FirstCol Services Limited - Home Care - Worthing

FirstCol Services Limited is a domiciliary care agency. It provides personal care to both older people and younger adults living in their own homes. CQC only inspects the service received by people provided with 'personal care', which includes help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection there were 43 people who received personal care.

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

Since our last inspection the provider had made some of the improvements required to improve oversight and raise the standard of care people received One person said, “They give me my medicines, they take care of that for me. They come and give it to me and that's going really well”. However, not enough improvements had been made with managing medicines safely, which meant some people remained at potential risk due to shortfalls in the level of guidance and information available to staff.

People told us they felt safe and were confident to contact the office if they had any concerns. People were positive about the support they received from staff who had been recruited and inducted safely. People told us staff used PPE (Personal Protective Equipment) to keep them safe during the global COVID-19 pandemic.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems did not support this practice. People did not always have assessments of their capacity to make decisions considered in line with the principles of the Mental Capacity Act. The provider had not always assured themselves that those making decisions on people’s behalves had the legal authority to do so.

People’s needs had been assessed, considered and staff met people’s needs effectively. People were supported by staff who received appropriate training and support and worked with other agencies to ensure their health and social care needs were met. People’s care and support needs were documented effectively, the provider had implemented care management systems which ensured key information was available to staff.

There were effective incident reporting systems in place which ensured incidents were considered and monitored by the management team. The registered manager had recently joined the company and had demonstrated their focus on getting to know people and developing and improving the service and as part of this had ensured people received opportunities to feedback on the service provided.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 22 April 2021) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced focused inspection of this service on 17 February 2021. Breaches of legal requirements were found. We undertook this focused inspection to view the actions they had taken to address the previous breaches We have found evidence that the provider needs to make improvement This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for First Col Limited on our website at www.cqc.org.uk.

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 monitor the service.

We have identified two breaches of regulation. Medicine was not always being safely, or properly managed and the need for consent had not always been considered.

Please see the action we have 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.

First Col Limited is a domiciliary care agency. It provides personal care to both older people and younger adults living in their own homes. CQC only inspects the service being received by people provided with 'personal care', which includes help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection there were 60 people who received personal care.

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

Not all risks to the person's safety had been considered or mitigated sufficiently. Recruitment practices were not always robust which exposed people to unsafe recruitment practices. The provider did not work in accordance with their own policies and procedures or legislative requirements to ensure safe recruitment practices. They had not taken appropriate measures to ensure that staff were suitable and safe to work with the person before they began work. We sought immediate assurance from the provider that these shortfalls had been addressed.

Staff work in people’s own homes and rely on information from the person, family and professionals to ensure that they are providing personalised support. Care and risk records lack personalised detail and did not always contain guidance for staff to help ensure people remained safe.

Medicine records lacked detailed information with regards to “as required” medicine (PRN). Details about the dosage, when to take and what to do if concerns remain had not been recorded. The providers oversight of processes had not accurately identified ongoing concerns which then resulted in timely actions not being taken. One person did not have access to their prescribed pain medicine for over thirteen days.

There were shortfalls in reporting concerns and allegations to the Local Authority for consideration under safeguarding procedures. Systems were not effectively identifying allegations of abuse and there were incidents where allegations of abuse had not been reported to the appropriate authority for investigation.

There was a significant lack of oversight and quality assurance monitoring by the registered manager and provider. Quality audits were not always effective. Discrepancies with medicine auditing identified at inspection had not been identified or acted upon by the provider.

People were positive about the support they received from staff. One person told us, “They are amazing they chat with me,” another told us,” they are brilliant, they are very helpful.” Peoples view of the service was positive.

Staff told us they felt supported and had received the training they needed. They also told us about the effective infection control measures that they have had in place since the start of the Covid-19 pandemic

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.

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

The last rating for this service was good (published 22 October 2019).

Why we inspected

This focused inspection was prompted in part due to concerns received about the management and reporting of safeguarding incidents. A decision was made for us to inspect and examine those risks.

Enforcement

We were 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 five breaches of regulation. Safe care and treatment was not properly risk assessed and risks were not mitigated. Medication was not always being safely, or properly managed. Systems and processes did not always protect people from abuse and improper treatment. The provider had not always ensured safe staff recruitment, Quality assurance processes were not in place to assess, monitor and improve the quality and safety of the service. CQC had not been notified of reportable events and allegations. You can see what action we have asked the provider to take at the end of this full report

Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We sought immediate assurances on measures the provider had taken due to the serious concerns around safe recruitment. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

FirstCol Services Limited is a domiciliary care agency providing personal care to adults living with families or in their own homes in the community. 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. At the time of our inspection the service was supporting 62 people, living with frailty and other health related conditions, with the regulated activity of personal care.

