Premium Homecare Ltd

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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

We assessed all the quality statements within this key question. Our rating for this question has remained requires improvement. We identified a breach of the legal regulations. Risks to people’s safety continued to not be effectively assessed, and management plans continued to not provide complete and accurate information about people’s needs. Complete records were not maintained regarding the administration of topical creams. A new system was in place for scheduling staffing calls, and we heard that improvements had been made regarding the timing of calls. However, we found call scheduling data was not reliable and showed staff in 2 people’s homes at the same time and no travel time. Processes had been improved for oversight of incidents and staff training and support processes.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people and their relatives said they felt they could talk to care workers if they had any safety concerns and that they would be listened to. One person said, “Yes, definitely, I can talk to staff.” Another family member said, “I raised a concern, and it was addressed”.

Staff were aware of reporting procedures to ensure any incidents or accidents were learnt from. They were aware of the importance of recording details and reporting the incident to the management team.

Individual incidents and accidents were now recorded on the electronic system. This enabled staff to detail the concerns and report on any follow up action to support learning and reduce risk of recurrence. At the time of our assessment, the management team were not using the reporting function on the system to analyse this data but had introduced a separate system to review incidents to identify any trends or themes that could be learnt from.

People said Premium Homecare worked well with other services to ensure their safety. A relative said they would be able to talk to Premium Homecare if they had any concerns about their family members safety. They told us, “I am in contact with them all of the time, as [my family member] is in and out of hospital all of the time, I know the regular ones, I will meet them”. Another relative told us, there were safe systems in place when their family member transferred to Premium Homecare. They said, “Both parties met and they did the hand over with both of them going in and it was dealt with very well”.

Staff were well informed about people’s needs prior to starting care. Staff told us, “Before we go to the clients our manager gives us information about the client and what to do for the client.” And, “If a new package is given to me then we have a care plan, and all the information is inside. If you read it carefully then you would have all the information.”

We didn’t receive any feedback from partner agencies about safe systems, pathways and transitions.

Policies and procedures were in place to support safe transitions. Information was collected from referring agencies and family members prior to starting any care packages.

Several people and their relatives told us they felt safe and free from discrimination when receiving support from Premium Homecare. A family member told us, “[My relative] had been refusing care initially, but they worked with us as a family to persistently and respectfully help to turn that around.” A relative told us care workers knew what to do when an incident occurred to safeguard their relative. However, during our conversations with people, a safety concern was raised and we shared this with the local authority safeguarding team.

Staff told us they had received training in safeguarding adults, and they would report any concerns observed. Staff said, “Yes. It makes me more confident as we have received training and we would discuss it with our managers.” And, “Safeguarding is a main thing. I always be polite with the clients and make them comfortable. If I feel any concerns re safeguarding, I will raise it with the office.”

Safeguarding adults’ policies and procedures were in place. Processes were in place to report and record any safeguarding concerns, and we saw any concerns received were shared appropriately with the local authority safeguarding team.

People felt safe with care workers and said that any risks to their safety were identified and well managed. A family member said they work with their relative, and other professionals so risks are managed safely, whilst enabling people to do what is important to them. They said, “They have looked at respecting him and maintaining his independence as much as possible, so a lot of working together and also working with the doctors, they have done all of that.”

Staff told us they were well informed about any risks to people’s safety. They said, “Information about risks to people’s safety is provided by our care management team. They teach us about the risk factors and we discuss our clients.” “All information about risks is in their care plan.” Staff were aware of what to do in a medical emergency to ensure people received prompt support. A staff member told us, “If someone had a fall, first I would contact the emergency services and then I would inform the office.”

However, despite the comments above, we found that systems continued to not be in place to ensure adequate assessment and management of 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. These included risks relating to people’s mobility, falls and skin integrity. This was a concern at our last assessment and we continued to be concerned that people’s safety was not being effectively assessed and managed.

On the whole, those that used equipment, told us they had all the equipment they required. However, one person said they did not have all the equipment necessary for their needs, and they could be more comfortable. They said, “I could have another pressure cushion, I have a recliner chair but it’s not that comfortable”. We discussed this with the registered manager, who informed us they would liaise with the community health teams to get the equipment reviewed.

Staff were aware of what equipment to use to ensure people’s needs were met safely. Staff told us, “Yes, we have training on using equipment. Some of this is face to face and some online. These sessions include question sessions to test our understanding.” And, “We are very trained regarding all the equipment. Especially if there is anything new, we get the training before we start using it.”

