About the service:

Premium Community Care Ltd is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection, 50 people were receiving care and support services.

People’s experience of using this service:

¿ People told us they felt safe and staff knew how to protect people from the risk of harm or abuse. People’s risks were assessed, monitored and managed. People were supported by a sufficient number of safely recruited staff. Medicines were given as prescribed. Staff had access to personal protective equipment. Accidents and incidents were monitored for trends.

¿ People were cared for by staff who had the skills and knowledge to meet their needs, Staff understood their role and felt supported by the management team. Staff sought people’s consent before care was provided. People were supported to access healthcare agencies when required.

¿ People said staff were kind in their approach. People said their dignity and privacy was maintained and they were involved in the planning and review of their care.

¿ People received care that was responsive to their needs. Care records were reflective and up to date. The provider had a complaints process in place which people were aware of and knew how to access.

¿ The provider had quality auditing and monitoring systems in place which included competency checks on staff practice. People and staff said the provider and management team were approachable and the culture of the organisation open and friendly.

Rating at last inspection:

Requires improvement (report published 15 November 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At the last inspection the service was requires improvement overall (in the key questions of Caring and Well-led). We found the required improvements had been made and the service has met the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This inspection took place on 07 September 2017 and was announced. At our last inspection in June 2016, we identified three breaches of the regulations. This was because people could not always be confident they would always receive their calls as planned and their medicines as prescribed. Systems were not always effective to respond to people’s complaints and feedback or to ensure the quality and safety of the service. At this inspection, we found the previous breaches of regulation had been met and improvements made, although further progress was required to achieve ratings of a consistently good service.

The service provides care and support to people in their own homes. At the time of our inspection, 51 people were using the service. There was a registered manager in place who had joined the service in October 2016 and registered with the Commission in April 2017.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.

People told us they felt safe when staff provided care and support. People received safer support due to improved recruitment processes and medicines management systems developed by the provider since our last inspection. Staff understood how to help manage people’s risks, although risk assessments did not always contain enough information about the support people needed to remain safe and well. People we spoke with told us they received their calls on time and as planned. The registered manager was addressing concerns identified through their systems of some staff occasionally being late for people’s calls and leaving calls too early.

People were supported to have their needs met by staff who received training and guidance for their roles. Staff spoke positively about their training and induction. People were supported with their meals and to access additional healthcare support as needed. People were supported to make their own choices and decisions.

People spoke positively about staff and we saw that staff demonstrated care and respect for people they supported. Further improvements were required however to ensure this was a consistent experience for all people using the service and to ensure people’s feedback was always responded to and addressed.

Our discussions with people and staff demonstrated that people’s needs and wishes were responded to. People had opportunities to express their needs and wishes. People and relatives were able to have their complaints addressed through the provider’s complaints process.

Since our last inspection, a new registered manager had joined the service and a senior care team had been introduced to ensure clear leadership and support mechanisms for staff. Systems had been developed since our last inspection and had helped the registered manager begin to address ongoing areas of improvement and some concerns impacting the quality and safety of the service some people received. Further improvement was required to how some records and processes were completed. During this inspection, we identified a breach of legal requirements because the provider had failed to display their inspection ratings clearly and in line with our guidance. We are still considering what action we are taking in response to this and we will issue a supplementary report once this decision has been finalised.

The inspection took place on 6 June 2016 and was announced. The service is a domiciliary care service and provides care and support to 51 people in their own homes.

The service was last inspected in April 2014. There was a registered manager in place. 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 service was not consistently safe. There were no assessments and monitoring systems in place to support people with the specific risks related to their healthcare conditions. People were not always protected by robust recruitment processes.

People did not always receive their support calls on time and this was an ongoing concern that had been raised by some people and relatives. Processes were not robust to assure that people always received their medicines safely. The registered manager and staff had taken action to keep people who used the service safe in response to concerns.

Staff told us that they felt supported in their roles and we saw that they received training and supervision. We saw that people were encouraged to make their own decisions and choices, however we saw that the staff did not always work within the principles of the Mental Capacity Act.

People told us that staff provided them with choices when helping them to prepare meals. However, we found that staff had not always monitored and identified if people with special dietary requirements had eaten and drank enough to remain well. People were encouraged to access healthcare support when necessary and relatives were informed during emergencies or if people became unwell.

People and relatives told us that staff were caring, however some feedback suggested that this was not consistent practice. People’s daily care notes were written respectfully and people told us that they were supported to maintain their independence and dignity by staff.

People and relatives told us that they had been encouraged to share their feedback and views. People and relatives were involved in developing and reviewing care plans and they felt that these reflected people’s needs. A professional told us that staff listened to people about their care needs.

