Why we inspected:

This was a planned comprehensive inspection. The date of the inspection was based on our timescales for returning to services rated requires improv

This inspection took place on 22, 23 and 26 January 2018 and was announced.

We last inspected the service on 16, 17 and 21 June 2016 when the service was called ‘Premier Care Limited - Trafford & Manchester Mental Health Branch’. At that time we rated the service requires improvement overall, and found five breaches of the regulations. We asked the provider to make improvements in relation to safeguarding processes, good governance, staff training, submitting notifications to CQC about alleged abuse, and to their statement of purpose. A statement of purpose is a legally required document that provides key information about a service. The provider sent us an action plan and told us they would have made these improvements by December 2016. At this inspection we found the provider had made improvements and was meeting the requirements of the regulations for all previous breaches other than in relation to good governance. You can see what action we have told the provider to take at the back of the full version of this inspection report. Although we found some improvements had been made, this is the second time we have rated the service requires improvement.

Premier Care Limited – Specialised services is registered to provide personal care to people living in their own homes. At the time of our inspection the service provided support to people with a learning disability, or who required support in relation to their mental health, including people who required support with medicines administration. The service was provided through both a domiciliary care service and care to people living in supported living arrangements. At the time of our inspection, the service was supporting 25 people. Two people using the service received support with the regulated activity of personal care. CQC only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where people receive support with personal care, we also take into account any wider social care provided.

Both people who received support with personal care were using the service’s supported living service. These people lived in two supported living settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Since our last inspection, a new manager had registered to manage the service. 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.

Staff understood their responsibilities in relation to safeguarding, and were aware of how to raise and escalate any concerns they might have. The service had an appropriate safeguarding policy in place, and we saw information on safeguarding procedures was readily available to staff.

Staff had received training in medicines administration, and a senior member of staff had assessed their competency to administer medicines safely. There were procedures in place to help the provider monitor the safe management of medicines, but these had not always been effective. We saw one person had not been administered their medicine in accordance with the prescribing instruction printed on their medication records. The medicines audit had not identifie

This inspection took place over three days in June 2016. We gave 48 hours’ notice before the first visit on 16 June, so that the service would have time to let people know that we might contact them by telephone. On 17June we visited two people using the service in their homes, and also telephoned eight people to ask them about the service. On 21 June we concluded the inspection.

The previous inspection took place in May 2013 when no concerns were identified.

Premier Care Limited - Trafford & Manchester Mental Health Branch provides care and support for people living in their own homes in and around Old Trafford, in Manchester. At the date of this inspection 27 people were being supported. Most people were living in shared houses. Most of the people using the service had experienced mental illness in the past, and the service monitored their mental health. There were also three people with learning disabilities living in one house.

There was a registered manager in post who had been registered in April 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 we spoke with told us they felt safe. For the most part their care workers arrived reliably on time. The care workers contacted them if they were going to be late. The office monitored calls and could respond if the care worker had not turned up for any reason. The service also carried out a daily check that houses were secure.

Staff were trained in safeguarding although not all staff were up to date with refresher training. The safeguarding policy was not up to date. We found that some events which should have been reported to us as incidents of abuse had not been reported. This was a breach of the regulation relating to safeguarding people from abuse.

The service ordered medicines and delivered them to people’s homes. Some people administered their own medicines, other people were prompted. Staff kept records which were checked each week to ensure that medicines were taken as prescribed.

Staff were involved in helping and encouraging people to keep their houses clean.

Proper processes were followed to ensure that only suitable people were employed. New staff received induction training and shadowed existing staff. Ongoing training was provided through annual training days but some staff were overdue refresher training. There had not been role-specific training in recognising a deterioration in mental health, although we were told there was an intention to reintroduce it. This deficiency was a breach of the regulation relating to providing suitable training for staff.

There was regular supervision of staff, who told us they felt supported in their work. Staff assisted people using the service with shopping and cooking, according to their level of need for support. The service helped people with accessing healthcare. The service had not carried out any mental capacity assessments on people using the service.

People told us they felt well looked after, and that they were helped to have a good quality of life. People were encouraged and enabled to live as independent lives, as they could. However we did not find evidence that people were actively supported to move on to a more independent living arrangement.

Some people received support to access the community. We also saw that staff would sometimes go beyond what they were contracted to do, to support people. There was one person who complained about the support they were receiving.

Care records were kept confidentially in the office but not in people’s homes.

Care plans were created on the provider’s standard template which could be made more specific to the needs of people using this service. Some of the details

The manager is registered with the Care Quality Commission and we saw a copy of their certificate on display in the office.

We spoke with three members of staff who told us they always asked permission from people before carrying out any activity. One person said “I always ask permission to read a person’s care plan for example and I respect their wishes”.

The person we spoke with told us “I am happy and the staff are good, they know what they are doing”.

The staff we spoke with confirmed they received up to date training. One person told us “I am up to date with training for example medications and safeguarding”. Another person told us “I am trained to do my job appropriately”.

The manager told us there were up to date policies and procedures in place for staff to follow such as staff training, informed decision making and confidentiality.

We spoke with one person who used the service who told us “I know how to complain, I would go to the office”.

We did not speak with any people who use the service as part of this inspection.