First City Nursing Services

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

The providers tireless work during the pandemic influenced Government policy, facilitated a steady supply of personal protective equipment (PPE) across the sector and helped to enable hospitals discharge patients on time, avoiding backlogs and waiting lists. For this work the provider was awarded the MBE in the new year’s honours list.

The service also responded to the pandemic to ensure partners, local care homes and hospitals in the Swindon area were supported. The provider sourced and distributed PPE and hand gel to services in the area and supported the drive to provide updated information to staff and people using services. This work helped to ensure the latest information and guidance was shared across the local care sector. The service also ran a charity to support people from being socially isolated. It also raised funds that were used to ensure people leaving hospital were equipped to return home safely, thus reducing discharge time from hospital.

People told us the service was extremely caring. We were repeatedly told staff, “Went the extra mile” in providing compassionate care. People were respected and their diverse needs were championed by staff, enabling people to improve their well-being and quality of life. One person told us, “Caring staff, really incredible with a great capacity to care.”

The service continued being very well-led. Staff remained extremely positive about the team work and support they received from the management and about the positive and empowering culture that was promoted within the team. There was a strong emphasis on staff skill development and keeping the team motivated and enthusiastic. Staff had clear roles and responsibilities and they were constantly being upskilled so they could step up or act in other roles should this be required. Staff complimented the training provision and the support received from the management.

We found the management's vision was imaginative, innovative and put people at the centre of service delivery. The provider's governance was well-embedded and there were robust quality assurance systems that remained highly effective. Information was shared with service partners which enabled improvements to be made across the local care sector.

People’s independence was actively promoted improving people’s well-being and reducing social isolation. For example, one person was supported to travel to and maintain a job.

Staff also benefited from the services culture of compassion and care. Adjustments were made to facilitate staff’s religious beliefs and practices; staff rotas were altered to allow staff time to pray and specialised PPE was sourced for some staff on religious grounds. Staff told us they were extremely well supported.

The service was extremely responsive. The provider's long standing "The No / How pledge" continued to underpin the service's responsive ethos. The team demonstrated they successfully adopted 'you don't say 'no' you say 'how' can we do this' approach. The registered manager told us the pledge, “Is so deeply embedded in our culture it is just second nature.”

The service went the extra mile to ensure people’s communication needs were met. Time was spent with people to enable staff to fully understand people’s needs and worked with them to find solutions. Some staff spoke foreign languages and documents were available in the language of the person’s choice. Alternative communication methods were used such as Makaton or technology, all of which was tailored to people’s individual needs and choices. Makaton is a form of communicating where people use signs and symbols either as a main method of communication or as a way to support speech.

People were supported to take their medicines safely and as prescribed. People's care files contained risk assessments surrounding people's well-being, falls, mobility and other conditions. Where people had been identified at risk in certain areas of their lives; management plans guided staff on how to keep the person safe.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. For example, the provider ensured people’s needs were assessed before they were supported to ensure those needs could be met and individual care plans put in place. One relative said, “They (provider) came out and spent a lot of time listening to what he (person) needed,” Another person who lived with autism had a dedicated support team of staff who had received specific training in relation to their needs and condition. This ensured the person received individualised care that met their needs. The service had an exceptionally person-centred culture and welcomed feedback.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We checked whether the service was working within the principles of the MCA

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.

People were supported to access health services when required and the team worked closely with a number of external health and social care professionals where needed. People were supported to maintain good nutrition and encouraged to have a diet that met their dietary needs and preferences.

Rating at last inspection

The last rating for this service was Outstanding, published 1 August 2018.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

When we last inspected First City Nursing in November 2016, at their previous address the service was rated as Outstanding in well-led and Good in all other four domains and Good overall.

At this inspection we found the service remained Good in safe, effective and caring domains and remained Outstanding in well-led. We also found the service had improved to Outstanding in the Responsive domain and as a result, the service was rated Outstanding overall.

The service continued being very well-led. Staff remained extremely positive about the team work and support they received from the management and about the positive and empowering culture that was promoted within the team. Staff demonstrated a strong level of engagement, a real sense of pride of working for First City Nursing Services and there was a high level of satisfaction within the team. There was a strong emphasis on staff development and development of their skills and keeping the team motivated and enthusiastic. Staff had clear roles and responsibilities and they were constantly being upskilled so they could step up or act in other roles should this be required. Staff complimented the training provision and the support received from the management.

