This inspection took place on 22 and 24 August 2018 and was announced as this is a domiciliary care company.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults. Premier Care Limited - Wirral Branch provides a domiciliary service on the Wirral and was is into three geographic areas. At the time of our visit, the service was providing support for 570 people and provided staff for three extra care schemes. There were 279 staff employed and 22 office staff, including the registered manager. At the time of inspection, a director of Premier Care Limited was also in attendance at the service.

Not everyone using Premier Care Limited - Wirral Branch receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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 had a registered manager in post.

During our previous inspection in June 2017 there were breaches of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating of the service was ‘requires improvement’. This was because risk assessments did not give specific guidance for staff and the information in the risk assessments was sometimes contradictory and some medication administration records contained misleading information.

At this inspection we found that the service was ‘good’ and was no longer in breach of regulations. This was because improvements had been made to risk assessments, care plans and medication records.

However, we found that records management had improved but further improvements where still needed regarding processes followed for covert medication and daily logs in people’s homes. We were able to see how the service was continually improving regarding the visit times. However, the feedback we received from people was mixed as visits were not always on time. We were also told how people were not always informed of changes to either times or carers.

People's medicines were handled safely by trained staff and were given to them in accordance with their prescriptions. People's GPs and other healthcare professionals were contacted for advice about people's health needs whenever necessary.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults and whistleblowing. Staff received regular training and supervision to enable them to work safely and effectively. There was a complaints policy in place which people felt comfortable using if they had concerns.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. Management and quality assurance systems had been devised and were in place to drive continuous improvement and the service.

Staff understood the need to gain consent and followed legislation designed to protect people's rights and freedoms.

We saw that infection control standards were monitored and managed appropriately. We saw that the provider had an infection control policy in place to minimise the spread of infection, all staff had attended infection control training and were provided with appropriate personal protective equipment such as gloves and aprons.

This inspection was carried out on 19, 20 and 23 June 2017 and was announced. We carried out the inspection at this time as the service was in special measures and had been rated inadequate and we needed to check that improvements had been made to the quality and safety of the service.

Premier Care Limited - Wirral Branch provides a domiciliary service on the Wirral and was divided into three geographic areas. At the time of our visit, the service was providing support for 676 people and provided staff for three extra care schemes. There were 296 staff employed including the registered manager, a compliance manager, 10 co-coordinators, seven senior carers, five administrators and care staff. During the inspection a director of Premier Care was also in attendance.

The service is required to have a registered manager. 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 registered manager informed us that he would be moving to another branch in the near future and that the compliance manager intended to apply for registration with CQC as manager of the service.

At our last comprehensive inspection of the service in November 2016 we found breaches of a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care; dignity and respect; safeguarding people who use the service from abuse and improper treatment; meeting nutritional and hydration needs; and staffing.

During this inspection we found that some improvements had been made in all of these areas but further improvements were required. However, in response to the improvements that had been made we took the service out of special measures.

During this inspection, we found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our last inspection we found that the provider had no suitable system in place to ensure that risks in relation to people's care were adequately managed. We were able to see that the service had made improvements in this area. This included updating risk assessments in people’s homes. However, we had concerns about some of the risk assessments because they did not give specific guidance for staff and the information in the risk assessments was sometimes contradictory.

During this inspection we saw that improvements had been made in relation to the administration of medication. However, we identified that some records contained misleading information, for example incomplete medication administration records that differed from instructions on the boxes the medications were dispensed in. We also saw daily records that stated staff were administering medication that had not been written into people’s care plans.

During our last inspection we found that daily logs of people’s care had not been adequately completed after each visit. The times reflected in the planned and actual visit records had a lot of anomalies. We also found that the majority of late and missed calls had not been followed up consistently by the provider to ensure people were safe. At this inspection we found that improvements had been made. The provider had an electronic monitoring system that was being used effectively and we saw that improvements had been made to people’s daily logs.

At this inspection we saw improvements had been made to the recruitment procedures at the service. A Disclosure and Barring Service check had been obtained for all staff.

At our last inspection we identified that staff did not have sufficient support to ensure the

Premier Care Wirral provides personal care for people aged 18 years or over who need care or support at home. At the time of this inspection 830+ people were in receipt of support from the service. The majority of people who used the service had their care funded by their local authority. There were also 80 people paying privately for their own care.

Prior to our visit, we had received information of concern about the quality and safety of the service provided. This information prompted our visit. We gave the provider of the service 24 hours’ notice before our visit to ensure they would be available to participate in the inspection. We carried out the inspection on the 24, 25, 28, 29 and 30 November 2016.

There was a registered manager in post who participated in the inspection visit. 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’.

On the day of our visit the registered manager, compliance manager and one of the three directors of the service (the provider) in relation to how the service was managed were present during the inspection and were involved in the day to day running of the service also. We liaised with all three for the majority of our inspection.

During this inspection, we found breaches of Regulations 9, 10, 12, 13, 14, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the care files belonging to 14 people who used the service. 11 at the office and 3 in people’s homes. We found they did not adequately cover people’s needs and risks. They failed to provide clear information or guidance to staff in the provision of safe and appropriate care. This placed the person at risk of harm. Care plans were not personalised to people’s individual needs and preferences and staff lacked sufficient guidance on how to provide people with person centred care.

We found that some people had mental health conditions which may have impacted on their ability to understand about the importance of their care in relation to nutrition. Staff had no guidance on how to support people with mental health needs and appropriate action had not been taken by staff to report the day to day outcomes of their visits.

Due to the irregularity of visits, some people did not receive their medication at regular times. People’s medication administration charts showed gaps in the administration of medication that were unexplained and did not demonstrate that people always received the medication they needed or in a safe way. In some instances there were no medication administration record sheets (MAR’s) in people’s homes.

There was no evidence that the provider had checked on people’s welfare or reviewed their care to ensure that the support people received continued to be suitable for their needs. Where people’s support needs had changed, people’s care plans had not been updated. This placed people at risk of inappropriate or unsafe care.

The staffing arrangements in place at the service was in disarray due to the amalgamation of three new contracts commissioned from July 2016 to October 2016 taking staffing up from 40 to over 430. The information provided to us was not a true reflection of the service provision at this time as the system ‘Care Free’ did not contain all of the data required as yet about all of the people using their service the impact meaning the provider could not be confident that people’s needs would be met. The provider was aware of the staffing levels not being sufficient due to new contracts for being in place. Actions to review people’s care to ensure that the number of s