First Choice Home Care

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last ratings inspection we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant there were shortfalls in service leadership. Leaders and the culture they created did not always assure the delivery of high-quality care. The service was in breach of the legal regulation in relation to the governance of the service. Governance procedures were not always effective. The provider had not identified all the quality or risk concerns we found. This meant prompt action had not been taken to address shortfalls. The provider had appropriate policies in place. Most staff felt supported by management and were aware of the values of the service. Management was keen to learn and make improvements to the service.

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.

Staff appeared to have a strong shared ethos of supporting individuals within the community. Staff spoke highly of their colleagues. Staff told us that they felt communication between management and staff was the biggest challenge.

The service had a business plan and statement of purpose that set out their aims and visions. The provider had policies in place to support equality and diversity.

Most staff told us that they felt the service had improved since the service manager came into post. Staff felt that the service manager was approachable and listened to them, however, did not always find action to be taken with concerns raised by staff. Staff felt able to contact the office for support, but overall communication was poor. Some staff told us they do not often hear from the office, or do not hear back with feedback to a query raised. There were concerns raised from staff around being able to access the out of hours on-call phone.

The service manager told us that they plan to take an accredited qualification to support them with their position. We found there were concerns with knowledge gaps in relation to staff understanding in relation to the Mental Capacity Act and the documentation and consideration of this within people’s care plans. The service did demonstrate their willingness to continuously learn and improve, however we could not always be sure that information we were provided with was accurate for example when requesting a copy of documents related to recruitment, we received 2 versions of the same document, that had different dates and information on.

All staff could tell us about raising concerns and knew the process to do so. The service had a whistleblowing policy, which included relevant contact details. Staff felt they could raise concerns to management but were not always confident or aware of any outcomes due to a lack of communication. The service had appropriate polices in place as well as a policy on duty of candour to ensure staff acted in an open and transparent way in relation to care and treatment if people came to harm. Minutes of meetings showed this was discussed.

The service expressed how they support staff to the best of their ability and try to work around their personal commitments where they can. The staff felt due to the high levels of sickness this could often impact on their work life balance.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service manager carried out audits themselves along with members of the management team and used management reports to monitor the service. The service has moved to a new electronic monitoring system that was starting to formalise some auditing processes. We could not see a clear oversight of staff supervisions, training and competencies. For example, the staff training matrix showed approximately 23% of staff were non-compliant with their training. We could not be fully assured that oversight of training was robust. It was not clear if all staff members had up-to-date spot checks and there were gaps in the recordings of this. Since raising this to the service they have told us they have completed more spot checks after our assessment, and this had been pre-arranged prior to our visit. However, we cannot be assured that appropriate spot checks and competency oversights were taking place or that appropriate measures were in place to monitor and oversee it effectively. Leaders were not aware of some of the concerns we found in relation to handling complaints and therefore could not demonstrate the actions they were taking to address these concerns. We were not assured all notifications had been sent to CQC or other relevant parties as part of their registration requirements. The service manager has reflected on this and has since sent relevant notifications to us as well as other relevant parties. The service told us they did not have a ‘relationships at work policy’ to manage conflicts of interest although within their recruitment policy it says to refer to this policy with how this is managed. Emergency cover has meant that family members attend double up calls together but there was no policy or procedure in place to appropriately manage this. The service was unable to provide us with any risk assessments to manage this. The service manager and area manager told us they had discussed this and were planning to implement a local policy and risk assessment.

People and their relatives told us that felt supported by the service with speaking to other professionals if needed.

Staff told us how they have worked with other healthcare professionals within the community such as District Nurses.

Records showed the service worked with health and social care professionals to meet people’s needs.

The service manager demonstrated an understanding of the need to learn and improve, however we were not assured that the provider had a clear and comprehensive plan to address issues raised in timely manner. We did not see a lesson learnt log, however some concerns raised within our assessment had been acted on retrospectively. We did not see sufficient evidence to confirm the service was capturing and embedding all areas of improvement in a comprehensive manner.