First Choice Care Agency Limited

First Choice Care Agency is a domiciliary care agency which provides care and support to people living in their own homes. At the time of the inspection there were 13 people using the service, of which 12 received support with personal care. Care Quality Commission (CQC) only inspects where people receive personal care. This includes help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Improvements had been made and the service was no longer in breach of regulation. However, further time was required for new and improved systems and processes to become fully embedded and sustained.

Improvements had been made to safety. People’s care plans and risk assessments had been reviewed, updated, and developed further. Staff had detailed guidance of the action required to provide safe and effective care, which also reflected people’s routines and preferences.

People were supported by regular care staff who knew and understood their needs and routines. People were positive about the care and support provided. There had been no missed calls and late calls were minimal and within the agreed tolerance. Staff travel time had been added to the staff rota.

Staff had been safely recruited. Staff received ongoing opportunities to discuss their work, training, and development needs and their competency was checked.

Where people required support with their medicines and eating and drinking, staff had detailed guidance, and this was provided safely and effectively.

Infection prevention and control practice was followed to reduce the risk of cross contamination and the risk of infection.

People were protected as far as possible from the risk of abuse and harm. Staff had received safeguarding training and were aware of their roles and responsibilities to protect people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. New Mental capacity assessments had been implemented and completed when required.

People’s health care needs were assessed and monitored, and staff worked with external health and social care professionals to support positive outcomes.

New and improved audits and checks, systems, and processes in assessing, monitoring, quality and safety were in place. The registered manager had plans to further develop monitoring systems to enhance and develop the service.

The provider had developed their quality assurance process to enable people to share their experience of the service they received.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 21 January 2023), breaches in regulations relating to safety, staffing, consent, staff recruitment and governance were identified, and enforcement action was taken. At this inspection we found enough improvements had been made and the service was no longer in breach of regulation.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Please see the safe, effective, and well-led sections of this full report. You can read the report from our last inspection, by selecting the ‘all reports’ link for First Choice Care Agency on our website at www.cqc.org.uk.

Enforcement

Following the inspection in 2021 we recognised that the provider had failed to meet the conditions of their registration. This was a breach of regulation and we issued we issued a foxed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

First Choice Care Agency is a domiciliary care agency which provides care and support to people living in their own homes. At the time of the inspection there were 21 people using the service, of which 19 received support with personal care. Care Quality Commission (CQC) only inspects where people receive personal care. This includes help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People continued to receive a service that was not always safe. Risk assessments did not give clear guidance for staff to mitigate identified risks. People were not always protected from the risk of being supported by unsuitable staff. Staff were deployed before recruitment checks had been carried out. Infection prevention and control (IPC) measures were not consistently followed.

People's preferences, likes and dislikes were not always recorded in detail. Not all staff had received training to meet the health needs of those they supported with specialist needs. Staff confirmed that they received supervision.

Governance systems were in place but were not always effective. The provider's governance systems had failed to identify the concerns and shortfalls we found during our inspection. The concerns about ineffective systems were repeated concerns over the 3 previous inspections.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments were not always carried out and care plans lacked information on how to support people in their best interests.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 September 2022), breaches in regulations relating to safety, staffing and governance were identified. At this inspection we found not enough improvements had been made.

Why we inspected

We received concerns in relation to the care people received when they started using the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for First Choice Care Agency on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to consent, safe care and treatment, good governance, staffing and fit and proper persons employed at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

First Choice Care Agency is a domiciliary care agency which provides care and support to people living in their own homes. At the time of the inspection there were 16 people using the service, of these 13 were receiving personal care. Care Quality Commission (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.

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

Some improvement had been made since last inspection, however there were some areas that needed to become fully embedded. An example was medicines management, which had improved but medicines were not always managed safely.

Risk assessments were not always in place and some records lacked in detail. This was not identified by the provider’s own checks.

Infection control processes were not fully embedded.

There was a lack of staffing and the provider lacked oversight of this. However, staff who were employed were recruited appropriately and had received adequate training.

Systems and processes to oversee documentation had been put in place but did not identify all concerns we found at inspection.

There was a lack of opinion sought from people and relatives, for example through customer satisfaction surveys. However, the complaints recording processes had been improved and we heard people were happy to raise concerns about their care.

People told us they felt safe and received good care. Staff understood safeguarding and knew who to escalate their concerns to.

Staff, people and relatives felt confident to raise concerns with the provider.

The registered manager was clear in their role to notify CQC and the local authority and had done so.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 23 February 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of some regulations.

This service has been in Special Measures since 22 February 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 16 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for First Choice Care Agency on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, governance and staffing at this inspection.

Please see the action we have told the provider to take at the end of this 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.

Geraint House is a domiciliary care agency which provides care and support to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. At the time of the inspection 21 people were supported with personal care and one person was supported in other ways.

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

Care plans and risk assessments were not completed or reviewed in line with the provider’s policy, this included catheter care plans and pressure area risk assessment charts. This put people at risk of harm of unsafe care.

There was a lack of medicine administration records, detailing the type and dosage of medicines. People were at risk of not receiving their correct medicines because medicines were not managed safely. The provider did not recognise the importance of ensuring correct administration of medicines and so had not mitigated risks around medicines. We have identified this as an area requiring improvement.

We were not assured by the provider’s infection prevention and control (IPC) processes. The IPC policy did not mention COVID-19 and we were told by people who were supported by care workers, they had witnessed staff not wearing masks correctly.

Lessons had not always been learnt when things went wrong. Complaints were not logged in an effective way.

People and their relatives told us staff did not always stay for their full care duration and either arrived at their calls too early or too late. There is no call monitoring system in place, so the provider lacked oversight of this.

Records reviewed were not always complete or legible. The provider did not have effective systems and processes in place to identify this or to enable them to identify risks to people's health, safety and welfare.

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 13 February 2020).

Why we inspected

We received concerns in relation to staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Geraint House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we have identified breaches in relation to need for consent, safe care and treatment, good governance, staffing and receiving and acting on complaints.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Geraint House; First Choice Care Agency Limited is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection 10 people were receiving personal care.

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

People valued their close relationships with staff and felt they often went ‘the extra mile’ which made them feel valued and cared for. Staff treated people with kindness, compassion and respect.

People were fully supported to express their views and be involved in making decisions about their care.

Respect for people’s privacy and dignity was at the heart of the service’s culture and values. People and staff feel respected and listened to.

People received safe care and were protected against avoidable harm, neglect and discrimination. Risks to people’s safety were assessed and strategies were put in place to reduce the risks.

People received support from staff who had undergone a robust recruitment process. They were supported by regular staff who knew them and their needs well, which promoted continuity of care.

Where the provider took on the responsibility, people's medicines were safely managed. Systems were in place to control and prevent the spread of infection.

People’s needs, and choices were fully assessed before they received a care package. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care.

Where the provider took on the responsibility, people were supported to eat and drink enough to meet their dietary needs. Staff supported people to live healthier lives and supported them to access healthcare services when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their families were fully involved in the care planning and reviews of their care. The provider had a complaints procedure which was accessible to people using the service. This was used effectively when complaints were received. The service provided appropriate end of life care to people when required.

The service had good governance systems in place to ensure all aspects of the service and peoples care were continuously assessed and monitored. The service worked in partnership with outside agencies.

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 01 February 2019). Since this rating was awarded, the registered provider of the service has moved premises. We have used the previous rating of Good to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.