First Choice Home Care

First Choice Home Care provides personal care to people living in their own homes. Not everyone supported by the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection the service was providing personal care to 60 people.

People’s experience of using this service and what we found

Quality assurance systems and processes at the service were not always effective.

There was not always enough staff to meet people’s needs, the service had used their contingency plan to ensure people remained safe.

Medicines audits were not sufficient in fully identifying the circumstances behind identified errors.

Recruitment processes were not robust. The provider had not followed up on peoples work history or gaps in their employment, however the provider is reviewing their recruitment procedure.

People told us they felt safe with staff, and staff had received safeguarding training.

We received positive feedback from people about the provider's infection prevention and control processes. People told us staff always wore protective equipment appropriately.

Care files were shaped around people's preferences and support needs. Goals were set to support people achieve their wishes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (published July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This unannounced inspection was carried out on the 6 June 2018.

At the time of the inspection there was a registered manager in place. 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.

At the last inspection in June 2017 the service was rated requires improvement. We asked the provider to make improvements to reducing risks to people, safe administration of medicines, staff training, ensuring people receive the support they require and ensuring that there was effective monitoring of the quality of the service being provided.

At this inspection we found required improvements were made and the service is now rated as Good.

Staff were aware of how to keep people safe from harm and what procedures they should follow to report any harm. Action had been taken to minimise the risks to people. Risk assessments identified risks and provided staff with the information they needed to reduce risks where possible.

There was an effective quality assurance process in place which included obtaining the views of people that used the agency, their relatives and the staff. Where needed action had been taken to make improvements to the service being offered.

Medicines were in the main managed safely. Staff received training and their competency to do this was checked before staff could administer people’s medicines unsupervised. Medicines were stored securely. The records were not always an accurate reflection of medicines people had received. However, action was being taken to improve this.

Staff were only employed after they had been subject to a thorough recruitment procedure. There were enough staff employed to ensure that people had their needs met however they didn’t always arrive at the agreed times. Staff received the training they required to meet people's needs and were supported in their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice and worked within the guidance of the Mental Capacity Act 2005.

Staff were motivated to provide care that was kind and compassionate. They knew people well and

were aware of their history, preferences, likes and dislikes. People's independence, privacy and dignity were respected and promoted.

People were supported to maintain good health as staff had the knowledge and skills to support them. There was prompt access to external healthcare professionals when needed.

People were provided with a choice of food and drink that they enjoyed. When needed staff supported people to eat and drink.

Care plans gave staff the information they required to meet people’s basic care and support needs. Some areas of the care plans would benefit from more detailed information. People received support in the way that they preferred and met their individual needs.

There was a complaints procedure in place. People and their relatives felt confident to raise any concerns either with the staff or manager. Complaints had been dealt with appropriately.

Further information is in the detailed findings below.

First Choice Home Care (Wymondham) is a service that provides personal care to people in their own homes. At the time of the inspection, 164 people were receiving support from the service.

There was a registered manager working for the service. 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 and associated Regulations about how the service is run.

During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that risks to people’s safety had been assessed appropriately. Although staff knew how to keep people safe whom they saw regularly, they sometimes supported people who they were not familiar with. They therefore relied on accurate information about these people’s needs being made available to them but this was not always the case. This placed people at risk of unsafe care.

Although the provider was looking to make a number of improvements in their governance and quality monitoring systems, some of their current processes were not effective at driving improvement within the service.

You can see what action we told the provider to take at the back of the full version of the report. We have also made a recommendation that the provider seeks relevant guidance on how to improve staff knowledge in relation to applying the principles of the Mental Capacity Act 2005 to their practice.

There were enough staff to meet people’s needs and they knew how to protect people from the risk of abuse. The staff were kind and caring and treated people with dignity and respect.

Staff had received training to help them provide people with effective care. However, some shortfalls were noted in relation to the staff’s knowledge regarding how to provide good care to people living with dementia and where people lacked capacity to make their own decisions. The provider was aware of this and had recently sourced further training for staff in these areas.

The current systems in place to make sure people received their medicines when they needed them were not robust. The medicine records we looked at showed people may not have received their medicines as intended by the person who had prescribed them.

People who needed support to eat and drink as part of their care package received this and they were also helped to maintain their health where this was needed. People were involved in making decisions about their own care and were offered choice.

People’s care needs had been assessed but these were not always being fully met. The staff usually arrived on time to provide people with the care they required but they did not always stay for the required length of time.

People received information about how to complain to the service. Any complaints or concerns made were usually dealt with but there was no process in place to ensure verbal complaints were acted upon.

The staff were happy working for the service. Their morale was good and there was an open culture where they were able to raise concerns without fear of reprisal. Leadership was in place to provide staff with advice and guidance when needed.

We have made a recommendation that the provider seeks guidance and training for staff on the Mental Capacity Act 2015.