Date of Assessment: 6 to 20 December 2024. The service is a domiciliary care agency. It provides personal care to people living in their own homes. They supported adults of all ages. At the time of the inspection they were supporting 8 people. The service had made improvements and was no longer in breach of regulations. Monitoring and quality assurance systems had been implemented to ensure they were more effective in identifying areas for improvement and improving people’s care. The management of people’s medicines had improved. Records were being updated and staff had completed competency assessments before they supported people with their medicines. People were protected and kept safe. Staff understood people’s needs and managed any risks related to their care. There were enough staff with the right skills, qualifications and experience. Staff had shadowing opportunities and time to review people’s care records to fully understand their communication, personal and health needs. People were involved in assessments of their needs and decisions about their care. People were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. Staff monitored people’s health to support healthy living. People received fair and equal care and treatment. People with protected characteristics felt supported. People knew how to give feedback and were confident the service would take the appropriate action. The service supported staff wellbeing and considered any personal circumstances. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles.
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safe:Insufficient evidence to rateeffective:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted follow-up inspection of UK Prime Care Services found continued breaches of Regulation 12 (medicines management) and Regulation 17 (good governance), with quality auditing systems remaining insufficiently robust despite some improvements in risk assessment, recruitment and MCA compliance. The overall rating remains Requires Improvement and a Regulation 17(3) Letter has been issued; no registered manager was in post at the time of inspection.
Concerns (5)
criticalMedication management: “medicines information within the person's care plan was not always updated when there were changes in their medicines...This meant there was not an accurate and up to date record of the person's medicines.”
criticalGovernance: “A range of internal audits had not been carried out...The date for this to be actioned was 30 November 2022, but this had not been done.”
criticalLeadership: “At the time of our inspection there was not a registered manager in post. The previous registered manager deregistered on 15 June 2022.”
moderateStaff competency: “the staff member had completed medicines training, their competency had still not been assessed.”
moderateRecord keeping: “there were examples where times for care visits had not been recorded and tasks were being completed that were not part of the agreed care.”
Strengths
· Risk assessments improved with greater detail; staff demonstrated good understanding of moving and handling procedures.
· Safer recruitment processes now in place with updated application forms, reference checks and formal interview assessments.
· Mental capacity assessments implemented across all service users in line with MCA principles.
· People and relatives consistently positive about care quality and the cultural and linguistic matching of staff.
· Staff felt valued and spoke positively about the supportive working environment created by the nominated individual.
Quality-Statement breakdown (5)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles; continuous learning and improving careRequires improvement
UK Prime Care Services remained in repeated breach of regulations 11, 12, 17 and 19 with continued failings in recruitment, risk assessments, medicines management, MCA compliance and governance, leading to a second consecutive Requires Improvement rating and a warning notice for good governance. Despite these systemic management weaknesses, people and relatives spoke very positively about the kind, culturally-attuned care delivered by staff, and the caring domain remained Good.
Concerns (10)
criticalStaff competency: “safer recruitment procedures were still not being followed to ensure staff were suitable to work with people who used the service.”
criticalRecord keeping: “Interview assessment records were still not being completed and any gaps in employment histories were not recorded. References for all four staff files had not been verified”
criticalCare planning: “The care records and risk assessments we reviewed continued to lack any specific detail or guidelines for staff to follow to mitigate any possible risks.”
criticalMedication management: “Medicines information in this person's care plan did not match the medicines that were highlighted on their MAR chart.”
criticalConsent / capacity: “The provider was still not working within the principles of the MCA. Mental capacity assessments were not carried out or recorded at the initial assessment.”
criticalGovernance: “The provider failed to have effective quality auditing systems and processes to assess, monitor and improve the quality and safety of the service.”
criticalLeadership: “the CQC assessed them as being unable to demonstrate the full understanding of the registered manager role and was unclear on aspects of the management of the service.”
moderateSupervision / appraisal: “there continued to be no formal records of shadowing or supervision. The nominated individual acknowledged this”
moderateInfection control: “the provider did not have systems in place to ensure staff were following the current government guidance for COVID-19 testing requirements.”
moderatePerson-centred care: “information in some people's care plans continued to be basic and lacked detail about how people liked their care to be provided.”
Strengths
· Staff were kind, caring and treated people with dignity and respect
· Continuity of care, with staff knowing people well over long periods
· Staff and management spoke people's first language, supporting cultural and communication needs
· Positive feedback about timekeeping and reliability of visits
· People and relatives felt involved and could readily contact the nominated individual
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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 law
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Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to access healthcareRequires improvement
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 controlRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships and follow interestsGood
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 othersRequires improvement