At the inspection dated 15 and 16 of February 2017 we rated this agency as requires improvement. The office manager wrote us after the inspection telling us how improvements were to be made.

This inspection took place on 24 May 2018 and ended on 31 May 2018. The agency was given short notice of this inspection visit. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults.

A registered manager was 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 people we spoke with and who replied through questionnaires said they felt safe with the staff. The staff we spoke with said they had attended safeguarding of abuse training. Although two staff were not clear on the types of abuse they knew to report their concerns. The care manager said that at the next staff meeting refresher safeguarding training will take. Where staff suspected abuse by other staff they felt confident to report their concerns.

Risks were assessed and action plans were developed on minimising the risk. Individual risks to people included mobility needs and prevention of pressure sores. However, for one person the action plan on how to transfer was unclear as adequate equipment was not provided by the appropriate healthcare professionals. When the person then became frustrated guidance was not provided to staff on how to manage these situations.

Members of staff described how they managed situations when people became anxious during personal care and resisted their support. Guidance was not in place on how staff were to manage one person’s level of anxiety when they became frustrated. The care manager told us during feedback that this guidance was now in place.

Where people were at risk from pressure ulcers their care plans listed the preventative measures. Daily reports were not detailed on the repositioning changes that took place on each visit. This meant risks were not assessed and monitored to ensure preventative measures were followed. The care manager said repositioning charts had been reinstated as staff had discontinued recording position changes.

Moving and handling risk assessments were detailed on each movement, the aids and equipment used and the number of staff needed. The staff we spoke with had attended training in moving and handling.

Environmental risk assessments were in place to ensure staff were able to deliver personal care in safe surroundings.

Incident and accidents reports were completed and analysed for patterns and trends. At the time of the inspection there were no accidents logged.

Audits were used to assess the quality of care were in place. The audit log listed the areas assessed and monitored each week which included audits of records, complaints and people at high risks. Action plans were then developed on shortfalls identified. However, the findings of this inspection in relation to the areas identified for improvement were not consistent with audit log. The care manager told us they were going to consider improving the process for auditing the quality of care. For example, care planning. The care manager told us clear auditing process were being developed.

The arrangements for medicines were unclear. Staff that administered medicines had attended appropriate training. Completed medicine administration records (MAR) were not always returned to the agency office which meant they were not always audited. Some medicines particularly topical creams were labelled “as directed”. This meant staff were not given guidance on their application. The care manager told us during feedback that this infor

This inspection took place on the 15 and 16 February 2017 and the provider was given short notice of the inspection. We gave notice to make sure the staff and or registered manager was at the office. This was the first rated inspection for this service as there were changes in their registration.

Prime Care Associates provide personal care and support to people living in their own homes.

There was a registered manager in post who was responsible for the day to day running of 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 told us the staffing levels were appropriate although they were “busy” throughout the day. However, the deployments of staff as shown within the rota did not provide sufficient detail on how staff were to provide the allocated time, as well as arrive at the next visit within the same time frame.

Medicine Administration Records (MAR) charts were used to record the medicines administered but some lacked information. Protocols on when required medicines (PRN) medicines and creams were missing and where they were in place, lacked guidance on administration.

People told us they felt safe with their carers. Members of staff told us they had attended training on safeguarding of vulnerable adults procedures. Staff were able to identify potential abuse and knew their responsibility to report alleged abuse. Two community professionals told us the people that they had regular contact with and who used the agency were safe with the staff.

Staff said the induction included shadowing more experienced staff which helped them to perform the role they were employed for. Staff attended mandatory training, which the provider set as mandatory included safeguarding vulnerable adults from abuse, medicine competency and moving and handling. However, staff were not given the opportunity to discuss their personal development with their line manager.

Members of staff were knowledgeable about the actions in place to minimise risk. Where risks were identified actions plans were based on the advice given. However, some assessments lacked guidance on the staff actions to keep people safe from potential harm.

Care plans were updated and included information about people’s mental capacity as well as their ability to make decisions. However, some action plans we saw lacked person centred care, background history, and guidance on meeting people’s needs in their preferred manner. Members of staff had some understanding of the principles of the MCA. DoLS applications needed to be made to the supervisory authority to ensure where people lacked capacity and bedsides were used to ensure these restrictions were lawful

Staff said where appropriate the office staff organised healthcare appointments. A record of the visits and the outcome were maintained electronically. Staff said they were kept informed about changes in people’s needs before their visits to the person’s home.

Member of staff knew the importance of developing relationships with people. Two community professionals said the staff were caring and gave examples on when staff had shown great kindness and compassion to an individual.

Members of staff said the team worked well together and the team was stable. Team meetings and newsletters were used to inform staff of housekeeping issues, policy changes and training. Spot checks to monitor staff’s performance was undertaken annually by line managers. Staff were not able to benefit from formal structures where their personal development and goals was set. Spot checks were annual.

Overall quality assurance systems ensured the service provided was assessed and where shortfalls were identified action was taken to meet standar