Processes were in place to liaise with local community health teams to discuss any equipment needs people had.

Most people and their family members said they felt care workers had the knowledge and skills to meet their own and their relative’s needs. However, one person said not all care workers had enough training, and that care workers may not get enough breaks. They told us, “I have had someone before who couldn’t do my personal care. I asked to go into my wheelchair but she didn’t know how to use the slider board. We got there in the end but not in the time allocated. She is very nice but I feel she should have more training… My main care worker has had to go home as they are exhausted.” Family members told us care workers do not always turn up on time. One relative said, “On average they do, weekends are different”. Another relative told us care workers do not have enough time to travel between care visits.

Staff felt well supported in their role and had access to training to update their knowledge and skills. Comments from staff included, “I feel like it’s a second family. They put us on lots of training. They will pick it up if we are struggling.” “They are very supportive. Whenever we need any help, they will help in any situation.” “They call us into the office for training. It helps me to improve upon my skills and my knowledge.” And “It’s a privilege to be part of premium homecare. I am proud and happy to work with Premium Homecare. I have improved my skills and my knowledge. My clients are lovely. I like working for my clients.” Staff told us they had sufficient time to undertake their duties and support people’s needs, but we received mixed feedback regarding travel time between appointments. Staff told us, “Sometimes the rotas are too tight. Sometimes it is difficult to get to people’s home on time because of the travel time.” “Currently our clients are not far from each other. It is a short walk. There are no problems because they are close to each other.” “I will always inform the client and the office if there are any difficulties with travel time, and then the office will adjust for next time. Overall, we have enough travel time.”

No new care workers had been hired since our last assessment so we were unable to review current recruitment practices. However, the providers recruitment policy was in line with best practice guidance and directed the provider to undertake appropriate checks prior to a person starting employment to ensure they were suitable. This also included guidance to follow when recruiting overseas workers. A new electronic care system had been introduced that had improved call scheduling. This enabled office staff to better coordinate double up calls. It also enabled them to track when staff logged into the system to ensure they arrived on time and stayed the required length of time. A staff member said, “The new system is better – you can’t get missed visits as it will highlight if there’s any concerns or lateness. The new system is more in depth.” However, from our analysis of call data we found this system was flawed and it showed that at times staff were logged into two people’s homes at the same time, and that there was no travel time between appointments. Staff had access to mandatory training and were expected to complete refresher training to ensure their knowledge and skills stayed up to date. A system had been introduced to ensure greater oversight of this process and track when staff were due to complete their refresher training. This system had been extended to also track staff support structures in place to ensure staff were well supported in their role.

People told us care workers wore appropriate personal protective equipment (PPE) to manage the risk of infection and keep people safe. One person said, “They wear gloves and shoe covers as I had the carpet shampooed and I didn’t want them walking in and out and they are very good and don’t put muddy shoes inside”. People also said care workers clean up after themselves, which help people keep their home environments tidy and hygienic.

Staff were aware of processes to follow to protect people from infections, including the use of PPE. Staff told us, “Yes, we have access to PPE. Sometimes our manager drops it off for us and sometimes we go to the office to collect. We always make sure there is spare PPE at the clients’ home.”

An infection prevention and control (IPC) policy was in place, and IPC practice was reviewed during spot checks to ensure staff adhered to the policy.

People did not have any concerns about how care workers managed their medication. One person said, “[The care workers] put it near me and I do it myself. They put cream on me as I can’t wash myself, but apart from that I take my tablets”. Another person told us, “They ask me about it (medication) and I tell them how often I’ve taken my medicine and this sort of stuff”.

Care workers told us they had received training in managing people’s medicines and were aware of how to safely administer people’s medicines. Staff told us, “We always make sure medicines are done on time. I always make sure I check the medicines they are using. If I observe any side effects then I report it. I always make sure my clients’ medicines are safe and that they don’t run out of medicines.” And, “Everything is described on their records. We check the right medicines and the right times. We write down everything on the medicine’s records.”

However, whilst we saw processes were in place to inform staff about what medicines people were taking. We found some instances where it was unclear as to who was administrating people’s medicines, whether this was the person, their family or the care worker, meaning there was a risk people would not receive their medicines. We saw some people’s support plans instructed staff to apply barrier creams to protect people’s skin integrity, however, topical cream administration records were not maintained, and therefore we could not be assured that these were applied as instructed.