Premier Care – Salford Homecare Branch is a domiciliary care service who provide care and support to over 300 people living in their own accommodation within the Salford area. Premier Care is the main provider for the local authority in 4 of the 5 areas of Salford which are Swinton & Walkden, Little Hulton, Broughton and Ordsall. At our last inspection of the service in May 2023, we identified breaches of regulations 9 regarding Person Centred Care and 17 in relation to good governance. This was because People's care visits were not always completed in line with the agreed times as stated on their assessment, care plan and/or visit schedule and people's carer preferences were not always respected. There was also a lack of systems and processes in place to monitor the safety and quality of service provision, identify issues and ensure actions and regulatory requirements were addressed in a timely way. At this inspection carried out between March and April 2024, we found sufficient improvements had been made and the service was no longer in breach of regulations 9 and 17.
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Premier Care Limited – Salford Homecare Branch received an overall rating of Requires Improvement at this focused May 2023 inspection, remaining in breach of Regulations 9 and 17 following a prior breach in 2021. Key failures included inconsistent visit timings, disregarded carer-gender preferences, and a lack of robust audit and governance systems, resulting in a warning notice for Regulation 17.
Concerns (11)
criticalMissed or late visits: “The times they come vary greatly, today was 9am but sometimes it's 10am or even later”
criticalPerson-centred care: “People who had specifically requested female care staff, due to requiring personal care, had, on occasions, been supported by male care staff.”
criticalGovernance: “There was no clear audit schedule in place, which detailed what audits and monitoring was completed and how often.”
moderateMedication management: “2 people's medicine administration records (MAR) contained incorrect information regarding their allergy status.”
moderateSafeguarding: “Training records showed significant gaps in completion rates for safeguarding training.”
moderateRecord keeping: “The directions for how to administer a person's medicine had not been updated following a GP review.”
moderateIncident learning: “Prior to this system being implemented, it was not clear what analysis had been completed of incidents and accidents.”
moderateCommunication with families: “No surveys or questionnaires had been circulated since the last inspection in May 2021.”
moderateSupervision / appraisal: “An action plan linked to supervision completion, care plan review completion, staff observations and competency checks, all of which were not up to date.”
moderateCare planning: “We identified some inaccuracies and omissions within the care plans we viewed on inspection. These issues had not been picked up by the registered manager.”
minorComplaints handling: “I have had to complain about a few things...They said they would investigate, but no-one has come back to me.”
Strengths
· New staff were recruited safely with all necessary pre-employment checks completed including DBS, references and right to work verification.
· Risk assessments were in place covering environment, infection control and health and safety.
· Staff administering medicines had received training and been assessed as competent.
· Medicines audits had identified a number of issues which were addressed timely.
· Staff wore necessary PPE and up-to-date infection control policies were in place.
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 abuseRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
Premier Care Salford Homecare Branch was rated Requires Improvement following a focused inspection of Safe and Well-Led, with breaches of Regulation 12 (medicines management and rota/visit-time failures) and Regulation 17 (governance), resulting in a warning notice for medicines. Over 40% of visits were at least 30 minutes late monthly and medicines records were inaccurate, though no direct harm was evidenced; the new manager was noted as a positive influence and the service was engaging with the local authority to drive improvement.
Concerns (6)
criticalMedication management: “Controlled drugs were not managed safely. Records to monitor stock levels were not in place and staff had not consistently documented if these medicines had been given or at what time.”
criticalMissed or late visits: “Monthly alert data from January to April 2021 showed over 40 percent of visits had been at least 30 minutes late each month. The service's target was 10 percent.”
criticalRecord keeping: “Medicine administration records (MARs) were not accurate, despite the checking system in place. Care plans did not accurately detail the support people required with their medicines.”
criticalGovernance: “Governance systems were not robust enough to ensure issues with service delivery were either identified or addressed timely. This was a breach of regulation 17.”
moderateCommunication with families: “It's difficult to get through to the office, then there's no follow up to calls we've made to update us on what is happening.”
moderateCare planning: “Where family shared medicines responsibility, care plans were not clear how this would be managed.”
Strengths
· Staff were recruited safely with pre-employment checks including DBS and references from previous employers.
· Risks to people had been assessed and documented within care files with standardised and individual risk assessments.
· Staff had received training and felt confident using equipment such as hoists.
· Systems were in place to log and monitor accidents, incidents and safeguarding with pattern and trend analysis.
· The current manager was reported to have made a positive impact, with staff and people noting improvements since their arrival.
Quality-Statement breakdown (9)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires 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 infectionRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staff; Promoting a positive cultureRequires improvement
Premier Care Limited - Salford Homecare Branch was rated Good overall following an announced inspection in August 2015, with strong performance across safe, effective, caring, and well-led domains. The Requires improvement rating for responsive reflects a recurring pattern of late calls, particularly at weekends, causing distress to people with time-sensitive care needs.
Concerns (4)
moderateMissed or late visits: “"My only problem is the weekends, they are supposed to come between 8 and 9am but sometimes it is 11am, they don't ring to say they will be late"”
moderateMissed or late visits: “"It's a problem when my morning call is late, because I need help getting to the toilet and that can't wait."”
minorRecord keeping: “medication monitoring sheets did not record individually what medication had been administered from the 'Veralink' by staff”
minorConsent / capacity: “a number of staff were unable to explain the principals and either told us they had received no training or could not remember whether they had received training”
Strengths
· People felt safe with care staff in their homes and trusted them with their possessions
· Robust safeguarding procedures in place; all staff could describe types of abuse and appropriate actions
· Robust recruitment procedures including DBS checks and three-yearly renewals
· Comprehensive 12-week induction programme and 12-month development journey for new staff
· Electronic training matrix effectively managed individual training requirements
Premier Care Limited Salford Homecare Branch was rated Good across all five key questions at this November 2017 inspection, serving 611 people in the Salford area. The service demonstrated safe medication management, robust safeguarding practices, person-centred care planning, and a proactive quality audit system, with the Responsive domain improving from Requires Improvement at the previous 2015 inspection.
Strengths
· People felt safe and staff demonstrated good knowledge of safeguarding procedures
· Comprehensive and regularly updated risk assessments including lone worker and home risk assessments
· Staffing levels were appropriate and call times were adhered to in the main
· Medication administration records were accurately completed with no omissions
· Staff received thorough induction, regular mandatory training, supervision, appraisal and competency assessments
Quality-Statement breakdown (18)
safe: SafeguardingGood
safe: Risk managementGood
safe: Staffing levelsGood
safe: Medication managementGood
safe: Infection controlGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Mental Capacity Act / consentGood
Nutrition and hydration
well-led: How the provider understands and acts on the duty of candour
Good
well-led: Working in partnership with othersGood
effective:
Good
caring: Privacy and dignityGood
caring: Person-centred involvementGood
caring: Independence promotionGood
responsive: Care planning and reviewGood
responsive: Equality, diversity and human rightsGood