Premium Home Care Services Limited Also known as Home Instead Senior 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

Medicines were not always managed to protect people from the risks associated with them. There was a lack of guidance for the safe administration of medicines, lack of oversight and best practice was not always followed. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. Care records did not always ensure staff had the guidance to support people with their individual risks and health needs. Systems and processes to ensure learning opportunities were not effective. People were supported by staff who understood their roles and responsibilities in order to protect people from abuse and the risk of avoidable harm. The provider ensured infection prevention and control processes were in place and staff followed these accordingly.

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.

We received mixed feedback from staff. Some staff told us they felt listened to and could raise concerns regarding safety with the management team if they needed to. However, some staff told us they had raised concerns regarding medicine processes and environmental safety, which they felt were not addressed or learnt from appropriately.

The management team had not introduced effective auditing systems and processes to ensure learning opportunities and outcomes for people were monitored and effectively addressed. Lack of systems and processes in place meant managers did not have a robust oversight of the service to ensure they applied the learning and improvements identified in a timely manner and to ensure actions were taken to improve peoples care and keep people safe.

People and their relatives told us their care was assessed and planned with them before their service commenced. A relative told us “Premium Homecare managers came out to see us prior to the service starting and completed a comprehensive care plan and looked around the home to see if there were any hazards or risks.”

Staff used personalised approaches to support people when transitioning into using the service. Staff described how they worked alongside other services, health teams and relatives to gain information about people to plan their care and calls. However, some staff demonstrated a lack of understanding around roles and responsibilities to manage health needs such as diabetes, when other services were involved such as district nursing teams.

Partners feedback was positive. They were complimentary of the staff working with people and the care they were providing.

There was an absence of effective systems and processes to ensure that care records contained clear and relevant information when other healthcare professionals were involved. This meant information shared by healthcare professionals had not always been updated within care records. The lack of updated information had led to confusion over who was responsible for care tasks and staff had not developed their practice in line with guidance and recommendations.

Feedback confirmed people felt safe in the care of the staff from Premium Home care services. People’s relatives told us they were confident their loved ones received safe care from the service. One person told us, “They are very respectful and polite, and I feel very safe when they are here.” A relative said, “[Person] has the same carer, so they are very safe as they like the staff a lot.”

Staff knew how to keep people safe from harm or abuse. There were up to date policies and procedures in place for safeguarding which staff followed. However, the management team were unable to demonstrate an understanding of their responsibility to safeguarding people.

The provider had policies in place to ensure safeguarding processes were understood and guidance was available to all staff. However, lack of managerial oversight and ineffective systems and processes meant that incidents reported by staff were not dealt with in line with the providers policy. We found potential safeguarding concerns had not been addressed and actioned in a timely manner and the managers duty to report incidents to relevant organisations had not been upheld.

People and their relatives felt safe and told us their risks were managed, care records were updated when people’s needs changed. A relative told us “They always listen to what you have to say and if they notice any changes in [person] behaviour or if they are concerned about the slightest thing, they will contact me.”

Staff felt confident and competent to support people with managing individual risks. Some staff told us they would like additional training to work with people who displayed distressed behaviours.

Risk assessments were in place for people’s individual needs. However, risk mitigation for people with acute health conditions such as diabetes, catheter care and distressed behaviours lacked effective guidance for staff to follow. This meant staff did not have clear information to ensure safe care was delivered.

People told us their homes had been risk assessed before they received care services. Equipment checks were completed by staff regularly.

Staff understood their responsibilities to ensure peoples equipment and environments were checked regularly and concerns were reported to the office in a timely manner. However, the management team had not taken actions to address some concerns regarding environmental risks. We found some care records and risk assessments had not updated.

The provider has systems and processes to monitor and maintain the health and safety of people’s homes. However, we found the systems in place were not always effective. Care records and risk assessments were not always up to date, which meant staff lacked information and guidance to ensure people were supported safely within their own environment.

People and their relatives were positive that there were sufficient, experienced and competent staff who understood their care needs. A person told us “The carers are very reliable and arrive on time and if they are going to be late, they inform us, however this rarely happens “. A relative told us, “The carers are lovely, and [person] is very happy with them”.

Staff told us they were offered training to support them to deliver safe and effective care. However, some staff felt it was difficult to complete their online training programme within their own time. Some staff told us they did not feel they had the relevant training to support people with distressed behaviours. Most staff felt supported in their role and received regular support and supervisions with management teams.

The provider had systems and processes in place to ensure safe recruitment of staff. Not all staff had completed their annual training. Whilst the provider had identified this and had taken action to improve staff training, this had not yet been completed. Staff supervisions and staff meetings were held regularly with staff teams.

Feedback from people and their relative’s confirmed staff wore appropriate personal protective equipment (PPE) when attending care calls. A person told us “The carers use their gloves and aprons that they bring if required.”

Staff confirmed they had completed training in infection prevention and control (IPC) and demonstrated a good understating of the measures to manage and prevent the spread of infection. They told us they have access to PPE when needed and have supplies they can use. The management team told us how PPE stocks were managed and the process for staff to access.

Infection prevention and control (IPC) policies and procedures were in place. Individual care records contained guidance for staff to follow. The providers training programme evidenced staff received training in Infection prevention control.

Feedback from people confirmed they received their medicines when required. One person told us, “They will give me my tablets to take.” A relative told us, “[Person] has medication in Dossett boxes, and this is given to them at lunchtime, there have been no incidents or errors and the carers will watch [person] so they take it”

Staff responsible for administering medicines confirmed they received medicines training, competency assessments and observations. Some staff members raised concerns about the lack of clear and up to date information contained within care records. One staff member told us, “I have raised issues with medicine records a few times, and is something they said they are trying to rework how meds are done. I have raised that it states in the routine give meds in Dossett box, but I have asked for all medication is included on the list, so these can be checked before administering. Now we cannot check each medication and make sure there has been no changes. We need to see the medication we are administering and not just administer the blister meds. I have raised it and managers have said they are looking into improving this, but nothing has changed as yet." The management team told us they had oversight of medicines management. However, they were unable to demonstrate this at the time of the assessment.

The provider did not always manage people’s medicines safely. During the assessment process the inspection team identified several medicine concerns where the provider had failed to ensure appropriate actions were taken to keep people safe. The provider was unable to demonstrate lessons learnt or any additional risk mitigation. We found there was a lack of information and errors in the recording of information within care records, medicine administration record charts, ‘as required’ protocols and body maps for creams and patches applied to the skin. There was a lack of robust systems and processes to ensure effective oversight of medicine management.