Primera Assisted Living Limited

On this page

• 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

People were protected from the risk of harm and abuse. People were supported to understand and manage risks around their care. Risk assessments and care plans were clear and provided suitable guidance for staff to keep people safe. There were sufficient and appropriately trained staff in place to support people. People told us staff were reliable and punctual. This service scored 69 (out of 100) for this area.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team told us they maintained a culture of safety in the service based on openness and honesty, where concerns were listened to and incidents were reported and investigated. Staff confirmed they knew how to respond to incidents and accidents involving people they supported. A staff member said, "I immediately inform the office if something has happened to a client and I record it in the notes. The manager will look into it. I also know how to report safeguarding." The registered manager said, "We have improved the level of reporting since our last inspection. Carers are reporting more, such as witnessed and unwitnessed incidents, for example if a service user told them they fell outside of care hours."

We saw examples of learning in the service following incidents or complaints and concerns that were raised. However, we did not see much evidence of how the provider learned lessons from individual incidents or developed creative ways of helping to improve the quality of life for people. This was because accident and incident forms did not contain a section for learning lessons to prevent future re-occurrence of the incident. Despite this, it was clear that there was collaboration between the registered manager, senior staff and care staff on what improvements were needed in the service. There were quality assurance processes in place to help the service maintain standards and continuously improve the service.

Staff and managers were able to tell us how they initially assessed people that had been referred to the service through the care pathway, for example from hospitals or the community. The management team worked towards a collaborative, joined-up approach to safety that involved people, their relatives and professionals, such as doctors and social workers. The registered manager told us and records showed systems were in place to maintain people's safety. Specific risks to people were assessed and monitored. The service supported people through their care journey, for example if they transferred to another service or were admitted to hospital. When people moved between services, leaders ensured they used the correct referral pathway in accordance with the person's current arrangements. The registered manager told us relevant information about people's needs was shared between them and partner agencies in a timely manner.

There were processes and systems established for care to be provided to people in a way that was safe and for their needs to be assessed and understood. People's needs, risks and preferences were assessed and people were involved in the process. The provider had procedures in place to ensure safe care was carried out and people received care from staff that was appropriate and delivered as required. People told us their safety was assessed by the service so they could be provided the appropriate level of care for their needs. They felt safe with care staff, who knew how to support them. People told us the service worked with them to ensure their safety was monitored and managed.

People and their relatives felt the service was safe. Comments from people and relatives was positive regarding being safe in the company of staff. A person told us, "I feel safe. I have someone [staff] coming into my home, they are good. I’m happy with that." A relative of a person said, "[Family member] feels very safe. The carers are trustworthy and they treat [family member] with respect. They have a rapport with each other. I’m confident I could leave them with [family member] while I did something.” People also told us the service was reliable and staff were polite and punctual. If staff were running late, people told us they were informed by the service to reassure them that they would be attending. Records we viewed confirmed this. A person said, "We know the rough times the carers are going to show up. It’s a small pool of carers. Most we recognise."

Staff and leaders understood how to protect people from the risk of abuse, such as bullying, harassment, discrimination, physical harm and neglect. Staff and managers told us they made sure they shared concerns quickly and appropriately should they identify people at risk of abuse. A staff member said, "I would report abuse immediately to my manager." Staff worked with leaders such as field supervisors and the registered manager to make sure safeguarding processes were followed. Staff told us they knew how to identify possible abuse, for example what signs to look out for. They notified the Local Authority about safeguarding concerns. Staff told us they would be confident to escalate safeguarding concerns internally and to the CQC.

There were clear and up to date safeguarding systems and processes in place that considered the protection of human rights and protecting people from abuse, neglect and discrimination. The provider had a procedure for safeguarding adults so that concerns could be reported. The service worked with partner agencies such as local authority safeguarding teams. Staff were trained in safeguarding and had a good understanding about how to protect people from different forms of abuse. The provider's safeguarding policy and processes were in line with relevant legislation. This ensured people were safeguarded from the risk of abuse and their rights were upheld.

People and their relatives told us staff worked with them to protect them from coming to harm. They told us the service had carried out and assessment of their needs and risks. A relative of a person told us, “The carers have been coming for 3 ½ years. I know most of the carers I feel confident with them with [family member].” Another relative said, "The staff are trained and knowledgeable. We discuss everything so they understand [family member]."

At our last inspection systems had not been established or were not robust enough to demonstrate risks to people were safely managed. This placed people at risk of harm. This was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12. The management team completed regular audits and risks were reviewed if there were changes to people's needs. Risks to people had been assessed and risk assessments had been put in place to help mitigate risks. These risks included area such as supporting people with their mobility, food and drink, medicines, health conditions and their personal care. People and relatives told us staff knew how to support them or their family members with known risks. There were systems in place for staff to report concerns, incidents, and accidents. The registered manager had oversight of this so they were able to manage risks.

