About the service:

Premier Care Limited – Trafford and Manchester Homecare Branch is a large domiciliary care agency. The service provides care and support to primarily older adults living in their own homes in the Manchester and Trafford areas of Greater Manchester.

People’s experience of using this service:

Most people using the service told us they were satisfied with the service they received. People were usually supported by consistent teams of staff who knew them and understood their needs and preferences. During our home visits we observed positive, respectful and professional interactions from the staff providing support to the people we visited.

People told us care staff were often late, although they did not feel this had a significant impact on the care they received. The provider monitored staff timeliness through the use of electronic call monitoring. This showed calls were in most instances attended within the provider’s 35-minute tolerance. Staff were not always given time on the rota to travel between calls, which meant it was inevitable in some cases that they would be late.

Medicines were not managed safely, and there had been few improvements in this area since our last inspection. There were issues with the records kept, planning how people would receive their medicines and the procedures staff followed. People were at risk of not receiving their medicines as prescribed, and the provider’s monitoring of the safe administration of medicines was not robust. The provider had notified us of six medicines errors that they had deemed to be safeguarding concerns since our last inspection.

Most people felt the staff supporting them were competent. Whilst staff were generally satisfied with the standard training they received, there was a lack of in-depth training in relation to topics such as specific health conditions, diabetes and dementia.

Whilst the provider had carried out necessary pre-employment checks, we found shortfalls in their staff recruitment processes. Some staff had gaps in their employment histories without a recorded explanation. Several staff had been recruited despite not meeting the provider’s score thresholds for the interview process. Where this was the case, there was no recorded justification of the decision to recruit the applicant, nor details about any additional support or checks that would be carried out to ensure those staff had the necessary skills to carry out their duties.

Whilst care staff we spoke with understood people’s care needs, we found this information was not always reflected in people’s care plans. Assessments were heavily based on tick-lists with little further information given to staff about how to meet people’s identified needs. We found instances where significant information relating to the care people needed, and potential risks to their wellbeing had not been recorded in their support plans. Office based staff were also unaware of these details in some instances.

Whilst staff had recorded information about people’s social histories, there was very little information in care plans about people’s preferences, including food preferences, how they received their care, or the gender of staff that provided their support. This would make it more difficult to provide consistent care that was person-centred and met people’s needs.

People received an annual quality assurance visit and review of their service. People told us they felt involved in decisions about their care. The provider sought feedback from people using the service and people told us they were confident to provide honest feedback.

The provider was not operating robust procedures to monitor the safety of the service, or learn lessons when things went wrong. The provider aimed for supervisors to audit 20 percent of daily logs and medication records. This meant the majority of these records were not checked, and issues had not always been identified on those that had been checked. There was

This inspection took place on 12 and 13 September 2017 and was announced.

Premier Care Limited – Trafford and Manchester Homecare Branch (Premier Care) is a large domiciliary care agency. The service provides care and support to adults living in their homes in the Manchester and Trafford areas of Greater Manchester. At the time of our inspection, the service provided care to 340 people and employed 125 members of staff.

We last inspected the service in April 2016 when we rated it requires improvement overall and identified breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care, good governance and complaints. At this inspection we found the provider was now meeting the regulations in relation to person-centred care and complaints. However, we found an ongoing breach in relation to good governance and identified a new breach of the regulations in relation to providing safe care and treatment. You can see what action we have told the provider to take at the back of this report. We have also made a recommendation that the provider reviews good practice guidance in relation to implementation of the Mental Capacity Act (2005).

We found people’s experiences of the service varied widely. Some people were very happy with the support they received from kind and caring staff and told us they were listened to. However, others reported inconsistencies in the caring approach of staff and felt communication with staff at the service was poor. Some people told us members of care staff they had not seen before were often sent without them first being informed, or the new member of staff introduced.

Since our last inspection, we had received several notifications from the provider of missed and late calls that had affected people’s care. People told us they had not had any recent missed calls, but reports around the timeliness of calls varied. The provider told us they aimed to attend all calls within 30 minutes of the allotted time. Their electronic call monitoring system showed the majority of calls were attended on time. Less than 3% of 5,377 calls the week prior to our inspection had been more than 35 minutes early/late.

Records of medication administration were not always clear and we found repeated examples where staff had not signed to show they had administered medicines. The provider did not have an effective system for monitoring the completion of medication records and took ineffective action to follow-up potential medicines errors.

Staff and the provider had identified and reported potential safeguarding issues to the local authority and CQC as required. Staff had received training in safeguarding and safeguarding was also discussed in supervisions and team meetings. The provider had completed investigations as required when this had been requested by the local authority safeguarding teams.

Staff had considered and documented potential risks to people’s health and wellbeing. However, we found these assessments were not always accurate, and there were not always clear plans in place to help staff reduce any risks. For example, one person was indicated as being vulnerable if they left their home and another person was shown as being at risk of pressure sores. However, there was no clear information on how staff should help reduce such risks.

