Date of assessment 27 November 2024 to 05 December 2024, Prime 4 Care Limited is a community-based care provider that provides personal care to people living in their own home. At the time of this assessment, the provider told us they supported 9 people but not everyone received a regulated activity. Three people were in receipt of the regulated activity of personal care. People received care calls at the times they required and for the duration needed to meet their needs. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At this assessment we looked at 3 key questions of Safe, Effective and Well Led in full which covered 21 quality statements. This assessment was completed to check the provider had made improvements since our last inspection on 26 April 2023. Following that inspection, the provider sent us an action plan and we undertook this assessment to ensure improvements were met and the provider was now compliant with the regulations. At this assessment we found some of the previous issues from the last inspection remained. Following this assessment Prime 4 Care Limited has been rated as requires improvement. There was a continued lack of effective and embedded systems to check the quality of the service. Limited or no audit records could not show how the service oversaw quality improvements. Processes did not always ensure care plans were personalised and updated, and there was a limited understanding of the importance in recording quality checks of the service. The management team wanted to improve and took our feedback to consider what systems they needed to implement and improve. Management understood the importance of listening to people’s feedback to improve people’s outcomes. Staff understood their role in keeping people safe, supporting people to make choices and promoting people’s independence. Systems and processes.
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Prime 4 Care Ltd remains rated Requires Improvement for the third consecutive inspection, with continued regulatory breaches under Regulation 12 (safe care and treatment) and Regulation 17 (good governance), including unsafe medication records, inaccurate epilepsy action plans, absent risk assessment reviews, and ineffective governance audits. A Section 29 Warning Notice was issued for the ongoing Regulation 17 breach, though the provider demonstrated commitment to improvement through investment in new systems and training.
Concerns (9)
criticalMedication management: “Medicine administration records (MARs) were not always clear and did not always follow best practice guidance. There were unexplained gaps and crossings out in records.”
criticalCare planning: “Two people had a diagnosis of epilepsy. Their epilepsy action plans guided staff to contact 111 in the event of a seizure...the manager confirmed neither of these instructions were accurate.”
criticalGovernance: “Audits and governance processes of the safety and quality of care were either not in place or operating effectively.”
moderateRecord keeping: “Records relating to staff employed were not always stored securely. Spot checks of staff practice and their competency were kept in people's homes and not the registered office location.”
moderateCare planning: “Improvements were needed to ensure people's assessments were reviewed following changes in their health, to ensure they remained relevant and up to date.”
moderateConsent / capacity: “Improvements were needed to ensure statements regarding people's mental capacity were supported by mental capacity assessments.”
moderateStaff competency: “The manager advised us that spot checks of staff competencies to administer people's medicines were carried out. However, there were no records of these checks.”
moderateLeadership: “At the time of the inspection, there was no registered manager in post.”
minorStaff training: “Staff weren't attending training even though we would book it, and there were gaps in staff training records.”
Strengths
· Staff recognised the importance of keeping people safe from the risk of abuse and safeguarding concerns were reported to the local authority and CQC.
· Staff were provided with PPE and care plans included reminders on hand hygiene to promote good infection control.
· The provider and manager worked in partnership with other healthcare professionals to meet people's needs.
· Positive feedback received from relatives about care quality and staff responsiveness.
· Provider invested in new electronic systems, a new training provider, and joined Skills for Care following inspection.
Quality-Statement breakdown (17)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choicesRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
well-led: 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 empoweringGood
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving careRequires improvement
Prime 4 Care Ltd was rated Requires Improvement overall following a focused inspection of Safe and Well-led, with a continued breach of Regulation 17 (Good Governance) due to ineffective systems for risk assessment, medication records, and staff training documentation. While people and relatives reported positive experiences and staff demonstrated practical care knowledge, systemic governance failures persisted from the previous inspection cycle.
