Premier Care Limited - Trafford & Manchester Homecare Branch

Premier Care Limited - Trafford & Manchester Homecare Branch is a domiciliary care provider. It provides personal care to adults and older people in their own homes. Not everyone who used the service received personal care. 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 the time of our inspection the service supported 143 people with personal care.

People’s experience of using this service and what we found

The service had continued to improve since the last inspection. Medicine concerns identified at the last inspection had been resolved. The risks associated with people's medicines were now managed safely. Further improvement was still required to ensure visit schedules were not impacting negatively on people’s care.

The improvements implemented at the last inspection had been sustained. The staff culture was good and most staff we spoke to felt supported. The provider was working closely with the Local Authority and there was a schedule of audits in place to help drive further improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 October 2023) and there were breaches of regulations. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 1 March 2023. During this inspection the provider demonstrated that enough improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced focused inspection of this service on 29 & 30 August 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Limited - Trafford & Manchester Homecare Branch on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the Local Authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Premier Care Limited - Trafford & Manchester Homecare Branch is a domiciliary care provider. It provides personal care to adults and older people in their own homes. Not everyone who used the service received personal care. 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 the time of our inspection the service supported 171 people with personal care.

People’s experience of using this service and what we found

Not enough improvement had been made since the last inspection. Medicine concerns identified at previous inspections had not been resolved. Medicines audits had not been effective at identifying, resolving and preventing issues occurring. This meant people were at risk of avoidable harm. Governance systems had failed to address the management of visit schedules, which meant staff were frequently late to calls and there were delays in people receiving the care and support they needed. This had a negative impact on people’s care and their experience. The service has a long history of non-compliance, this is the eight consecutive inspection the service has been in breach of regulations.

The registered manager had been in post 9 months and had led improvements in some areas of the service. The staff culture had improved, and staff told us they felt valued and supported in their work. Systems to manage safeguarding concerns were now effective and there was a schedule of audits in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 01 March 2023) and there were breaches of regulations. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 23 & 24 January 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Limited - Trafford & Manchester Homecare Branch on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We took enforcement action but this did not proceed fully through an appeals process, as a later reinspection of the service demonstrated that improvements had been made.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Premier Care Limited - Trafford & Manchester Homecare Branch is a domiciliary care provider. It provides personal care to adults and older people in their own homes. Not everyone who used the service received personal care. 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 the time of our inspection the service supported 326 people with personal care.

People’s experience of using this service and what we found

The risks associated with people's care were not always managed in a safe way. This included out of date care plans, poor management of home visits, high use of agency staff and poor management of medicines. This meant people were at risk of avoidable harm. Systems to manage safeguarding incidents had not been effective or consistent and we could not be assured that the correct processes had been followed. Opportunities to learn had been missed.

Quality issues identified at the last inspection had not been resolved. There had been a lack of robust systems in place to monitor the delivery of care and this impacted on the care that people received. Audits had not been effective at identifying or preventing issues occurring or continuing at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 February 2022) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the safe management of visits to people’s homes. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last focused and comprehensive inspection, by selecting the 'all reports' link for Premier Care Limited - Trafford & Manchester Homecare Branch on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Premier Care Limited - Trafford & Manchester Homecare Branch (known as Premier Homecare) is a domiciliary care agency providing personal care for people living in their own homes. The service was supporting 220 people at the time of our inspection.

People’s experience of using this service and what we found

Risk assessments had not always been reviewed and the guidance to manage the risks was not always clear or detailed enough. Staff wore the required Personal Protective Equipment (PPE).

Premier Homecare had struggled to recruit to vacancies in their office staff. This had resulted in care plans not always being reviewed, staff spot checks / observations and supervision meetings not being completed. Staff had been safely recruited.

Quality audits were not completed for care plans, daily notes and staff files. The provider’s quality team had started to support the service and had identified similar issues in October 2021.

People received their medicines as prescribed. Monthly medicines audits were completed, and any issues identified had been actioned. Improvements had been made in the management of medicines since our last inspection.