People told us staff were trained to support people in their own home environment. Records showed an assessment of the person's environment was carried out. People told us they were supported by staff who were trained and who respected their homes. A person said, "I feel safe. You have someone coming into your home and staff are good. I’m happy with that.”

Assessments were carried out to ensure staff and people had a safe working environment in people’s homes. For example, assessments around environmental hazards and risks were completed during an initial assessment of the person. Records confirmed people using the service had the necessary risk assessments and guidance for staff in place. Staff told us they were able to access support from senior managers out of office hours. The registered manager was also available on call when needed, for example if there was an incident or emergency.

At our last inspection we found staff were not effectively deployed to ensure people received their care visits as planned. This was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 18. There were processes in place to ensure staff were deployed in the community effectively and they knew where they had to be and at what time. A rota was provided to staff with all their scheduled visits. Staff told us they had enough time to travel in between visits to people so that they were not delayed and could arrive on time. Staff were required to log in and log out of calls at each visit and the information was connected to the providers electronic call monitoring system that was tracked by senior staff in the office. People told us the service was organised and reliable which enabled them to receive care as planned. However, some people and relatives told us staff could sometimes be late, especially if their main care staff were not available. We carried out an analysis of calls made to be people over the previous 2 months using the data and found some concerns with staff failing to log in and out correctly and some staff frequently late. However, records showed the provider was aware of issues some staff had with the system, which did not always enable them to log in accurately. The registered manager also regularly monitored individual staff member's performance in relation to their availability and punctuality. This meant action was taken if staff were found to be persistently late. We received assurance from the registered manager they were investing in new and more reliable call monitoring system.

The provider had robust and safe recruitment practices to make sure that all staff were appropriately and safely recruited. The registered manager ensured the process was thorough and processes were followed correctly. The management team carried out recruitment checks prior to staff working with people to determine they had the right level of temperament, qualifications, and skills to meet the needs of the people using the service. Police checks were also carried out to check for previous convictions and references and proof of eligibility to work in the UK were obtained. The management team pursued professional references for new staff and their work history and experience was explored. This enabled them to make safe recruitment decisions. Staff undertook a week long induction followed by 2 days of shadowing more experienced staff before they started working full time on their own within the community. Shadowing helped staff get to know each other, the processes they needed to follow and the people they supported. People and relative's feedback confirmed that staff were professional, competent and caring. A relative said, “For me the personal caring side is done very well. The rapport they have with [family member] is good. I praise them for what they are doing.” Staff told us they went through a thorough recruitment and induction process before starting their roles. Staff received training, regular supervision and support from the management team. Staff told us that the training helped prepare them for supporting people with their care. Staff were trained in topics such as safeguarding adults, infection control, moving and handling, medicine administration and the Mental Capacity Act (2005). They received continuous training and support throughout their employment with the service to ensure their learning was refreshed. A staff member said, "The training was excellent and was very helpful."

Infection prevention and control procedures were in place. Staff had access to sufficient supplies of PPE. One staff member said, “We always have a good supply of PPE.” Observations and audits of staff at work were carried out to check their competence in following the infection control policy in people's homes. Staff demonstrated how to work in a safe and clean way. Staff received training as a continuous process to help them maintain good standards of infection control. Staff told us they followed procedures to protect people from the risk or spread of infection. They confirmed they wore Personal Protective Equipment (PPE) when needed. These included gloves, aprons, shoe covers and hand gels. People also confirmed staff followed safe infection control practices. A person said, "The carers wear gloves, shoe covers and aprons and they wash their hands.”

At our last inspection we found medicines were not managed safely. This was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12. People and relatives felt staff safely supported them with taking their medicines at the prescribed times. They did not express concerns in this area. A person told us, "They give my medication, I don’t have problems with any of them, not the carers nor the office.” A relative said, “We’ve got a dossete box. The carers write it down or do it electronically. Normally it’s me and my [relative] do it.”

Staff told us they received medicines training and felt confident supporting people with medicines. Staff told us that information about people's medicines including their preferences were included in care plans. Staff completed medicine administration records (MAR) after giving people their medicines. We saw these were completed. Spot checks were carried out to ensure staff followed correct and safe medicine procedures and continued to remain competent.

The provider had a medication policy in place that reflected current and relevant best practice and professional guidance. People’s medicines were appropriately administered in line with the relevant legislation and current national guidance. The management team carried out audits of medicine records to ensure staff recorded medicines correctly. Errors were identified and discussed with staff as part of their learning and improvement. People's safety was checked following errors. The registered manager had implemented other assessments of staff competence with medicines which was used during the induction process, where staff had to spot a deliberate error in medicine records and follow the correct processes. This enabled the management team to both support and assess staff and help to reduce the frequency of errors or incidents involving medicines.