Concerns (7)
criticalCare planning: “One person with epilepsy had no risk assessment or care plan for their condition until after they had experienced seizures.”
criticalMedication management: “One person needed support with epilepsy medicine because of short term memory loss. However, due to a lack of understanding there was no medicine administration record for this person.”
criticalGovernance: “Systems to continually assess, monitor and mitigate risks to the health, safety and welfare of people...were ineffective. This placed people at risk of harm.”
moderateRecord keeping: “There were no records available to evidence the training staff had undertaken or observations of their practice.”
moderateStaff training: “The provider told us staff received medicine competency training before being allowed to support people with their medicines. However, there were no records of training.”
moderateIncident learning: “Care records did not always evidence when action was taken in response to health concerns or incidents or when conversations took place with other health professionals.”
minorSafeguarding: “Contact details for the safeguarding authority were available for staff in the office, but not all staff knew where to access this information or who to contact externally.”
Strengths
· People felt safe and well looked after by care staff, with consistent staffing and sufficient travel time between calls.
· Staff demonstrated knowledge of specific health risks such as catheter care, skin integrity, and infection signs.
· People and relatives gave strongly positive feedback about care staff kindness, competency, and communication.
· Provider maintained regular weekly telephone contact with people to gather feedback and act on concerns.
· Staff wore PPE and carried out regular lateral flow testing for infection control.
Prime 4 Care Ltd received an 'Inspected but not rated' outcome across all five key questions following its first inspection in August 2018, as the service had only one person receiving a limited care package, providing insufficient evidence to award ratings. Minor gaps in recruitment record-keeping and the absence of a developed quality assurance system were noted, though the provider had plans to address both as the service grew.
Concerns (2)
minorRecord keeping: “the provider had not obtained a full work history for one care worker which meant we could be clear as to the source of the reference on the file. The provider assured us the checks had been made, but not recorded.”
minorGovernance: “no other audits had been carried out to review the service's performance because the provider had only recently secured a care package.”
Strengths
· No missed calls and relative confirmed no problems with timekeeping; visits delivered at regular times and for agreed durations.
· Provider and registered manager understood safeguarding responsibilities and obligation to report concerns to local authority and CQC.
· Care delivered with a person-centred approach; staff gave people time to process information and communicate choices.
· Positive relative feedback: 'They are all very skilled both with dealing with physical aspects of [name's] care and their needs relating to their dementia.'
· Clear management structure with delegated responsibilities across registered manager, care co-ordinator and nominated individual.
Prime 4 Care Ltd was rated Requires Improvement overall at its July 2019 inspection, with a breach of Regulation 17 identified due to failures in governance, staff training systems, recruitment record-keeping, and risk management for a person with epilepsy. Caring and Responsive were rated Good, with staff praised for dignity, personalised care, and effective partnership working.
Concerns (7)
criticalGovernance: “The Provider had failed to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.”
criticalRecord keeping: “The provider was unable to evidence that reference checks and employment history for new staff had been obtained prior to employment.”
criticalCare planning: “One person's assessment indicated they had epilepsy, but there was no information about this in their care plan or risk assessments.”
moderateStaff training: “There was no organised system to ensure staff had the training to administer medicines safely.”
moderateStaff competency: “The provider had not ensured all staff had received training relevant to their roles.”
moderateLeadership: “The registered manager was unavailable throughout the inspection process and was not responsive to requests made by the inspector.”
moderateSupervision / appraisal: “There was no system to identify what training staff had attended and when refresher training was required.”
Strengths
· People were treated with dignity and respect; a relative stated 'All the staff are kind and caring without exception.'
· Medicines records were accurate, complete and up to date with an audit system in place.
· Staff understood safeguarding responsibilities and knew who to contact if abuse was suspected.
· Care plans contained sufficient information and people were involved in decisions about their care.
· The provider worked collaboratively with other healthcare professionals to ensure positive outcomes.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongNot rated
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 diet
Not rated
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
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 preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: 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 empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Working in partnership with others; Continuous learning and improving careGood