The registered manager told us that they sought feedback from people who used the service through sending questionnaires, reviews and by keeping in touch with people.

While people told us that they felt able to complain if they had concerns about the service, the registered manager did not always respond effectively to concerns that people and their relatives had raised.

People we spoke with told us they were happy with the service and the support that staff provided. Staff told us that they found the registered manager approachable and promoted a learning culture.

Processes to manage risks to people and monitor and improve the quality of the service were not always effective.

You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found:

Is the service safe?

We carried out this inspection because we had received anonymous comments expressing the view that unsafe care was being provided by this agency as staff were not checked or trained in a suitable way. In addition to carrying out this visit, we referred the comments to the local authority, which has responsibility for investigating safeguarding concerns. Neither us, nor the local authority commissioning officer found evidence to support this view.

We met four people who used the service and spoke with several relatives of people receiving support. All said that they felt that people were cared for in a safe way.

There were enough, competent staff to meet people’s needs. Staff were subject to checks, including checks through the Disclosure and Barring Service (DBS), prior to being employed. As part of their induction training, staff received training in safeguarding people.

We spoke to several members of staff. They all knew how to report any suspected abuse of people and were confident that the manager would take appropriate action.

We saw risk assessments and other records which indicated that the possible risks to people and staff had been considered and there were records to show how these had been minimised.

Is the service effective?

People and their relatives told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. One person told us. "I like having the same carer each time. She is great.” A relative told us, “Since (relative’s name) has been with Premium she has improved in leaps and bounds.”

Staff had received relevant training to meet the needs of the people using the service. This included training in moving and handling, infection control and the safe preparation of food.

Is the service caring?

People were supported by kind and attentive staff. People told us that care workers showed patience and gave encouragement when supporting people.

We observed support being provided to four people who used the service. Staff demonstrated that they knew the people well and cared that they received appropriate support.

Relatives told us about times when staff had provided emotional support to them as well as the person receiving the service at times of crisis and when staff had exceeded their expectations.

Is the service responsive?

People told us they were asked about how they wanted to be supported and staff respected the choices which they made.

We found that there were good arrangements to provide appropriate support to people with diverse needs.

People’s relatives told us that if they needed to make changes in the hours the service was provided, in order to accommodate changes in their routines, the manager made the necessary arrangements to accommodate their request.

Is the service well-led?

Staff and people who used the service told us that the manager was approachable and supportive.

We found that there were good arrangements for monitoring the quality of the service and for making improvements, where needed. These included consulting people who used the service.

People received the care and support that they required. However, people’s short term care needs were not always planned. This meant that temporary care requirements were not documented, so support and care given by staff not familiar with the person could overlook that part of their care.

People told us that they were well supported by the service and that the care staff understood their care needs. One relative told us; “They are a big help to me and my relative.”

People told us that they were happy with the service they received and that the management team were approachable. The provider took account of people’s and staff views to make improvements to the service they provided. A member of staff told us; “I feel comfortable to make suggestions.” This meant that both people and staff were able to contact the provider to make comments and suggestions.

People told us that they felt safe with the care staff that supported them in their homes. Staff had undertaken training to meet the needs of vulnerable people. When asked about this staff demonstrated a good knowledge of their responsibilities. The provider operated an effective recruitment process. They ensured that all the records they required to make recruitment decisions were in place before allowing staff to attend to people requiring the service. This meant that people could be assured that staff had the skill and good character to meet their needs and maintain their safety.

The provider had organised the service so that audits of records kept could be undertaken, to ensure documents they relied upon were present and correct. The provider had a records management system in place that ensured that records they relied upon were stored and retrievable promptly. This meant that people could be assured that information about them and staff were kept securely and could be located when required.

This service has delivered regulated activities since October 2012.

At inspection we looked five care documents and five personnel files, spoke with three staff and three relatives. We discussed with the manager our intention to speak with people who used the service and were advised that they may find it confusing and distressing if we were to make direct contact. Relatives confirmed that this was the case, and they were happy to share with us their views about the service provided.

People were afforded dignity and respect. Staff described how they maintained people’s dignity, we saw descriptions of maintenance of dignity in communication books. We spoke to relatives who told us how they saw staff maintain this.

People’s care and treatment needs were met by enough staff, who regularly cared for them. One relative told us, “[my relative] is a lot happier now”.

The provider had a safeguarding policy which was not adequate, it was to replace one the provider felt was not robust enough. There was no record of when this training had been undertaken by staff.

Recruitment practices were not vigorous enough; checks had not been completed for good character of staff in some cases.

Some monitoring of service provision occurred, but was not sufficient to be compliant.

Record keeping was an issue as documents which the provider may rely upon could not be found. We saw other records which lacked detail; this could have put people at unnecessary risk.