We found the management’s vision were imaginative, innovative and put people at the centre of the service delivery. The provider’s governance was well-embedded and there were robust quality assurance systems that remained effective. The provider welcomed any form of external auditing and any feedback received was treated as an opportunity to reflect and further improve the quality of the service for people. The management team continuously looked for new, innovative ideas how to keep people safe and how to adapt the service delivery to the changing demands and the needs of the of people and the health and social care community. There was a positive culture that reflected people were put first and that culture was reflected throughout the entire structure in the organisation.

The service acted as an important part of the local community. The provider had formed a charity that supported local community and people had opportunities to receive additional support such as from befriending volunteers. This enhanced people’s wellbeing and reduced the risk of social isolation. People had opportunities to visit a newly opened café at the provider’s office site, where they could socialise and received additional support such as signposting to other support services and voluntary organisations.

The service retained their drive for excellence and retained their position of a positive role model and earlier this year they successfully secured the contract with the Local Authority to become the Lead Provider of social care. They therefore acted as a first point of contact for all referrals for the borough. The provider enabled a number of external professionals to be based at the same site to ensure good communication and smooth referral processes were maintained.

The contract around the Lead Provider was a completely new and innovative approach. The provider’s aim was to ensure the new system was very much people led and the identifying and meeting people’s outcomes was a key point of focus. The management worked to ensure people’s stories, expectations, wishes and outcomes they wanted to achieve were captured and recorded. First City Nursing Services management involved a reputable and well known social care organisation that specialises in delivering bespoke training surrounding person centred and outcome based support. The new, outcomes based documentation focused around people’s expectations and not around tasks orientated support.

There was a registered manager running the service who had been working with the team for 18 years. 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. The director was also registered as a second manager, this was to ensure the stability and managerial cover in case of the absence of the service's manager.

We found the service was exceptionally responsive. The provider's “The No / How pledge” underpinned the service’s ethos. The team demonstrated they successfully adopted ‘you don't say 'no' you say 'how' can we do this’ approach. This promoted increased benefits for people as well as morale, sense of team work and feeling valued. Staff were exceptionally skilled at recognising people's individual needs and wishes in relation how they want to live their lives and to the full. This included suggesting ideas people themselves might not have considered and empowering people to engage in social activities that enhance people’s well-being. Staff were empowered to suggest innovative use of technology where this was to benefit people’s lives and contribute to people’s quality of life. There was a designated team responsible for keeping people’s care plans up to date and we found people’s care plans were current and reflected people’s needs.

The service also demonstrated their responsiveness on a more strategic level that positively affected the local community and the local health services. In the last year First City Nursing Services successfully demonstrated their ability to lead the local social care market and they stepped in and took over a significant number of people’s packages of care from providers that ceased operating. Due to this prompt action no people were left without support and people were protected from potential negative implications of receiving no care.

People knew how to complain and there was evidence available the complaints and concerns were managed appropriately. The registered manager demonstrated an innovative and proactive approach to the complaints management and they reflected on each complaint. The reflection considered whether the complaint was avoidable, what could be done differently in a future and any other lessons learnt.

When required people were supported to have a comfortable, dignified and pain free end of life. Staff had a training on how to support people during towards the end of their lives. We received very positive feedback about end of life support provided to people and emotional support provided by the staff to families during that difficult time.

People told us they were safe with the staff. There were sufficient staffing in place. Staff knew how to report and escalate safeguarding concerns. The provider ensured safe recruitment practices were followed and they were proactive in stamping out any inappropriate practices.

People were supported to take their medicines safely and as prescribed. People’s care files contained risk assessments surrounding people’s well-being, fall, mobility and other conditions. Where people had been identified as at risk, management plans guided staff on how to keep the person safe.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. 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. People’s rights to make own decision were respected.

People were supported to access health services when required and the team worked closely with a number of external health and social care professionals where needed. People were supported to maintain good nutrition and encouraged to have a diet that met their dietary needs and preferences.

The service was caring and people told us staff were kind and compassionate. We found people’s individual needs, including equality and diversity were considered and respected. People’s dignity, privacy and confidentiality were maintained. People were supported to be independent as much as possible.