Primera Assisted Living Limited provides care and support to people living in their own homes. The service provides support to older people, people living with dementia and people with a physical disability. We carried out our on-site assessment on 23 September 2024. Our off site assessment activity started on 9 September 2024 and ended on 30 September 2024. At the time of our inspection 79 people were being supported with personal care by the service. We looked at 2 key questions; Safe and Well-Led. We covered 11 quality statements; Safe systems and pathways, Safeguarding; Involving people to manage risks; Safe and effective staffing; Supporting people to live healthy lives, Capable, compassionate and inclusive leaders, Governance, management and sustainability and Learning, improvement and innovation. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered to support this population group.
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Primera Assisted Living Limited was rated Requires Improvement overall following a November 2022 inspection, with breaches of Regulations 12, 17 and 18 identified relating to unsafe medicines management, inadequate risk assessment, missed and late care visits due to poor staff deployment, and ineffective governance audits. The service demonstrated strengths in its caring approach, person-centred responsive care, staff training, safeguarding awareness and infection control.
Concerns (9)
criticalCare planning: “One person was at risk of choking due to dysphagia...the service had not requested for specialist support from a healthcare professional to ensure the person received a comprehensive swallowing assessment.”
criticalMedication management: “MAR stated to administer 1 tablet of a medicine twice daily; instructions also said to administer half a tablet of this medicine twice daily.”
criticalMissed or late visits: “On 1 occasion their relative did not receive their first care visit until 12:20pm when this should have taken place between 9:30am and 10am.”
criticalGovernance: “Management audits were not robust enough as they did not reveal the shortfalls we found in relation to the safe management of people's medicines.”
moderateMedication management: “Staff received training in safe management of medicines, they were not assessed to ensure they were competent to administer medicines.”
moderateMissed or late visits: “For 33% of the calls, staff had no travel time which could have affected call punctuality...a significant number of short and/or late calls.”
moderateStaffing levels: “4 out of 8 care workers commented on the lack of travelling time to get from one person to another.”
moderateGovernance: “They did not have a clear improvement plan in place to demonstrate the steps they were planning to take and details of any timescales.”
moderateIncident learning: “A staff survey carried out by the service in June 2022 revealed the difficulties staff faced...Suggestions from staff which had not been acted upon at the time of the inspection.”
Strengths
· People felt safe and protected from abuse; staff received safeguarding training and knew how to identify and report concerns.
· Staff followed appropriate infection prevention and control measures, with access to full PPE.
· Comprehensive needs assessments were conducted before care began, with ongoing reviews of people's needs.
· Staff received induction including the Care Certificate, regular refresher training, supervisions and appraisals.
· Staff were described as kind, respectful and caring, and respected people's faith, culture and religious beliefs.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
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
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: 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: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersGood