Premier Care Limited - Trafford & Manchester Homecare Branch received an overall rating of Requires Improvement following a focused inspection on 30 January 2024, with both Safe and Well-led key questions rated Requires Improvement. The service remained in breach of Regulation 17 due to persistent late and missed visits and an insufficiently robust quality assurance system, though it exited Special Measures after resolving prior medicines management breaches.
Concerns (5)
criticalMissed or late visits: “There were 567 calls in January more than 45 minutes late. This represented 50% of the total number of calls.”
criticalMissed or late visits: “22% of calls in January were less than half the allocated time required to meet people's needs.”
critical
Governance
: “The quality assurance system was not robust. This was a continued breach of regulation 17 of the Health and Social Care Act 2008.”
moderateMedication management: “For 1 person who received Paracetamol, we found the time interval between doses being given were too close together.”
moderateLeadership: “At the time of our inspection there was not a registered manager in post. They had recently left, and a new manager has been recruited.”
Strengths
· Medicines management had been significantly improved since the last inspection and the provider was no longer in breach of regulation 12.
· Staff completed regular safeguarding training and knew how to identify and report concerns.
· Care plans were up to date with systems in place to ensure they were reviewed and updated when required.
· The provider was meeting regularly with the Local Authority quality team to support further improvement.
· Staff culture was positive and most staff felt supported; improvements in values and culture had been sustained.
Quality-Statement breakdown (9)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
well-led: Continuous learning and improving care; Managers and staff being clear about their rolesRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
Premier Care Limited - Trafford & Manchester Homecare Branch was rated Requires Improvement overall (Safe: Inadequate) following a focused inspection in August–September 2023, representing the eighth consecutive inspection with regulatory breaches. Persistent failures in medicines management and late care visits placed people at risk of avoidable harm, resulting in enforcement notices to cancel registration, though improvements in safeguarding, care planning and staff culture were acknowledged.
Concerns (9)
criticalMedication management: “Medicines were not managed safely. We found continued concerns in relation to the administration and reconciliation of medicines. The service has a history of noncompliance with medicines and has been in breach of regulations on 8 occasions.”
criticalMedication management: “For 2 people who received when required Paracetamol, we found the time interval between doses were given too close together.”
criticalStaff competency: “Appropriate medicine competency assessments had not been completed. We could not be assured staff had the necessary skills and knowledge to give medicines safely.”
criticalMissed or late visits: “Of the 19 visit schedules we reviewed the first visit on 10 of the schedules was over 50 minutes late. The visit schedules also didn't have sufficient travel time between visits.”
criticalMissed or late visits: “Yesterday I had to phone the office because [staff] didn't come. I had to make sure I got my medicines.”
criticalGovernance: “The provider had failed to ensure effective governance systems were in place to ensure the continual improvement of services provided to people and compliance with regulations.”
moderateCare planning: “When I get staff who don't know me, I have to tell them what I need doing, there's a care plan, surely they have it, but they don't look.”
moderateRecord keeping: “The electronic medicines records were not updated in a timely manner to reflect the most current medicines that needed to be administered to people.”
moderateIncident learning: “Although some medicines audits were completed, the errors we found during the inspection had not been identified.”
Strengths
· Safeguarding systems were now effective, with prompt action taken on concerns and refresher training up to date.
· Care plans were now up to date with sufficient detail to guide staff, and systems were in place for review and updating.
· Staff culture had improved markedly since the new registered manager joined in December 2022; staff felt valued and supported.
· An audit system was now in place, shortfalls in care reviews, spot checks, supervision and team meetings had been resolved.
· Use of agency staff had ceased since May 2023.
Quality-Statement breakdown (9)
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
well-led: Continuous learning and improving care; Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
Premier Care Limited - Trafford & Manchester Homecare Branch was rated Inadequate overall following a focused inspection of Safe and Well-Led, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) resulting in Warning Notices and placement in special measures. Key failures included approximately 100 out-of-date care plans, unsafe medicines management, ineffective call monitoring leading to missed and shortened visits, heavy reliance on agency staff, and a lack of robust governance and audit systems.
