Premium Community Care Ltd was rated Requires Improvement across all five key questions following a June 2016 inspection, with three regulatory breaches identified covering medicines management (Regulation 12), governance (Regulation 17), and staffing (Regulation 18). While staff were described as caring and training systems were in place, persistent late calls, unsafe medicines recording, ineffective auditing, and poor complaints handling placed people at risk of harm.
Concerns (10)
criticalMissed or late visits: “records confirmed that people often experienced late calls and in one instance a person received their call one hour and 20 minutes late.”
criticalMedication management: “Records of medicines administered were inconsistent with the records of prescribed medicines...it was not possible to identify whether staff had supported people to take their medicines as prescribed.”
criticalStaffing levels: “No review or action had been undertaken to identify if there were insufficient numbers of staff employed or if the deployment arrangements needed to be changed.”
criticalGovernance: “Systems in place to monitor compliance with the regulations were not effective and had failed to identify that compliance was not consistently achieved.”
moderateCare planning: “There was no detailed guidance for staff about how they were to protect people from the risks associated with their health conditions.”
moderateIncident learning: “We found that incidents were not always used as a learning opportunity to improve how risks were managed.”
moderateComplaints handling: “We saw that no complaints had been recorded since 2013, however...some issues raised...met the definition of a complaint...but had not been addressed as such.”
moderateConsent / capacity: “although staff provided examples of how they encouraged people to make their own choices, they were not aware of the MCA.”
moderateRecord keeping: “one person's daily fluid and food monitoring notes were not consistently completed, with gaps in one person's daily records for up to 19 days on one occasion.”
moderateSafeguarding: “the registered manager had not met their requirements in relation to informing us of safeguarding incidents and concerns that had occurred.”
Strengths
· Staff knew how to report safeguarding concerns and had responded appropriately to concerns raised.
· Staff received training, supervision, and were supported to complete the Care Certificate during induction.
· People and relatives reported staff were caring, kind, and supported independence and dignity.
· People and relatives were involved in developing and reviewing care plans.
· Staff encouraged people to access healthcare professionals when necessary and followed healthcare guidance.
Quality-Statement breakdown (17)
safe: Staffing deployment and timeliness of callsRequires improvement
safe: Medicines managementRequires improvement
safe: Safeguarding awareness and responseGood
safe: Risk assessment and care records guidanceRequires improvement
Premium Community Care Ltd was rated Requires Improvement overall at this September 2017 inspection, with Safe, Effective and Responsive rated Good but Caring and Well-led requiring improvement due to inconsistent staff conduct, insufficiently embedded quality assurance processes, and gaps in care records including non-compliant DNACPR documentation. Previous breaches around call scheduling and medicines management had been resolved, though a new breach was identified for failure to display CQC ratings on the provider's website.
Concerns (8)
criticalConsent / capacity: “information was not recorded in adherence with the Code of Practice of the Mental Capacity Act (2005)... one person's care plan contained a small written note relating to their advance decision”
moderatePerson-centred care: “people could not always be confident therefore that they would receive a consistently caring service”
moderateGovernance: “quality assurance processes introduced since our last inspection were not fully embedded to always drive ongoing improvements to the service”
moderateRecord keeping: “some people's care records we sampled did not always reflect the full extent of people's needs and risks to always clearly guide staff as needed”
moderateCare planning: “one person's care plan omitted an aspect of the support they received to manage a healthcare condition, and the details of the guidance and training provided to staff”
moderateComplaints handling: “feedback and complaints had not always led to sustained improvements to the overall quality of the service provided”
minorCommunication with families: “systems had not ensured people's feedback was directly addressed and acted on following their involvement in quality assurance calls”
minorMissed or late visits: “some staff occasionally being late for people's calls and leaving calls too early”
Strengths
· Improvements made to medicines management since last inspection, with audits reducing recording errors and records completed clearly and correctly.
· Improved recruitment processes including DBS and reference checks consistently completed for all staff.
· Staff demonstrated good understanding of safeguarding, risk management, and how to escalate concerns.
· Staff received training in core areas including dementia care, MCA, infection control, and medicines management, and spoke positively about training and support.
· Complaints procedures improved with timely responses and evidence of learning; people and relatives confirmed complaints were addressed.
Quality-Statement breakdown (16)
safe: Medicines managementGood
safe: Recruitment processesGood
safe: Risk management and risk assessmentsRequires improvement
safe: Call scheduling and timelinessGood
safe: SafeguardingGood
effective: Mental Capacity Act compliance and consentGood
Premium Community Care Ltd achieved an overall rating of Good across all five key questions at its March 2019 inspection, having improved from Requires Improvement in Caring and Well-led since November 2017. The service demonstrated safe practices, person-centred care, effective governance and a supportive open culture with no regulatory breaches identified.
Strengths
· People felt safe and staff demonstrated clear understanding of safeguarding responsibilities.
· Sufficient staffing levels with no missed calls reported; safe recruitment practices including DBS checks in place.
· Medicines administered as prescribed with staff competency checks and MAR records confirming compliance.
· Staff completed induction including Care Certificate and received ongoing training with competency spot checks.
· People involved in care planning and reviews; care records personalised, up-to-date and held in people's homes.
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
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
caring: Dignity, respect and person-centred approach
Requires improvement
caring: Responding to people's feedback and viewsRequires improvement
responsive: Complaints handlingGood
responsive: Care planning and person-centred careGood
well-led: Quality assurance and governance systemsRequires improvement
well-led: Record keeping and documentationRequires improvement