Date of assessment: 10 – 13 March 2025. Premium Homecare is a care at home service providing support to people living with a range of needs, including those living with dementia. At the time of our assessment 65 people were receiving support with their personal care. We undertook this assessment to follow up on enforcement action taken at our previous assessment. Included in this assessment were 5 quality statements within the safe and well-led key questions. The scores for these areas have been combined with scores based on the key question ratings from the last assessment. Improvements had been made, and the provider was no longer in breach of regulations. New risk assessments had been introduced. These clearly identified risks to people’s safety and gave clear instruction to staff about how to support people and mitigate risks. Clear records were now maintained around medicines management to ensure people received their medicines as prescribed. Staff were well supported and received regular training, supervision and support. Improvements had been made to call scheduling and people, on the whole, received support on time and staff stayed the required length of time. Scheduling of travel time had been improved to enable staff to do this. However, some people told us there were still some concerns with punctuality. Governance systems had been improved to enable the management team to have clear oversight of service delivery and check on the quality of care provision. This included a regular programme of spot checks, welfare visits, telephone monitoring quality assurance calls and care reviews. The system to review spot checks and staff supervision sessions was not always kept up to date. The care manager told us this was due to staff sickness and was updated in response to our assessment. Clear action plans were now in place and there was a commitment to continuous improvement.
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The assessment took place between 15 to 25 October 2024. We undertook this assessment to follow up on previous breaches of regulation. Premium Homecare Ltd is a domiciliary care agency providing personal care to people in their own homes. At the time of our assessment there were 78 people using the service. We assessed all quality statements across safe, responsive and well-led key questions. There continued to be ineffective systems in place to assess and manage risks to people’s safety. We found risk assessments did not take account of all of people’s needs, were missing information, contained conflicting information and had not been updated in response to changes in people’s health. There continued to be ineffective governance systems in place to review and improve care records and oversight of call scheduling. A new system had been introduced regarding call scheduling, but this was flawed and there were not effective systems in place regarding the governance of this system. A service improvement plan was in place, however this did not include timescales to ensure timely improvements were implemented. The registered manager had not adhered to all of their CQC registration requirements and had not submitted notifications of key events that occurred at the service. Improvements had been made regarding oversight of incidents and accidents, and in regard to staff support systems, staff training, and monthly quality monitoring telephone calls to people using the service. Improvements had been made to ensure more information about people’s individual preferences and what was important to them, was captured in their care records. We found the provider continued to be in breach of regulations relating to safe care and treatment, and good governance. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations process has been concluded.
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Premium Homecare Ltd was rated Requires Improvement following a focused inspection on 20 November 2023, with breaches of Regulations 12, 17 and 19 identified relating to unsafe risk assessment practices, inadequate governance and record-keeping systems, and unsafe staff recruitment processes. People were generally happy with their care workers and felt safe, but systemic issues around late and missed visits, incomplete care records, and lack of management oversight represented significant risks to people's safety and wellbeing.
Concerns (9)
criticalCare planning — “Accurate, complete and contemporaneous records were not maintained for each person receiving support. This was a breach of regulation 17 of the HSCA 2008.”
criticalMissed or late visits — “My mum has 4 visits a day, but they don't always stick to the times she is supposed to have, might be a couple of hours late.”
criticalGovernance — “The provider did not have appropriate systems in place to assess, monitor and improve the quality of service delivery. They were in breach of Regulation 17.”
criticalStaff competency — “Gaps in employment were not explored, discrepancies between information identified at interview and on people's applications were not reviewed, and references were not validated.”
criticalSafeguarding — “Risk assessments were not completed correctly and were not updated in line with changes in people's health and support needs.”
moderateRecord keeping — “We found gaps in recording in both systems meaning there was not one place where details of the planned support and the delivered support was recorded.”
moderateStaffing levels — “Our analysis of call data showed at times there was not sufficient overlap of care workers time to ensure people that required support from 2 care workers received it.”
moderateIncident learning — “There were not systems in place to ensure adequate oversight and analysis of incidents and complaints to identify any themes or trends which may inform service improvement.”
moderatePerson-centred care — “Other people felt they were not involved in their care and had not been involved in the development of their care and support plan.”
Strengths
· People felt safe and comfortable with their care worker and had developed good relationships with regular care workers.
· Adequate systems were in place for the administering and management of medicines.
· Good infection prevention and control procedures were in place.
· Staff had training on how to recognise and report abuse and knew how to apply it.
· The provider worked in partnership with the local authority and had a service improvement action plan in place.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmGood
safe: Learning lessons when things go wrongGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
First inspection of Premium Homecare Ltd, a small domiciliary care agency supporting four people, rated Good across all five key questions. People received personalised, safe care from well-trained staff, with strong COVID-19 controls and an engaged registered manager committed to continuous improvement.
Strengths
· People received personalised care that met their needs and staff minimised risks to safety.
· Safe recruitment practices with criminal record checks, identity and right-to-work verification.
· No missed visits; staff arrived on time and stayed required length of time.
· Robust COVID-19 infection control measures, including arranging staff transport and shopping support during isolation.
· Staff completed regular training and competency checks, with frequent supervision sessions.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careGood
well-led: Working in partnership with othersGood
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 candourGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
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 candour; understanding quality performance, risks and regulatory requirementsGood
well-led: Continuous learning and improving careGood