Date of assessment: 19 August 2024 to 18 September 2024. As part of our assessment methodology for people with a learning disability and autistic people, we assess if services are meeting the Right Support, Right Care, Right Culture (RSRCRC) statutory guidance. This includes: Right support: Model of care and setting maximises people's choice, control and independence. Right care: Care is person-centred and promotes people's dignity, privacy and human rights. Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. At our last inspection, we identified the service needed to make improvements to meet these principles as some people’s choice and control over their lives was not maximised. During this assessment, the service has made improvements and is now meeting the RSRCRC guidance. At our last inspection we identified breaches in two regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment and good governance. During our assessment we found the provider was no longer in breach of these regulations and had made improvements at the service.
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Prime Care Support Limited remained in special measures with an overall Inadequate rating following a follow-up inspection in April 2022, having failed to make sufficient improvement since the previous Inadequate rating published November 2021. Continued and new breaches across Regulations 9, 12, 13, 17 and 18 were identified, including unsafe medicines management, variable and late care visits, non-personalised care plans, and a lack of robust governance and management oversight placing people at risk of harm.
Concerns (13)
criticalSafeguarding: “Systems and processes were not robust to protect people from abuse. Staff had received safeguarding training, however, some incidents where potential abuse took place were not recognised and reported.”
criticalMedication management: “Medicine processes were not safe. People did not always receive their medicines at the correct time, and oversight was not effective nor robust.”
criticalMissed or late visits: “A care visit had taken place for a person at 05:59am when their agreed care visit time was 07:30am... People's care visits were not scheduled for their agreed times.”
criticalStaffing levels: “There were not enough staff to meet the needs of people. People experienced variable planned call times which were not reflective of their contractual agreements.”
criticalCare planning: “Care plans were not personalised and did not reflect the required support needs and preferences of people. This was a breach of regulation 9.”
criticalGovernance: “The provider had failed to ensure systems had been robustly reviewed since our last inspection. The breaches of regulations had not been considered holistically.”
criticalIncident learning: “The registered manager was not aware of this incident, and we were therefore not confident in reporting practices and oversight.”
criticalLeadership: “The registered manager and provider lacked oversight in key areas which placed people at risk of harm. Clear and effective quality assurance systems were not embedded at the service.”
moderateInfection control: “People considered vulnerable did not have individual COVID-19 risk assessments in place. Guidance was therefore unavailable to staff to mitigate risk.”
moderateStaff training: “Long standing staff had not consistently completed training which new staff received during their induction. This included key topics such as skin, continence and catheter care training.”
moderateRecord keeping: “One person's care plan stated staff should leave their left-side bedrail down... however, the risk assessment did not contain this information, was generic.”
moderatePerson-centred care: “People did not always feel included in all aspects of their care, including the planning and knowledge of care visit timings. People told us this impacted negatively on their day to day lives.”
moderateComplaints handling: “One person said, 'The office doesn't take notice of my concerns, the boss never rings me back.' A third person said, '[It's] not worth doing as nothing changes.'”
Strengths
· Staff logging in and out of care visits had improved, and reviews had taken place with staff.
· People told us visiting staff were caring and supportive, and respected their privacy and dignity.
· People were supported to access health and well-being services, medical reviews and assessments from occupational therapists and social workers.
· Safe recruitment procedures took place and staff received induction programmes, regular supervision and appraisals.
· The provider had implemented processes to reduce the likelihood of people's medicines running out, including advance reviews.
Quality-Statement breakdown (18)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Preventing and controlling infectionInadequate
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; Supporting people to express their viewsRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesInadequate
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
well-led: Promoting a positive culture; Managers and staff being clear about their roles; Continuous learning and improving care; Engaging people and staffInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Working in partnership with othersRequires improvement
Prime Care Support Limited improved from Inadequate to Requires Improvement and exited Special Measures, with notable progress in safeguarding, infection control, staffing and care planning, but two continued regulatory breaches (Regulations 12 and 17) remain due to ongoing shortfalls in medicines management, risk assessment accuracy, staff training effectiveness, and management communication. Warning notices were issued requiring the provider to make further improvements within a set timescale.
Concerns (10)
criticalMedication management: “some protocols and procedures required improvement. Where people were prescribed variable dose medicines...guidance needed to be expanded for staff.”
criticalMedication management: “medicines were documented on the medicine administration record to be given at the same time as all other morning medicines.”
criticalCare planning: “one person's pressure sore risk assessment stated the person was fully mobile, when their mobility was restricted.”
criticalGovernance: “audits and governance systems had not identified specific areas for improvement which had been found during this inspection.”
moderateStaff training: “Staff had completed training relating to the Mental Capacity Act...however, were unable to explain their understanding, and how they would apply the principles in practice.”
moderateStaff competency: “we found staff were unable to evidence an effective understanding of all training that had been completed.”
moderateCommunication with families: “one person told us, 'They don't let me know if carers are going to be late.'”
moderateCommunication with families: “If you ring up, they say they will let [specific staff member] know, but you never get a call back unless they want something from you.”
moderateRecord keeping: “Another person's medicine risk assessment did not detail their medicine allergies...two people were prescribed nutritional supplements due to a risk of malnutrition, however, this detail was not included.”
minorPerson-centred care: “Some people, and their representatives, told us they sometimes experienced language barriers with staff...they talk to each other in a different language which I find rude.”
Strengths
· Service exited Special Measures; no longer rated Inadequate overall or in any key question following improvements since last inspection.
· Staffing levels improved; care visit times made reflective of contractual agreements and staff deployed in geographical areas to reduce travel time.
· Safeguarding processes strengthened: dedicated whistleblowing email, safeguarding lead in post, staff training completed and lessons learnt shared.
· Infection control improved: COVID-19 risk assessments completed, PPE supplies sufficient, clear procedures understood by staff.
· Care plans updated to be person-centred, detailing desired outcomes, preferences and guidance for staff, accessible via electronic devices.
Quality-Statement breakdown (15)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law