Archived: First Practice Healthcare Limited

The service has a registered manager. A registered manager is a person who has registered with

the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected this agency in June 2015. At that time the service was meeting the regulations. but some improvements were needed to make sure the service was effective and well-led. Some improvements had been made but this inspection identified further improvement was needed.

Some systems were in place to regularly assess and monitor the quality of the service. This included checks on staff competency, a range of audits such as medication and regularly seeking the views and feedback of people and staff. Improvement was needed to ensure people received a consistently good service. The registered provider had failed to display the service’s ratings from their last inspection.

We were told by people who used the service and staff, that people were supported at each call by the number of staff identified as necessary in their care plans. We received some mixed views from people and their relatives in regards to their overall satisfaction with the service they received. Some people told us that they often experienced short calls or calls that were not on time.

People told us that they felt the service kept them safe. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice.

Those people who required assistance to take their medicines told us they were happy with how they were supported. Staff had received training and were assessed as competent to support people to take their medicines.

Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills. All staff received an induction when they were initially employed. People described the staff as being kind and caring and staff spoke affectionately about the people they supported.

People had individual care plans and risk assessments that were regularly reviewed. Staff were not always provided with detailed information about managing risks associated with people’s conditions.

People who required assistance to eat and drink told us that they were supported by staff who understood and met their nutritional needs and preferences.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 (MCA) which applies to services providing care in the community. Although staff were aware of the principles of the MCA, they did not have access to sufficient information to enable them to understand the ability of some people to make specific decisions for themselves.

The provider had arrangements in place to deal with any concerns or complaints. People told us that they would not hesitate to contact the agency office if they had a concern. People, relatives and staff said the registered manager was approachable and available to speak with if they had any concerns.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

As part of our inspection we spoke with the manager and three members of staff. We also spoke with four people who were receiving support from the agency and with the relatives of three people who were receiving support.

Is the service safe?

We spoke to people who used the service who confirmed they felt safe. We discussed issues of consent with the manager, who demonstrated knowledge about the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We checked people's care plans and found that these were detailed and up to date. Risks related to people's homes or their specific care needs had been identified and recorded to ensure that people had their care provided safely and risks to them and / or other people were minimised.

We looked at the staff recruitment records for five members of staff. We identified that improvements were required to make sure the recruitment process was robust.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law.

Is the service effective?

People told us they were happy with their care and support. People's comments included ; 'They provide very good care' and 'I'm currently very satisfied.'

Care plans were in place for people who received care from the agency. Staff and people we spoke with confirmed that people's care plans were available in people's homes. This meant that staff had the information they needed about how to support the person.

Records showed that regular meetings were held with people or their relatives if appropriate, to review their care needs.

Is the service caring?

Staff spoke with compassion about the people they were supporting. People told us that staff were caring and polite.

The planning of staff rotas ensured that, where possible, staff were allocated to look after the same people. People using the agency told us that they had regular staff providing their support. Some people told us there had initially been some difficulties in having regular staff but that these had been resolved.

Is the service responsive?

People told us they were regularly asked if they were happy with the service and were given the opportunity to make a complaint if they were unhappy. Two people we spoke with told us they had previously raised some concerns and that the issues had been resolved to their satisfaction. One person told us, 'They listened when we requested a change of staff' another person told us, 'We were getting too many different staff, the manager came out and spoke with us, we discussed what was expected. They did a wonderful job in responding to the issues.'

Where people who used the service were able, they were asked to comment on the service provided, this included questions about the support they received. The feedback was used to develop the service or provide assurance that people were receiving safe and effective care that met their needs.

During our visit we looked at records of complaints and incidents. We found that consideration had been given to these by the manager and actions had been taken to reduce the likelihood of similar incidents happening in future.

Is the service well-led?

At this visit we found that the provider was unable to protect people from unsafe care and treatment. The systems in place to assess and monitor the service failed to identify if compliance with the relevant regulations was being maintained to ensure that people were

receiving safe care and support.

We found there was not an effective system in place to monitor the number and type of complaints received so that any trends or themes could be identified. There was currently no effective system in place for seeking the views of care staff employed by the agency.

The provider did not have satisfactory systems to analyse the number of missed or late calls. Action was being taken to address this. We were told that the agency was going to use a call logging system via the computer to register when staff arrived and left a care call. We were told that the system had been installed and the agency was awaiting the allocation of an 0800 telephone number so that it could be implemented.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law.

People told us that they felt safe with the staff that were supporting them and that they had got to know them well. One person told us, 'They help me with everything. I would recommend them to other people.'

People using the service had opportunities to express their views about the service they received.

People told us that they were confident that they could raise concerns if they were not happy with the care and support they received.

Record keeping was an issue as some documents which the provider may rely upon were not up to date or had not been completed.

Following our visit, we spoke with one person using the service, the relatives of two people and one person's social worker. We also spoke with two members of staff.

Responses we had from people who used the service or their relatives indicated they were treated with respect by staff. Both relatives we spoke with told us there had been some issues when the service first started but that these had been resolved. One relative we spoke with compared this agency favourably with other agencies they had experienced.

During the inspection we looked at three people's care files. It was not evident that care was always planned in a way that ensured people's safety and welfare.

Staff demonstrated a good awareness of the procedures they would follow if they suspected abuse.

We were unable to evidence that the agency had followed robust recruitment procedures before staff started working with people or had all the training they needed.

We found systems of monitoring the service, to assess quality and risk, were not effective.

During our review, we discussed the quality of the service provided by the agency with local authority staff involved in monitoring them. They told us they had some concerns about the agency that included staff recruitment and training.