First Choice Medical Solutions Ltd

About the service

First Choice Medical Solutions Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats and supported living. It provides a service to older adults, younger adults and children who may live with sensory or physical disabilities, people with dementia or learning disabilities and autistic people. At the time of this inspection 28 people were using the service.

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. Where they do, we also consider any wider social care provided.

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

Right Support

People were not always supported to have maximum choice and control of their lives. Staff had not supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff needed further training to develop their skills and understand how to support people with a learning disability or dementia in their best interest.

Staff were not recruited through safe recruitment processes. This increased the risk that people were not supported safely by staff with the right skills and experience.

Staff were at times late arriving to support people. Relatives told us the office staff failed to alert them of staff lateness, which caused upset. This was not improved even after they repeatedly raised this issue with the office staff.

Right Care

Staff needed further training to understand how to provide people with safe and personalised care. People were not always protected from the risk of abuse. This was because safeguarding systems and processes were not embedded in staff’s daily practice. Risk assessments needed further developing to ensure they gave enough guidance for staff in how to mitigate risk.

The registered manager carried out regular audits to help ensure medicines were administered safely. They failed to identify in their audits concerns reported by relatives of people who repeatedly found medicines on the floor. Staff were not retrained in medicine administration or had their competencies checked when they made an error.

Right Culture

The registered manager failed to ensure they had a full understanding of their management responsibilities. They had little oversight of the service and they failed to ensure people received support safely. They did not promote a positive culture through their leadership and support for staff. The provider did not evidence organisational visions and values to underpin the principles of ‘Right support, right care, right culture.’ This guidance provides a framework for the planning and delivery of care and support for adults with learning disabilities and autistic people.

The registered manager did not demonstrate an open and transparent approach. Information requested during the inspection was not always accurate and, in some circumstances, had been developed only in response to us raising concerns.

People were in general happy with the support they received and felt safe. However, we found that not all processes and systems operated by the provider promoted safe and quality care.

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

Rating at last inspection

The last rating for this service was good (published 30 April 2022)

Why we inspected

We received concerns in relation to unsafe recruitment processes, lack of support and training for staff. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 First Choice Medical Solutions Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding, recruitment, staffing skills, notification of incidents and good governance.

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

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 Medical Solutions Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger adults and children who may live with sensory or physical disabilities, dementia or learning disabilities and autism. At the time of this inspection 18 people were using the service.

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. Where they do, we also consider any wider social care provided.

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

Staff received training and knew how to report their concerns to their managers or externally to local safeguarding authorities.

Risk assessments were in place to give staff guidance in how to keep people safe from harm. Everyone who gave us feedback told us there were no missed visits to people and if staff were delayed, people were alerted to this.

Staff told us they received training and support to carry out their roles effectively. Where needed, people had support with meal preparation and staff ensured they had good food and fluid intake. Staff liaised with other health and social care professionals for a better coordinated support which enabled people to remain in their own homes.

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.

The service had systems and processes in place to enable staff to provide people with personalised care and support. Consistent staff teams were supporting people, and this helped them develop a good knowledge about people’s likes and dislikes. Care plans were developed and reviewed with people and their views were recorded.

The registered manager undertook a range of audits and checks to assess the quality and safety of the service. Where needed improvements were made in a timely way. Health and social care professionals told us the service was successful in supporting people effectively and safely even where previous support failed.

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. People’s choices were respected, and staff promoted their privacy and dignity. Staff understood the importance of supporting people to live the life they wanted.

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

Rating at last inspection

This service was registered with us on 10 October 2020 and this is the first inspection. The last rating for the service at the previous premises was good, published on 25 January 2019.

Why we inspected

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

Follow up

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

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.