People were very positive about the support provided by the permanent Premier Homecare staff. However, they had several issues with the agency care staff used to cover calls. We were told the agency staff rushed the calls.

Care staff said they felt supported and could contact the office if they had any issues. However, they also noted that this was more difficult since the office staff numbers had reduced.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 June 2020) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

We carried out an announced focused inspection of this service on 30 January to the 5 February 2020. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection (September 2019) to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last focused and comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Limited - Trafford & Manchester Homecare Branch on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the lack of detailed guidance for managing risks, the risks not being reviewed as planned and the quality assurance system not being robust at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Premier Care Limited - Trafford and Manchester Homecare Branch is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

People’s experience of using this service

The systems in place to manage people's medicines were unsafe which placed them at risk of harm. There were discrepancies with the records kept and the procedures staff followed. People were at risk of not receiving their medicines as prescribed, and the provider's monitoring of the safe administration of medicines was not robust.

The systems for auditing and monitoring accidents and incidents needed improving. Governance systems had not identified the issues we found with the unsafe management of people's medicines. Systems were in place for gaining feedback from people and their relatives about the quality of care they received.

People's care plans had continued to be updated since the last inspection to make them more person centred and now contained a wider range of information.

Staff had awareness of safeguarding and knew how to raise concerns. Systems were in place to recruit staff safely; there were sufficient numbers of trained staff to support people safely. Staff followed safe infection control practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was requires improvement (published 09 January 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 11, 12, 19, 20 and 25 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Limited -Trafford & Manchester Homecare Branch on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Premier Care Limited – Trafford and Manchester Homecare Branch is a large domiciliary care agency. The service provides care and support to primarily older adults living in their own homes in the Manchester and Trafford areas of Greater Manchester.

Not everyone who used the service received personal care. 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.

People’s experience of using this service and what we found

The systems in place to manage people’s medicines were unsafe which placed them at risk of harm. There were discrepancies with the records kept and the procedures staff followed. People were at risk of not receiving their medicines as prescribed, and the provider's monitoring of the safe administration of medicines was not robust. Information was not always in place to identify to staff where to apply people’s creams. Governance systems had not identified the issues we found with the unsafe management of people’s medicines.

Accidents and incidents were not always acted upon and there was limited information about what action had been taken for some incidents. The systems for auditing and monitoring accidents and incidents needed improving.

Some people’s care plans had been updated since the last inspection to make them more person centred. However, there were limited details in one person's care plan on how staff should support their mobility needs, and the equipment to be used.

People told us they were supported by a group of regular staff who had developed relationships with them. People told us staff knew them well and supported them in a friendly and respectful way. People and their relatives were complimentary about the staff and their caring attitude. Staff supported some people to access other healthcare professionals when required. Staff supported some people to access the community.

Staff had awareness of safeguarding and knew how to raise concerns. Systems were in place to recruit staff safely; there were sufficient numbers of trained staff to support people safely. Staff received training, support and induction to enable them to meet people’s needs.

People were involved in making decisions about their care and involved in reviews to ensure their care plans met their needs and supported them to achieve outcomes. People’s needs were assessed before starting with the service. People knew how to make a complaint. There was an effective complaints process in place to deal with any complaints that might be raised in the future.

Systems were in place for gaining feedback from people and their relatives about the quality of care they received, and the latest feedback we saw was positive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 06 March 2019) and there were four breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made in some areas and the provider was still in breach of regulations. This is the fourth time this service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. During the inspection, the provider took action to mitigate the risks identified but this had not always been effective. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Premier Care Limited - Trafford and Manchester Homecare Branch on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Premier Care Limited – Trafford and Manchester Homecare Branch is a large domiciliary care agency. The service provides care and support to primarily older adults living in their own homes in the Manchester and Trafford areas of Greater Manchester.

People’s experience of using this service:

Most people using the service told us they were satisfied with the service they received. People were usually supported by consistent teams of staff who knew them and understood their needs and preferences. During our home visits we observed positive, respectful and professional interactions from the staff providing support to the people we visited.

People told us care staff were often late, although they did not feel this had a significant impact on the care they received. The provider monitored staff timeliness through the use of electronic call monitoring. This showed calls were in most instances attended within the provider’s 35-minute tolerance. Staff were not always given time on the rota to travel between calls, which meant it was inevitable in some cases that they would be late.

Medicines were not managed safely, and there had been few improvements in this area since our last inspection. There were issues with the records kept, planning how people would receive their medicines and the procedures staff followed. People were at risk of not receiving their medicines as prescribed, and the provider’s monitoring of the safe administration of medicines was not robust. The provider had notified us of six medicines errors that they had deemed to be safeguarding concerns since our last inspection.

Most people felt the staff supporting them were competent. Whilst staff were generally satisfied with the standard training they received, there was a lack of in-depth training in relation to topics such as specific health conditions, diabetes and dementia.

Whilst the provider had carried out necessary pre-employment checks, we found shortfalls in their staff recruitment processes. Some staff had gaps in their employment histories without a recorded explanation. Several staff had been recruited despite not meeting the provider’s score thresholds for the interview process. Where this was the case, there was no recorded justification of the decision to recruit the applicant, nor details about any additional support or checks that would be carried out to ensure those staff had the necessary skills to carry out their duties.

Whilst care staff we spoke with understood people’s care needs, we found this information was not always reflected in people’s care plans. Assessments were heavily based on tick-lists with little further information given to staff about how to meet people’s identified needs. We found instances where significant information relating to the care people needed, and potential risks to their wellbeing had not been recorded in their support plans. Office based staff were also unaware of these details in some instances.

Whilst staff had recorded information about people’s social histories, there was very little information in care plans about people’s preferences, including food preferences, how they received their care, or the gender of staff that provided their support. This would make it more difficult to provide consistent care that was person-centred and met people’s needs.

People received an annual quality assurance visit and review of their service. People told us they felt involved in decisions about their care. The provider sought feedback from people using the service and people told us they were confident to provide honest feedback.

The provider was not operating robust procedures to monitor the safety of the service, or learn lessons when things went wrong. The provider aimed for supervisors to audit 20 percent of daily logs and medication records. This meant the majority of these records were not checked, and issues had not always been identified on those that had been checked. There was no overview of accidents people using the service sustained if staff had not observed the actual incident, which limited how effectively the registered manager could monitor whether people might require additional support or referral to another service.

The provider had notified us of nine missed calls since our last inspection. They had investigated the reasons for missed calls and had taken action, such as disciplinary action against staff. However, there was no clear overview of missed calls or apparent monitoring of trends,

Premier Care - Trafford and Manchester Homecare service is a large domiciliary care agency. The registered manager was supported by four office based care co-ordinators. Tasks such as auditing of daily logs and medication records, and writing care plans was delegated to supervisors who worked primarily ‘in the field’. We found office based staff did not always have a clear picture of the support people were receiving. We also found information we requested was not always readily available.

Rating at last inspection:

We last inspected this service on 12 and 13 September 2017 when we rated the service requires improvement. The report was published on 21 November 2017. This is the third consecutive time the service has been rated requires improvement.

Why we inspected:

This was a planned comprehensive inspection to follow-up our last inspection when we rated the service requires improvement. Following our last inspection, we asked the provider to complete an action plan telling us how they would become compliant with the two breaches of regulations we identified relating to good governance and safe care and treatment.

Enforcement:

We are considering options in relation to enforcement action. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to the end section of reports after any representations and appeals have been concluded.

Follow up:

• We identified breaches of the regulations relating to good governance, employment of fit and proper persons and safe care and treatment. We will request an action plan from the provider to tell us how they plan to address the concerns identified at this inspection, and make improvements to ensure the service is rated at least good at future inspections.

• We will request that the provider meets with us and commissioners of the service to discuss how they will make improvements.

• We will continue to monitor the service.

Premier Care Limited – Trafford and Manchester Homecare Branch (Premier Care) is a large domiciliary care agency. The service provides care and support to adults living in their homes in the Manchester and Trafford areas of Greater Manchester. At the time of our inspection, the service provided care to 340 people and employed 125 members of staff.

We last inspected the service in April 2016 when we rated it requires improvement overall and identified breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care, good governance and complaints. At this inspection we found the provider was now meeting the regulations in relation to person-centred care and complaints. However, we found an ongoing breach in relation to good governance and identified a new breach of the regulations in relation to providing safe care and treatment. You can see what action we have told the provider to take at the back of this report. We have also made a recommendation that the provider reviews good practice guidance in relation to implementation of the Mental Capacity Act (2005).

We found people’s experiences of the service varied widely. Some people were very happy with the support they received from kind and caring staff and told us they were listened to. However, others reported inconsistencies in the caring approach of staff and felt communication with staff at the service was poor. Some people told us members of care staff they had not seen before were often sent without them first being informed, or the new member of staff introduced.

Since our last inspection, we had received several notifications from the provider of missed and late calls that had affected people’s care. People told us they had not had any recent missed calls, but reports around the timeliness of calls varied. The provider told us they aimed to attend all calls within 30 minutes of the allotted time. Their electronic call monitoring system showed the majority of calls were attended on time. Less than 3% of 5,377 calls the week prior to our inspection had been more than 35 minutes early/late.

Records of medication administration were not always clear and we found repeated examples where staff had not signed to show they had administered medicines. The provider did not have an effective system for monitoring the completion of medication records and took ineffective action to follow-up potential medicines errors.

Staff and the provider had identified and reported potential safeguarding issues to the local authority and CQC as required. Staff had received training in safeguarding and safeguarding was also discussed in supervisions and team meetings. The provider had completed investigations as required when this had been requested by the local authority safeguarding teams.

Staff had considered and documented potential risks to people’s health and wellbeing. However, we found these assessments were not always accurate, and there were not always clear plans in place to help staff reduce any risks. For example, one person was indicated as being vulnerable if they left their home and another person was shown as being at risk of pressure sores. However, there was no clear information on how staff should help reduce such risks.

Staff had received a range of training relevant to their job roles and had regular supervisions. Staff told us they felt supported and said they were able to approach the registered manager with any concerns they might have.

We found some people’s care files contained consent forms in them that had been signed by relatives. However, there was no evidence the service had considered whether people’s relatives had legal authority to provide consent on their family member’s behalf.

People told us staff respected their privacy and dignity. Staff supported people to retain their independence, and people reported they were never rushed by staff during their calls.

Records of complaints showed the provider had promptly investigated and responded to formal complaints. People told us they would be confident to raise any concerns with the provider and we saw staff checked people were aware how to raise a complaint during ‘spot check’ visits. Most people we spoke with told us they had been satisfied with actions taken by the service in response to any concerns, such as not sending the same staff members to them again, although this was not everyone’s experience.

Care plans were personalised and contained information on the health and social care support needs people had. People told us staff had talked to them about their preferences for their care and had incorporated this into the care plans. However, we found copies of care plans in the office had not always been kept up to date and did not always reflect the support people were currently receiving.

We received mixed reports from people using the service as to whether there was effective communication with the provider. Some people found office based staff responded promptly to any queries or requests they had. However, other people told us phone calls to the office often went unanswered or were not returned when they had left a message.

Staff were motivated and happy in their job roles. They told us they felt the service was well organised and well run. The staff we spoke with demonstrated caring values.

The service had a registered manager in post who was supported by a team of care co-ordinators who also assumed some management responsibilities. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had sought feedback from people using the service via surveys and telephone interviews. The majority of the feedback received had been positive, and the registered manager had followed up any concerns raised by individuals. However, people told us they had received no feedback on the findings of these surveys that they had regularly completed.

There were few audits in place to monitor the quality and safety of the service. For example, there was no formal medicines audit and we found checks of care records returned to the office were blank on all the documents we looked at. There provider used an external auditor to carry out a twice yearly review of the service on their behalf. However, we saw they had not acted on a number of concerns identified in these reviews that we found to be ongoing at this inspection.

The previous inspection took place in April 2013, when no concerns were identified.

Premier Care Homecare is a domiciliary care service which means it provides care and support, including personal care, to people living in their own homes. At the time of this inspection the service was providing support to around 350 people in Manchester and Trafford. People received between one and four calls a day. There were approximately 140 staff. They were organised and supported by a team of office staff based in Stretford.

There was a registered manager who had been in post since 2012. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people generally were happy with their regular care workers. There were very few missed calls reported. When there was a missed call it was investigated in order to prevent a recurrence.

Premier Care Homecare were using modern technology to ensure care workers had accurate rotas and to reduce the number of missed or late calls. This enabled staff to log in or out and alerted the office if a care worker had not arrived.

However, there was still a high rate of late calls, some of which had been reported to the CQC. Many of the 24 people who were using the service and ten relatives we spoke with said they had received late calls, especially when their regular care workers were not on duty. Other people told us that carers were unreliable, coming at different times. There had also been a missed call for someone who had just come out of hospital. We found there was a breach of the regulation relating to meeting people’s needs.

Staff were trained to recognise any signs of abuse and report them as needed. The registered manager conducted disciplinary proceedings to ensure a safe service was maintained.

Safe recruitment practices helped to ensure only suitable staff were employed. Staff were trained in the administration of medicines and kept records. We have made a recommendation relating to improving the handling of medication.

There was a system of training and shadowing for new staff. There was a specific form used for supervision at the end of training to ensure that staff were ready to deliver care independently. Existing staff received regular refresher training from an in-house trainer. Staff could also receive more detailed training in other subjects. The provider attached high importance to the delivery of training.

Staff received regular supervisions and spot checks, which were unannounced.

The Mental Capacity Act 2005 was applied when appropriate and the service had conducted its own mental capacity assessments.

Staff could help with food preparation. They would co-operate with medical professionals.

The majority of people we spoke with thought the care workers were caring and helpful. Some people said they enjoyed their company and regarded them as friends.

There was also some negative feedback, but in some cases there were alternative explanations. When people told us about isolated examples of poor care, the registered manager said she would take immediate action.

The service stored records securely.

The care planning and risk assessment system used by Premier Care Homecare was thorough and person-centred. Information was obtained about people’s life history in order to enable staff to engage with people on a personal level.

One problem we encountered was that the care planning document was completed by hand and was not always easily legible.

Care plans were reviewed at regular intervals in the home of the person receiving the service.

Annual surveys were done but the results were kept at head office.

We saw that complaints were not always handled effectively.

Staff were aware of the vision of the service. The office staff worked efficiently and the structure of the organisation meant the registered manager could delegate responsibility.

We saw reports from Manchester City Council had been responded to positively.

People using the service could often not recall completing a survey, but said they could speak to the office if there was a problem.

The registered manager reported events to the CQC as required under the regulations.

Staff meetings were held in the different areas where staff worked

Audits were completed by head office which identified whether all required documents were present in files but did not assess the quality of the contents. This meant there was insufficient monitoring of the service. This was a breach of a regulation under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In relation to the breaches of regulations you can see what action we have required the provider to take at the end of the main report.

Three people who used the service confirmed staff asked for permission before carrying out any activity. One person told us 'staff ask permission if something is new and they are respectful and always knock on their door and wait to enter".

We looked at four peoples care files. We saw they were clear, concise and provided staff with up to date information. We saw information including personal details, health and care information, care planning, risk assessments and evaluations. We saw that staff had completed dates and times of visits.

During our inspection we looked at three staff files. We saw evidence of up to date training relevant to their role including basic life support, responding and recognising abuse.

We spoke with staff. They told us 'The manager is very good, if there was a problem or a concern they were able to go to them'. Another person told us they were 'happy, felt supported and listened to by the manager'.

People told us they had their care delivered at the right time, usually by the same people and in ways they wanted. One person said 'They usually come at the same time now, it used to be different times. We have a routine now and we get the same staff."

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe with the care staff and said they would report any concerns to a manager. One person said "There is a book with a list of people I can speak to. The office staff are good and I can phone them whenever I want."

Staff told us they felt supported and they could always get hold of a manager for advice and support. We found that staff were very respectful in they way they talked about the people they supported and the care they provide. All of the people we spoke to said the staff treat them with respect and dignity.