Concerns (12)
criticalMedication management: “Medicines were not managed safely. Good practice guidance was not followed and effective systems were not in place to ensure medicines were given as prescribed and accurate records were made.”
criticalCare planning: “Approximately 100 care plans were out of date. These were planned to be reviewed annually or if there were any changes in people's support needs.”
criticalMissed or late visits: “21 had concerns about the time and duration of calls...30 to 45 minutes calls were completed in less than 15 minutes...2 to 3 hours late, which has an impact as I take my medication in the morning.”
criticalSafeguarding: “We could not be assured these had always been reported to the local authority safeguarding team or to the Care Quality Commission.”
criticalIncident learning: “When families raised concerns the previous manager would brush issues under the carpet. Including issues related to short or late visits or poor care.”
criticalGovernance: “There had been no effective system for auditing in place...Governance processes did not identify shortfalls found during the inspection.”
criticalStaff competency: “Some care staff who administered medicines had not had their competency assessed to ensure they had the necessary skills and knowledge to give the medicines support.”
criticalLeadership: “The service had not been well led. Management arrangements and quality assurance systems had not been effective since the last inspection.”
moderateStaffing levels: “There was a high use of agency staff. People told us agency staff did not know people's needs...agency staff who have no idea who I am or what to do for me.”
moderateSupervision / appraisal: “No spot checks made, although 1 staff had had a spot check after your visit, the 2nd one in 5 years.”
moderateStaff training: “Refresher training for staff was out of date and many staff had not received refresher training for over 2 years according to the training matrix provided.”
moderateRecord keeping: “Records about medicines were not always accurate and could not show that people were given their medicines as prescribed because some staff did not have access to the new electronic system.”
Strengths
· People and their relatives were complimentary about the permanent Premier Homecare care staff.
· Staff were recruited safely and had the appropriate pre-employment checks in place before employment commenced.
· The new manager had demonstrated an open and honest approach and was clear about the requirements of the duty of candour.
· The new manager had been proactive in reporting and managing any concerns since joining in December 2022.
· The manager met monthly with the lead social worker and met regularly with the Local Authority quality team to address shortfalls.
Premier Care Limited - Trafford & Manchester Homecare Branch remained in breach of regulations 12 and 17 due to inadequate risk assessment review, lack of detailed risk guidance, and a non-robust quality assurance system exacerbated by long-standing office staff vacancies. Medicines management had improved and was no longer in breach, but the service has been rated requires improvement for five consecutive inspections.
Concerns (9)
criticalCare planning: “half of the care plans we saw had not been reviewed within this timescale.”
criticalGovernance: “The quality assurance system was not robust. This placed people at risk of harm and was a continued breach of regulation 17(1)”
moderateCare planning: “Clear guidance was not always in place for any specific support required.”
moderateStaffing levels: “Premier Homecare had struggled to recruit to the office-based co-ordinator and supervisor roles and had carried vacancies in these areas for several months.”
moderateSupervision / appraisal: “staff spot checks / observations and supervision meetings not being completed.”
moderateMissed or late visits: “Half of the agency carers don't stay very long, they are miserable, and the timings are no good.”
moderatePerson-centred care: “Some agency staff turn up and don't know anything about her and mum gets confused with this.”
moderateRecord keeping: “the information they were able to access via their work phones about people's risks and support needs was 'basic' and was not always updated”
minorInfection control: “one person's assessment stated there were no risks associated with infection control, but staff needed to clean the commode and so were dealing with bodily fluids.”
Strengths
· People received their medicines as prescribed and monthly medicines audits were completed with issues actioned.
· Improvements had been made in the management of medicines since the last inspection.
· Staff were safely recruited with all pre-employment checks completed prior to starting work.
· Staff wore the required PPE and followed COVID-19 guidance, including weekly testing.
· People were very positive about the support provided by permanent Premier Homecare staff.
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement