Prime Care Domiciliary Essex

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. We assessed a total of 7 quality statements from this key question. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. During our assessment of this key question, we found 3 breaches of the legal regulations in relation to staffing, fit and proper persons employed and safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke to felt staff had received training to do their job. One person said, “They always know what they’re doing.” However, a relative told us, “I have tried on a few occasions to speak to someone in the office regarding [relative] but nobody ever answers the call. I am concerned about the way staff are supporting [relative] but I can’t discuss my concerns with anyone.”

Staff knew how to record accidents and incidents however, the reports often lacked information and detail. Staff told us, “I know how to report accidents and incidents. I always report everything to my manager.”

There were systems in place to record incidents and accidents which were reported by staff but these often-lacked information and detail. The manager reviewed incidents to identify where actions were needed but care plans and risk assessments were not always updated accordingly. There was no formal record of lessons learnt; however, the registered manager told us they discussed lessons learnt with staff during team meetings. The registered manager completed a monthly audit for accidents and incidents but these lacked detail and were not analysed for themes and trends.

A relative told us, “They came out and saw us and did an assessment and there is a care plan in the house. They are very flexible and helpful if you need them to do something extra, it’s never a problem” and “I have all the office numbers and I would speak to them if I had a problem with anything, but it’s all been very professional and helpful”. However, another relative told us, “This was arranged by the hospice. They didn’t come out to see me, they just turned up, and no there isn’t a care plan anywhere and they haven’t asked anything.”

The operation manager told us they worked with the local hospital to help people transition from being in hospital and back to their own homes with the support of care workers.

We received positive feedback from a health professional. They told us, “Prime care are a reliable option for us when sourcing packaged of care in the community and will always feedback in a timely manner if their carers feel that a patient requires more care visits/double handed support.”

The systems in place for when people move between services were not always robust. The registered manager kept a copy of the hospital referral in people’s care plan. However, this information was not always updated and amended on the electronic system for staff to have up to date information about people’s individual care and support needs. People's care plans and risk assessments were not always personalised, and support was not always delivered in line with people's care plan guidance.

People were protected from the risk of abuse and told us they felt safe using the service. One person told us, “I feel safe, and I have no concerns when the carers come to see me.” Another person told us, “Well we have had it [care service] 8 months now and I am thrilled with it, I was concerned about (relative) having carers as you hear such awful things, but it has been so good, very professional.”

Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people. This action included informing other agencies if they were concerned about action being taken. A staff member told us, “I would report to my manager, and I would escalate to Local authority if I needed to”. However, the staff training matrix did not provide any dates of when staff completed their safeguarding training. This meant we cannot be assured staff were trained and skilled in supporting people safely with the relevant training required. Following the assessment, the operations manager sent an updated training matrix which included dates of completed staff safeguarding training.

Safeguarding policies and procedures were in place however, these were not always followed when safeguarding incidents had occurred. The registered manager had been raising safeguarding alerts with the local authority however, there had been occasions whereby statutory notifications had not been sent to CQC as required. Providers must inform CQC of all incidents that affect the health, safety and welfare of people who use services. Limited information was being recorded in the investigation reports. Accident and incidents were documented but there was little evidence the service used this information to learn from and prevent a similar accident or incident from occurring in the future. The failure to notify CQC of notifiable incidents is a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Most people felt involved in planning their care and managing risks. However, a relative told us, “Well we have had it [a care service] 4 to 5 months, we wanted another agency, but they were full, so this was arranged by the hospice. The carers come twice a day, 2 people, I never know who is coming but staff do always turn up on time. I have some issues [relative] is getting sore under their arms and groin, the District Nurses are measuring the sores and say it’s because the staff are not drying [relative] properly and I have said to the carers, but they say they are. They are lovely people, but they just don’t seem to know what to do.”

Staff knew people they cared for well, however, changes to people’s care needs were not always recorded or updated. A member of staff told us, “I always read any information that comes through on the care plan so I am fully aware of what needs to be done and how I can support the person.”

Risks to people's safety and wellbeing were not fully assessed, recorded, or provided enough detail as to how identified risks should be managed and mitigated. For example, people’s specific healthcare needs had not been assessed. A person who required support with their mobility did not have a risk assessment or care plan in place for his mobility needs. People's care plans and risk assessments were not always personalised, and support was not always in line with people's care plan guidance. Improvements were required to ensure completed care plans and risk assessments were person centred and included how risks to people were to be mitigated and reduced. Some information was generic and not personalised to the individual people using the service. Care plans did not include end of life wishes. We recommend the provider seek and implement best practice guidance and training for staff on end-of-life care to ensure support plans are consistent, person-centred and respectful of people's wishes about end-of-life care.

People received personal care and support in their own homes. People and relatives told us they had not seen a completed environmental risk assessment to provide staff with guidance on how to keep people safe and minimise risks in their own home environment.

The operations manager told us, ''We involve families and health professionals when formulating and reviewing the care plans and work closely with them on a regular basis.'' However, we found risks to people's safety and wellbeing were not fully assessed, recorded, or provided enough detail as to how identified risks should be managed and mitigated.

Risk assessments had not been completed to provide staff with guidance on how to keep people safe and minimise risks. For example, there was no risk assessment in place describing risks to people's home environment. Following the assessment the registered manager told us they will be implementing risk assessments for people's home environments.

Most feedback we received was positive from people on staffing. One relative said, “Staff are really very good, they have never not turned up, we have never had a problem. We have never experienced a missed call, and they are very rarely ever late.” However, a relative told us, “I don’t wish to sound awful but some of their English isn’t so good, they say they understand what you have said and then go and do something completely different.”

Staff told us they were happy working at the service and with the support they received from the management team. However, a member of staff told us, “I don’t feel any pressure from the manager. However, travel time is included in my calls, so I make sure I leave on time to make it to my next call.”

The registered manager had not always ensured staff were safely recruited. We saw gaps in recruitment files, such as staff not having a completed application form containing medical history, no documentation on staff files in relation to their interview, and not all references received had been verified. Some staff did not have signed contracts on file and one member of staff only had one reference. Staff were subject to Disclosure and Barings checks. (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, one employee’s DBS check was completed after they had already started working. There was no risk assessment in place for this staff member. This demonstrated a breach of Regulation 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Staff told us they were supported with an induction when they first started working. However, the induction on file comprised of one day and did not demonstrate a robust induction had been completed to enable staff to carry out their role and responsibilities effectively. Not all staff received regular support in the form of a supervision. Staff told us they have regular supervisions; however, this information did not concur with the care agency's supervision matrix. This meant there were no effective arrangements in place to monitor staffs' practice, performance and professional practice. This was a breach of Regulation 18 Staffing of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

People were supported by staff who had received training in how to manage infection prevention and control. A relative told us, “They always have their PPE (personal protective equipment) on and change it when they need to.”

Staff told us when new people started using the service personal protective equipment (PPE) was supplied to them for staff to use. When PPE levels needed to be replenished this was collected by staff from the service office.

Staff had received training in infection prevention and control and were observed by senior staff periodically during spot checks to ensure they were following their training. However, the staff training matrix did not provide any dates of when staff completed their training. This meant we cannot be assured staff were trained and skilled in supporting people safely with the relevant training required. Following the assessment, the operations manager sent a updated training matrix which included dates of completed staff training.

A relative we spoke with told us, “The staff are very good with medication. I have no concerns.” A person told us, “They help me with my medicines and write everything down.” Another relative told us, “My [relative] has set up a dosette box, but they do check it’s been taken and when there was a change in medication, the main carer wanted it all explained to him and sorted out the paperwork, we are really happy (relative) is safe with them.”

Staff had received training in managing medicines and had their competency checked. A member of staff told us, “I had my medicines training, and my manager carried out observations and checked my competency.”

The provider had a medicine management policy in place for staff to follow and all staff received training. If people were being supported with medicines an electronic medicine administration chart was put in place. This contained all the information staff needed to safely support people with medicines.