Staff had received a range of training relevant to their job roles and had regular supervisions. Staff told us they felt supported and said they were able to approach the registered manager with any concerns they might have.

We found some people’s care files contained consent forms in them that had been signed by relatives. However, there was no evidence the service had considered whether people’s relatives had legal authority to provide consent on their family member’s behalf.

People told us staff respected their privacy and dignity. Staff supported people to retain their independence,

This inspection took place over three days on 26 and 27 April and 9 May 2016. We made phone calls to people using the service on 28 April 2016. The first day was unannounced, which meant the service did not know we were coming. The second and third days were by arrangement.

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

Premier Care Homecare is a domiciliary care service which means it provides care and support, including personal care, to people living in their own homes. At the time of this inspection the service was providing support to around 350 people in Manchester and Trafford. People received between one and four calls a day. There were approximately 140 staff. They were organised and supported by a team of office staff based in Stretford.

There was a registered manager who had been in post since 2012. 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.

We found that people generally were happy with their regular care workers. There were very few missed calls reported. When there was a missed call it was investigated in order to prevent a recurrence.

Premier Care Homecare were using modern technology to ensure care workers had accurate rotas and to reduce the number of missed or late calls. This enabled staff to log in or out and alerted the office if a care worker had not arrived.

However, there was still a high rate of late calls, some of which had been reported to the CQC. Many of the 24 people who were using the service and ten relatives we spoke with said they had received late calls, especially when their regular care workers were not on duty. Other people told us that carers were unreliable, coming at different times. There had also been a missed call for someone who had just come out of hospital. We found there was a breach of the regulation relating to meeting people’s needs.

Staff were trained to recognise any signs of abuse and report them as needed. The registered manager conducted disciplinary proceedings to ensure a safe service was maintained.

Safe recruitment practices helped to ensure only suitable staff were employed. Staff were trained in the administration of medicines and kept records. We have made a recommendation relating to improving the handling of medication.

There was a system of training and shadowing for new staff. There was a specific form used for supervision at the end of training to ensure that staff were ready to deliver care independently. Existing staff received regular refresher training from an in-house trainer. Staff could also receive more detailed training in other subjects. The provider attached high importance to the delivery of training.

Staff received regular supervisions and spot checks, which were unannounced.

The Mental Capacity Act 2005 was applied when appropriate and the service had conducted its own mental capacity assessments.

Staff could help with food preparation. They would co-operate with medical professionals.

The majority of people we spoke with thought the care workers were caring and helpful. Some people said they enjoyed their company and regarded them as friends.

There was also some negative feedback, but in some cases there were alternative explanations. When people told us about isolated examples of poor care, the registered manager said she would take immediate action.

The service stored records securely.

The care planning and risk assessment system used by Premier Care Homecare was thorough and person-centred. Information was obtained about people’s life history in order to enable staff to engage with people on a personal level.

One problem we encountered was that the care planning document was completed by hand

We spoke with the manager of the service who confirmed the process of registration with the Care Quality Commission had been completed and they had been registered as the registered manager with the Care Quality Commission since February 2012.

Three people who used the service confirmed staff asked for permission before carrying out any activity. One person told us “staff ask permission if something is new and they are respectful and always knock on their door and wait to enter".

We looked at four peoples care files. We saw they were clear, concise and provided staff with up to date information. We saw information including personal details, health and care information, care planning, risk assessments and evaluations. We saw that staff had completed dates and times of visits.

During our inspection we looked at three staff files. We saw evidence of up to date training relevant to their role including basic life support, responding and recognising abuse.

We spoke with staff. They told us “The manager is very good, if there was a problem or a concern they were able to go to them”. Another person told us they were “happy, felt supported and listened to by the manager”.

People who use the service told us they were happy with the support they received and said they were in involved in decisions about how it was provided. A relative said “Mum is asked about her care and she will say what she wants and doesn't want. The staff ask me as well."

People told us they had their care delivered at the right time, usually by the same people and in ways they wanted. One person said “They usually come at the same time now, it used to be different times. We have a routine now and we get the same staff."

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe with the care staff and said they would report any concerns to a manager. One person said "There is a book with a list of people I can speak to. The office staff are good and I can phone them whenever I want."

Staff told us they felt supported and they could always get hold of a manager for advice and support. We found that staff were very respectful in they way they talked about the people they supported and the care they provide. All of the people we spoke to said the staff treat them with respect and dignity.

One person said, "The carers are so obliging."

Another person told us that care staff were very kind and gentle.

People told us they were very satisfied with the service provided.

People told us that they felt safe and were well treated by care staff.

Some people told us that the care staff arrived on time and they always had the same team of care staff.

Other peoples experience of the agency varied. Some people told us that weekends were problematic and care staff often arrived late or they had care staff who they didn't know, some care staff didn't have any information about how they were expected to assist them.