First Choice Home Care

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe- this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to governance and safeguarding service users from abuse and improper treatment. We found actions taken were not the most effective. The management of complaints and safeguarding people from actual and or suspected abuse ‘did not protect people’. Complaints and safeguarding procedures were not always followed and where appropriate there was a lack of reporting of safeguarding concerns to the Care Quality Commission. There was also a lack of oversight and sharing of information more widely within the service meaning lessons were not learnt across the wider organisation. Staff had a knowledge of safeguarding and whom they would report any concerns to. When reviewing staff recruitment folders, we could not be sure all checks had been carried out appropriately which meant we could not be assured all staff had been safely recruited. We identified concerns around their, (staffs) knowledge of the Mental Capacity Act. Risks to people were not always appropriately captured or documented, and we had some concerns over appropriate risk assessments for people using the service. For example, people who had the same condition such as diabetes did not all consistently have a relevant risk assessment in relation to this. The service manager acknowledged that some improvements did need to be made to all of the issues above.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. The service did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

We reviewed the services lessons learnt process and found some actions that were taken were not always appropriate and sometimes were missed. We noted all lessons learnt were identified through the complaints process and no other systems or processes within the service. For example, through customer feedback. A clear log of lessons learnt was not in place which might have helped to identify themes and trends.

The service could not evidence that concerns were investigated appropriately, and we were not assured that their documents were thorough and clear. There was an inconsistent approach towards the investigation of concerns and policies and procedures were not followed. We found concerns around two staff members was not handled effectively potentially placing people at risk of harm.

The provider asked people for their feedback of the service by issuing surveys. Feedback from surveys had not been analysed or used to improve or sustain improvements across the service. The service manager acknowledged that they would do this in the future.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People told us they felt safe, and we found staff had good knowledge of their responsibilities around working with other healthcare professionals. The service had a new electronic system in place that supported with monitoring safety and continuity of care. People told us that although they have not required the service to support them with booking medical appointments, there had been occasions where the staff had escalated health concerns appropriately with their consent.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service had assessed this within peoples care plans. Staff we spoke to had good knowledge of protecting people’s right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff had all completed safeguarding and mental capacity act training, however, staff we spoke to did not always assure us that they understood the mental capacity act and their responsibilities under it. The service lacked consistency around mental capacity assessments within care plans. At the time of assessment, the service manager acknowledged that staff and service knowledge of the mental capacity act was an area for improvements and told us ways that they were introducing and improving different ways of learning to improve staff knowledge in this area.

The service did not always share concerns quickly and appropriately leading to a wider risk of harm to people. For some concerns raised around staff members the services safeguarding policy was not always followed and there were occasions where relevant parties like the local authority and CQC had not been notified of safeguarding concerns that had been raised. There was also lack of information sharing and risk assessing in place within the service resulting in risk to the wider organisation.

All the people we spoke with raised no concerns around managing risks and always felt in control of their care needs. Staff members could tell us how they would escalate concerns appropriately. We reviewed several care plans which were person centred and demonstrated a full assessment had taken place. However, we found that there were not always consistent risk assessments in place within people’s care plans. For example, some people with diabetes had the appropriate risk assessments around their health condition, where others with the same condition did not. We also found mental capacity assessments that were not always appropriate or required within some people’s care plans and others where a mental capacity assessment would be appropriate to best manage risk and protect people, but these were not in place.

People we spoke with told us they felt safe within their home environment and that employed staff kept their home safe and clean. On reviewing visit logs and notes we could see that the service attempted to send the same staff to people on a regular basis. People told us that they do see lots of different staff, but the service tries to keep regular staff. Staff could express to us that they knew the people they were supporting well and could identify if there was a change in support needs promptly. The service carried out environmental risk assessments for each person they supported. We noted that within one person’s care plan the care team were locking the door after leaving for a person living with dementia. There was no documentation within their risk assessments, or mental capacity assessments about, how that individual would vacate the property in an emergency, such as a fire. The service manager advised us a process was in place to evacuate this individual in an emergency and their care plan would be updated to reflect this

People we spoke with told us the service attempted to send the same individuals to their visits and were provided rotas, although they often felt the rotas were pointless as the times never stayed the same.

Staff we spoke with could not always recall their last supervision or training session. Staff told us they knew that they do have spot checks but were unaware of how often they were. We found it was unclear with how the service record and keep track of staff training, staff supervision, competencies and spot checks. The staff training matrix showed some staff had expired training and we could not be fully assured of the clear oversight of staff training, spot checks and supervisions.

Staff told us that the on-call system was not always answered making communication a challenge.

Senior staff and care staff told us that staffing had been an ongoing challenge due to sickness levels. Low staffing levels resulted in the service having to offer care based on a priority rating system. This is whereby a service rates people into a colour coded system of red, amber or green based on that person’s level of needs. The service had to reduce some visit times to enable continuity of the service when short staffed. The service manager told us that all office staff are trained and ready to support with care calls if the need arose. The service told us they have a target of being 20% overstaffed to the capacity of the service and to do so, this requires the recruitment of 3 new members of staff a month. At the time of our assessment, the service was unable to demonstrate how they determined the staffing capacity needs of the service and people using it. The service did demonstrate their drive for recruitment of new staff to the service.

People we spoke with told us that staff mostly wear their personal protective equipment (PPE) and wash their hands. The service sent out a feedback survey to people and one of the questions asked was about PPE, to which some responses told the service PPE was not always consistently worn by staff. The service did not explore the feedback or embed learning from this. Staff told us they always have access to a supply of PPE and that they receive spot checks that will check they are wearing their PPE. Staff could tell us how they prevent cross contamination during and between visits.

People told us they had no concerns and trusted the staff with the handling of their medication. We reviewed several people’s medication administration records, medication audits and medication error logs. The service regularly assessed staff’s medication competencies and staff had completed medication training. The service had implemented a new electronic monitoring system that notifies management of medication errors or if medication had not been administered. There was an improvement of medication errors since the new system had been in place and auditing tools was also included within this new system. The service audited medication administration but it was not clear what time medication was administered from medication administration records (MAR). We asked the service manager if the system can allow for identification of what time medication is administered for instances such as time sensitive medication or medication that requires a gap before the next dose. The service manager told us the system does have features that can allow time sensitive windows to be put in place but at this moment in time they have not needed to use this feature. When we queried how timings of medication were identified in auditing processes, the service manager told us they refer to the daily notes of people who use the service to check the time the medication was administered. We did not see consistent timings of administered medication documented within daily records of people. This did not assure us that medication audits were effective at identifying timings of medication administration.

The service had identified where there were risks to people living with dementia and had risk assessed this within their care plan. However, at the time of our assessment, the provider was unable to demonstrate if a capacity assessment had taken place for when the service was locking medication away. This was not in line with the mental capacity act and best interest guidance.