Premium Home Care Services Limited Also known as Home Instead Senior Care

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The provider had not established and operated effective systems and procedures to assess and monitor the safety and quality of the service. During our assessment of this key question, we found concerns around the lack of provider audits, oversight and leadership of the service which resulted in a breach of Regulation 17 Good governance 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. There had been several changes in management, and this had impacted the service. Processes and procedures were ineffective in ensuring continuous learning, innovation, and improvement within the service. The provider lacked effective systems and processes that supported partnership working to collaborate for improvement. There was an open and positive culture within the service where most staff felt valued and respected. The provider had policies in place to support workforce diversity, well-being and flexible working.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Changes in leadership impacted sustainability and effective management of the service. The management team had identified this as a concern and was committed to making improvements. However, this was not yet embedded in practice. Staff told us there was a positive staff culture and that they felt valued and respected.

There were overarching policies, however, they had not translated into local policy or practice. Internal auditing systems to enhance strategy and vision had been undertaken, however, the management team had not embedded identified actions at the time of the assessment.

Some staff said they felt supported by the management team, However, some staff told us there had been changes to the management team recently which impacted staff. A staff member said, “There have been lots of changes with managers coming and going. I have recently been told I have another supervisor over me now, I asked if I could stay with my previous manager but was told I couldn’t, I was happier before.” The management team acknowledged there had been changes with management roles over recent months.

There was a lack of systems and processes across the service to ensure effective management and leadership. The management team did not always understand their roles and responsibilities to safeguard people and lacked accountability to ensure information was shared with relevant organisations in a timely manner. The management team had developed actions following an internal audit. However, this had not yet been embedded in practice.

Some staff told us they were happy to raise concerns with the management team within supervisions or team meetings. Some staff told us they would email or speak directly to the manager to raise concerns, if they needed to do so. However, some staff told us they have raised concerns in the past but found they had not been managed well. A staff member told us, “Management rebuffed my concerns, but I voiced them about 3 times I have had no update about my concerns. There is a lack of objectivity from the management team”

A whistle-blowing policy was in place which was easily accessible to staff. There was an open-door policy and various opportunities for staff to speak up including in team meetings, supervisions and appraisals. However, the lack of robust systems and processes meant there was no oversight of concerns raised to ensure actions were taken in a timely manner or a review of care practices to improve service delivery.

Staff told us they enjoyed working at the service and that they felt they had fair and equitable treatment. One staff member told us “I really enjoy working here. English is my second language, so I have at times found things difficult. But the managers have really supported me to ensure I make the most of my employment to keep in my job and get the right support and training. I am very grateful for all their help.”

The provider had policies in place to support workforce diversity, well-being and flexible working. Staff rotas considered staff’s shift and work pattern preferences.

Staff understood their roles and responsibilities to ensure information or concerns were reported in a timely manner. A staff member told us “Anything that concerns me is reported. Sometimes I call the office and speak to a manager if it’s serious. Other times I complete an incident report which should be sent to managers to review. I don’t always know what the outcome is after I have reported it.” There was a lack of effective systems and processes to ensure good governance and oversight of the service.

We identified significant failings in the management and oversight of the service. Care records were not always reflective of people's current needs. lack of systems and processes for robust oversight and management of the service meant people were not safeguarded in a timely manner, organisations were not reported to, and risk mitigation had not been implemented to keep people safe. Lessons learnt was not embedded in the service to support the development of safe care and treatment. The provider had been informed of some of the concerns through internal auditing processes but had not taken sufficient action or implemented effective governance to improve the quality of care.

People were referred to other services appropriately and professionals’ advice and recommendations were shared with staff teams. People told us staff had access to their individual services if needed. One person told us, “There has not been an occasion where the carers have had to contact a doctor, but they are aware of the telephone numbers for the surgery.” However, some relatives felt the communication with management teams could be improved. A relative said, “When I have phoned and left messages for the manager, they have not got back to me quickly” and “The carers are wonderful, but flexibility and understanding from the office is not good”

Staff knew how to safely support people to access services, places and appointments. Staff told us they communicated effectively with relatives to ensure people were supported to their appointments.

Staff reported information from healthcare professional visits to the management team. However, this was not always recorded in people’s care records. A person with acute health conditions did not have their records updated by the management team following directions from health professionals to do so.

Staff told us they felt learning was not effectively communicated following incidents or concerns they had reported. One staff member told us they had not received action from a concern they raised 2 years previously. They told us “I am not happy that the manager is trying to turn the responsibility of this onto me. There is still no forthcoming advice”

Processes and procedures were ineffective in ensuring continuous learning, innovation, and improvement within the service. We identified a lack of internal audits and analysis which failed to reduce the likelihood of accidents and incidents reoccurring. Where actions had been identified, there were no records to demonstrate these had been implemented. Learning opportunities and identified outcomes to improve the service or mitigate risks was not always taken and shared with staff.