Prestige Home Care

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulations in relation to the ways people’s medicines were managed and recruitment and selection of staff.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a system in place for recording accidents, incidents and any issues or concerns. The registered manager explained the process of managing these events. They said the issue would then be discussed within the team and ways to prevent it recurring would be identified and implemented. The registered manager noted they did not record these conversations. They told us how these conversations could be incorporated onto the system to support reviews and audit trail. The staff told us they would discuss changes needed to people’s care. However, staff’s feedback confirmed reviewing and discussing incidents and accidents, and any lessons learned was not completed or carried out consistently to continually identify and embed good practice. People and their relatives were encouraged and supported to raise concerns. People and relatives knew who to contact if they had any issues or did not feel safe. They said they would contact the managers for support. People and relatives said they were informed about any incidents and/or accidents. Staff explained how to report incidents and accidents and took action to ensure people’s safety. Staff said, “All staff know [people] well and what may not be safe. We chat and explain the risks, ask if we can make it safer and if we can refer to GP or others for…equipment like walking frames to help them do things they want more safely.” We discussed with the registered manager the duty of candour and what incidents were required to be notified to the Care Quality Commission. There had not been any notifiable safety incidents where duty of candour would apply. The provider had a policy that set out the actions staff should take in situations where the duty of candour would apply.

People and relatives were involved, informed and supported by the registered manager and the staff team. They worked together with professionals to ensure continuity of care, including when people moved between different services or required temporary stays at the hospital. People and their relatives were involved in planning of their care.

People said the provider was flexible and pro-active when people’s needs changed. Other professionals such as community nurses and GP were contacted appropriately and in a timely manner to support continuity of care. People and relatives said, “There is continuity of care. Communication is very good, either by phone, [text] or email”, “[My care] is planned and organised well and I am happy with it” and “The care we are receiving is what we need at the moment. The manager is on the phone frequently checking we are ok.”

The registered manager explained their responsibilities in regard to safeguarding people who use the service and reporting concerns to external professionals accordingly such as the local authority, police and the Care Quality Commission. Staff told us how to recognise abuse and protect people from the risk of abuse. Some of the staff could not explain what whistleblowing was. However, they were able to explain what actions to take if they felt people were at risk including to contact the outside organisations. Staff were confident the manager would act on any concerns reported to ensure people's safety.

People said they felt safe when receiving care. Family members agreed their relatives were safe when receiving care. People felt the staff treated them well and the care they received was good. People knew who to contact if they had any concerns over any safeguarding issues. People were given choices in everyday life. Risks were identified by care staff and solutions found. People said, “Carers treat me well and help my [partner]. I am given choices about what I do and what I wear on a daily basis”, “[Staff] are very good at safeguarding. For example, carers noticed the skin was sore so they contacted me and we discussed what to do. Very supportive” and “[The person] has dementia and the carers keep [the person] safe. They sit and chat to [the person] who has accepted them.”

People had care plans and risk assessments describing support and care needed. However, this information had not always been reviewed or updated as required. We considered this under the question whether the service was well-led. People told us staff supported and looked after them in a positive way. People felt safe when receiving support and understood their risks, for example regarding falls management. There were no concerns raised over the use of any equipment. People and their relatives were involved in decisions about the care they received. Relatives added, “If there are any risks, [the staff] would point it out to me. They are very confident, professional and well trained. They never let us down” and “There is definitely good care from carers. They will leave me little notes if [the person] needs anything.” The registered manager told us how they worked with people, their relatives and staff to understand and manage risks. This helped ensure the care met people’s needs and enabled them to do the things that matter to them as much as possible. The registered manager continuously communicated with staff about people, their care, any changes and what action to take to address it. They said, “Risk assessments are done with care plans. The staff report to us any new risk when visiting, then to report to us, notify the person as well about the changes or risks and what we need to help them with. When staff go out, provide care, they always look at the safest way to do things…the risks are different for different people. Have a look around the premises to ensure any risks to address and mitigate those.” Staff explained about identifying potential risks, managing and keeping these under review. Staff told us how they supported people including when they were upset or anxious. Staff said, “Encouraging people to be independent…supporting them with risk taking. We must highlight risks but encourage [people] to do things for themselves."

The service supported people and relatives oversee and manage potential risks in the home environment. They made sure equipment, facilities and/or technology supported the delivery of safe care to people. The registered manager noted they reviewed and discussed any risks and mitigation relating to people’s homes and equipment they wanted to use to ensure people’s safety, independence and privacy.

Staff noted if they were worried about people they would report this to the managers and family to ensure timely response. Both staff and the registered manager supported and protected people safely without any restrictions or use of restraint.

The registered manager did not always ensure all required recruitment checks and information were gathered before staff started work. We found missing information such as explanations of gaps in employment and information on evidence of conduct from a previous employment working in health and social care. Records did not include information of the verified reasons why the previous employments ended. We found one police check was completed 8 months after the staff started work. Failing to obtain all required recruitment information, put people at risk of being supported by unsuitable staff. Staff completed a variety of training on topics the provider had determined was mandatory, and role dependant. However, review of the training matrix and information indicated staff were not always appropriately trained to ensure safe care and treatment. For example, managing wound care and skin integrity and applying dressings; managing people’s diabetes and blood sugar monitoring. As these tasks should be delegated and assessed by a health professional, this was not completed to ensure staff were competent to provide such support. The records did not demonstrate the staff were assessed regarding support with medicine such as using nebulisers, creams, drops and other specific medicine. The provider’s policy did not have a clear and defined process for appropriate completion of the care certificate including observations and assessing staff’s knowledge for each standard. We had some feedback there was not always continuity of staff, time keeping was variable and the staff did not always inform if they were running late. However, majority of people said regular staff attended visits which ensured the continuity of care. They said the time keeping was good and people were informed if the staff were going to be late. Staff stayed the allocated times and there were no missed calls reported. New members of staff were introduced to people and shadowed more experienced staff.

People and relatives raised no concerns over personal protecting equipment (PPE). People said the staff wore masks, gloves and aprons when appropriate, including when providing personal care. Staff told us they were provided with and used PPE to prevent the spread of infection. Any other infections would be reported to the registered manager to ensure timely response and support to people. Staff had training in infection control and followed procedures on this to use PPE. The service assessed and managed the risk of infection.

The registered manager did not always ensure people’s medicines and treatments were safe and met people’s needs, capacities and preferences. People were prescribed 'when required' (PRN) medicines to help them manage various conditions. However, the protocols did not contain personalised information about people, and any side effects to observe, how and when each PRN medicine should be used and managed safely. The medication administration record (MAR) sheets did not include clear information when regular medicine was not administered. When people had changes in the prescriptions from regular to PRN medication, staff continued giving it to people daily. Staff did not always record the reason why medicine was not given. Some daily medicines were not given however it was not clear how this was identified and clarified with staff. Another person had their medicine crushed and added to their meals. This practice was followed after their discharge from hospital. There was no clear record that a pharmacist was consulted to ensure crushing and mixing medicine with certain food and drink was suitable. Some medicine was to be taken in liquid form, but it was not noted in the PRN protocol if this needed to be thickened due to the person having thickened fluids. It was not clearly described how to ensure the person was informed about having medicine in their food. It was not noted what to do if the person refused food or drinks with mixed medicine. Although the registered manager confirmed staff were telling the person about the medicine in the food, the daily records did not demonstrate this was done to ensure the person maintained informed consent about their medicine management. People and relatives told us how the staff supported them with management of medicine. Some relatives raised a few queries with us regarding medicines safety. We raised this with the registered manager who followed it up with the relatives to ensure they had necessary response.