Date of assessment: 12 October 2024 to 17 October 2024. We undertook the assessment in response to concerns about how the service dealt with safeguarding issues, and managing people's health needs. The service was performing well following the introduction of a new management structure. We found that processes around safeguarding people and learning from incidents had improved and staff were more confident about reporting concerns. Following the last inspection, improvements had been made in the management of medicines, recruitment and the quality of people's care plans and risks assessments; the service was no longer in breach of the legal regulations. There were enough staff to meet people's needs, however at times staff struggled to reach service users on time due to issues such as traffic and staff sickness. Care plans were person centred and contained a good amount of detail so that staff knew people's needs and preferences. This was an improvement following the last inspection and the service was no longer in breach of the legal regulation. Staff had completed a number of relevant training courses recently which they commented had improved their knowledge and skills. Staff enjoyed their jobs and were committed to meeting people's needs effectively. The manager listened to staff and people well, and there were processes to ask people for their feedback. The service had access to a specialist health team at provider level that could support and guide staff to help manage people's complex health needs. There were robust governance procedures in place, and managers were aware of risk. Staff felt confident about raising issues and felt they would be listened to. Improvements had been made following the last inspection around following policies, and managers were better at monitoring performance and outcomes; the service was no longer in breach of the legal regulation. The manager conducted audits and took action to make improvements when required.
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Premier Care Blackburn Branch received an overall rating of Requires Improvement at its first inspection, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) identified, including unsafe medicines management, missing or conflicting care plans, and shortened visit durations. A warning notice was issued for the Regulation 12 breaches, though caring was rated Good, with staff praised for their compassionate and dignified approach.
Concerns (9)
criticalMedication management: “One person had not been receiving the correct dose of their medication for several weeks. The error was noticed however, no action was taken to safeguard this person, such as informing their GP.”
criticalMedication management: “Time specific medicines were not always adhered to, for example one person was prescribed pain relief 12 hours apart...resulting in a risk of overdose or poor pain management.”
criticalCare planning: “Some people using the service did not have a care plan in place. This meant there was no information to guide staff on how to safely care for people.”
criticalGovernance: “Governance systems were not always effective. Audits had not identified the issues we found during our inspection.”
moderateCare planning: “We reviewed 2 people's mobility care plans and found them both to hold conflicting information on how to safely assist people with their mobility.”
moderateMissed or late visits: “Staff regularly did not stay for the full length of the call...They are supposed to have a half hour visit but they are here for about 20 minutes.”
moderateSafeguarding: “We did find incidents where safeguarding concerns were not always reported in a timely manner.”
moderateRecord keeping: “There were gaps in some people's medication records with no explanation.”
moderateStaffing levels: “Visit durations were not being monitored and addressed when short in duration. Feedback from people raised concerns around visits not lasting the full length of time.”
Strengths
· Staff spoke positively about people they support; people and relatives described staff as responsive, experienced, polite and friendly.
· Staff received training including the care certificate, with detailed induction and regular competency checks completed prior to working with people.
· Accidents and incidents were recorded electronically, enabling the registered manager to identify trends and take action to reduce risks.
· IPC practices were in place with sufficient PPE supplies worn in line with government guidance.
· End of life care wishes and advanced decisions around resuscitation were identified and recorded where appropriate.
Quality-Statement breakdown (17)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safely monitoring and management; Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
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 care; 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 preferencesRequires improvement
responsive: Meeting people's communication needsGood
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; understanding quality performance, risks and regulatory requirements; Promoting a positive cultureRequires improvement
well-led: Duty of candour; Continuous learning and improving care; Working in partnership with othersGood