First Practice Healthcare Ltd

Updated 1 April 2021

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. A visit was made to the office on 26 January 2021 and telephone calls to people using the service, their relatives and staff members were made between 27 January and 5 February 2021.

Service and service type

This service is domiciliary care agency. It provides personal care to people living in their own homes.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave 48 hours’ notice of the inspection. This was because we needed to be sure that the registered manager would be in the office to support the inspection.

What we did before inspection

We reviewed information we had received about the service since it was registered. We sought feedback from the local authority. We did not ask for a provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with seven people who used the service and with ten relatives of people who use the service about their experience of the care provided. We spoke with seven care workers, the registered manager who is also the provider and nominated individual and an independent consultant working with the service. We reviewed a range of records. This included six people’s care records and medication records. We looked at five staff files in relation to recruitment. We also looked at records that related to the management and quality assurance of the service.

After the inspection the provider supplied us with additional information.

Updated 1 April 2021

About the service

First Practice Healthcare is a domiciliary care agency providing personal care to 98 people including children aged 4-18, older and younger adults. People using the service may experience the following; dementia, learning disabilities or autistic spectrum disorder, mental health issues, they may misuse drugs and alcohol, they may have an eating disorder or have a physical or sensory impairment.

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

Risk assessments were not always detailed and person centred, in particular to ensure people and staff were kept safe. Records were not always kept appropriately. Recruitment was not always carried out in a safe manner. Some people told us that staff did not always arrive on time, others were happy with the timings of calls. Incidents and accidents were dealt with, although it was not always clear if or what follow up action had been taken. Personal Protective Equipment (PPE) was used as required with the exception of a small number of concerns raised. Medicines were given appropriately and records for their administration were kept as 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.

Initial information gave a good overview of the person but did not always detail information on care required and how conditions could be improved or managed. However, people told us staff understood their needs. People’s likes and dislikes were considered. People’s life history was acknowledged. Staff received appropriate training to assist them in their role. People told us they were supported to eat and drink without issues.

There was a mix of opinion about staff members attitude towards people. Some felt it was caring and supportive, whilst others felt it was abrupt and rushed. People told us their privacy and dignity was managed well during the care they received. People’s decision making was promoted.

There was inconsistency in care plans, and some had a higher level of information than others. People had been part of developing their care plan. Feedback was taken from people on a regular basis.

Whilst systems were in place to record complaints, lessons learnt were at times generic and not person centred. Audits did not identify the issues raised during the inspection. Audits did not lend themselves to the easy identification of patterns and trends. People’s preferred communication were used. The service worked with external agencies.

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 guidance CQC follows 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 were offered choices and encouraged to make decisions on the care they wanted to receive.

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

This service was registered with us on 19/12/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the safeguarding of people using the service and the timeliness of notifications received by CQC. A decision was made for us to inspect and examine those risks.

We found evidence the provider needs to make improvements. The overall rating for the service is requires improvement. This is based on the findings at this inspection.

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.

We have identified breaches in relation to good governance. Please see the action we told the provider to take at the end of this report.

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.