First Choice Home Care

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All the people we spoke with told us they had an assessment of their needs before the service started and people had, actively participated in their care plan. Care plans were reviewed on the system and people told us their care had been reviewed since starting the service. The service manager said the initial assessment was completed directly onto the system as their care plan. We reviewed 6 peoples care plans. Care plans were detailed and provided a good insight into the person and their likes and dislikes. The person’s support needs, and medical history was clear and important information such as if a person had a ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) form and where this was located within a person’s home. However, care plans did contain inconsistencies with risk assessments and mental capacity assessments.

All the people we spoke with expressed how they felt in control of their care needs. Staff we spoke with knew the people they were supporting well and were adjusting to the new electronic care system in place. The service manager told us that the move to a fully electronic system in October 2024 has been a large change for staff and acknowledged there has been some learning along the process. Staff told us how they would escalate concerns around people’s health and care and gave examples of this. Staff said the office team were mostly good at passing on concerns that require working alongside district nurses or a general practitioner (GP).

Staff we spoke with expressed they felt they worked well as a team and had a shared dedication for caring for people who use the service. Staff understood the process of working with other services and could demonstrate examples of this. Care plans we reviewed contained other services they were working alongside as well as their contact details for staff to use. The service manager understood the processes of tendering (a formal process of bidding for contracts) with the local authority and monitored people’s contracted care packages.

Staff told us of concerns around the on-call system being hard to reach. Staff acknowledged that this was often due to the person holding the on-call also covering care calls which often meant that staff had no senior member of staff to approach in lone working scenarios. Staff told us that they would ring their colleagues if they could not get an answer from the on-call thus meaning decisions were being made by the care team rather than a senior member of staff. We could not be assured that the team and office work holistically.

All of the people we spoke with told us that the service supported them to live healthier lives and promoted their independence. People told us they have the choice with what they want to eat and drink. One person told us “they give me the confidence and I am a very independent person”. Another person told us “[Staff] has given me exercises for my arms and legs - That's very good”. Staff told us what they would do if they had concerns around a person who was at risk of malnutrition or dehydration. Staff told us they always record what a person has chosen to eat and drink including the amount when appropriate. We reviewed care records and they evidenced that people were encouraged to choose a meal and drink and staff recorded these choices in people’s daily records.

We reviewed care records, and the service reviewed people’s care needs again following a hospital discharge to enable the right level of support from the service and to check for any medication changes. Staff we spoke with told us how they monitored people’s health within the service. They all told us that they would seek medical advice if they had concerns around a person’s presentation and depending on severity, which medical service they would approach such as the GP, 111 or 999. Staff assured us they knew how to seek medical advice appropriately.

We reviewed the feedback survey that was given to people using the service and we were not assured that appropriate action was always taken. On several of the questions people answered ‘no’ to questions around staff staying the full allocated visit time, arriving on time to visits and if care plans reflected their needs. The service did not analyse or learn from this feedback. This did not assure us that the service always listened to people’s concerns or offered feedback to them appropriately. During our assessment the service manager acknowledged that they would analyse and respond to future feedback survey results.

People we spoke with told us they felt in control and their consent was always gained for any area of their care and support.

The service manager told us that if a person had a lasting power of attorney (a legal document that allows a person to choose a trusted individual they want to make decisions on their behalf) they made sure they see the original and they have a copy of this which is kept on file. Staff understood the importance of gaining consent from people who use the service. Staff understanding around best interest decision was limited.

There were inconsistent records around mental capacity assessments within care plans. Some areas assessed were not required and in other scenarios, where a capacity assessment would be appropriate, we found this was not in place. For example, one person’s medication was locked away for their best interests, but there was not a clear capacity assessment in place in relation to this aspect of this person’s care.