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

People’s care plans were not always personalised. Peoples history, their background, aspirations, goals, likes and dislikes were not always included. Examples of where this was included, lacked detail. The provider had already identified this through their quality assurance audit system and was in the process of updating and improving these areas.

Peoples end of life preferences hadn’t been sought or captured. We made a recommendation the provider consults a reputable source to further develop end of life planning.

People said they felt safe and were protected from harm. A person said, “I feel very safe. It’s because of their attitude, I suppose, and the way they behave. They’re always kind and they always ask if they can do anything else, if I need anything else doing. I’ve got nothing bad to say about them.” Another person said, “I feel it’s fine. I feel safe and well cared for."

Staff had a good understanding of what safeguarding meant and the procedures for reporting any issues of harm to people. All the staff we spoke with were confident any concerns they raised would be followed up appropriately by the registered manager.

Staffing levels were specific to individuals. A person said, “[Staff member] is always here 15 minutes early. It’s nearly always the same person. It’s nice to see the same face.” The staff recruitment procedures ensured appropriate pre-employment checks were completed to ensure only suitable staff worked at the service.

Medicines were managed safely by trained staff. Effective practices were in place to protect people from infection.

Staff received supervision and appraisals to support them in their role and identify any learning needs and opportunities for professional development. Senior staff carried out spot checks on staff to monitor the quality of the service provided and to seek the views of the people who were supported. A person said, “They (staff) know what they’re doing."

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.

Staff supported people to have enough to eat and drink and to make choices about what they ate and drank. A person said, “Staff do the cooking for me and the shopping. They respect my wish not to eat with a knife. They get the lids off and chop up my meals when they need to. They do advise me to eat sensibly.”

People received appropriate healthcare support as and when needed and staff knew what to do to summon assistance. A person said, “Staff notice when I’m not well. I get a lot of pain and they ask if I want a doctor or for them to ring 999. They always give me the option.”

People were supported by kind and caring staff who knew them well. People spoke highly of the staff who looked after them and said they were treated with dignity and respect. A person said, “They’re (staff) very caring. They do the things they’re asked to do and they’re very caring in what they do.” Another person said, “Staff are pleasant. My day is better for them coming in.” A relative said, “It couldn’t be better. They (staff) come in, at night, they’ve been working all day and it’s like it could be the first call of the day. They come in all bright and smiling and say, ‘How are you?’” People were involved in all aspects of their care and were supported to express their views.

Complaints were investigated and managed appropriately in line with the provider's policy. The registered manager monitored the quality of the service and used feedback from people and staff to identify improvements and act on them.

The service worked in partnership with other agencies to ensure quality of care across all levels. People, relatives and staff were encouraged to provide feedback about the service.

There was a culture of openness and transparency. Staff were positive about the management and leadership of the service. The service had quality assurance systems in place, which were used to good effect and to continuously improve on the quality of the care provided.

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 21 March 2017)

Why we inspected

This was a planned inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection there was a new manager in post who had applied to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Since the inspection took place the new manager had become registered with the CQC.

Some people were supported by staff to have their medicines. Some people were prescribed PRN medicines. PRN medicines are given 'when required' and should be administered when symptoms are exhibited. There was no specific guidance for staff regarding when and how to use such medicine, what the expected effect would be and the maximum dose and duration of use. This meant that people were at risk of not being given PRN medicines consistently and in accordance with prescribed instructions. Medication Administration Records (MAR) were used to record and monitor the administration of people’s medicines. We found that there were some gaps in recording on the MAR charts. The provider’s system for monitoring recording had identified that there were gaps, but it was not clear what actions had been taken as a result. The manager had introduced a new system for monitoring MAR charts, but this was not yet fully embedded. We have identified this as an area of practice that needs to improve.

People told us the service was reliable and helped them to feel safe living at home. One person said, “They do make me feel safe, very much so, they are all very good.” Risks to people had been identified and were managed effectively. People were supported by staff who had a clear understanding of their responsibilities with regard to keeping people safe from avoidable harm and reporting any safeguarding concerns. The provider had robust recruitment procedures in place to ensure that staff were suitable to work with people. There were enough staff to provide care safely and people told us that they received their visits on time and that staff stayed for the expected duration of the visit.

Staff received the training and support they needed to carry out their roles effectively. People told us they had confidence in the staff. One relative said, “They have helped my husband to be able to walk again, their perseverance and encouragement has contributed to his recovery.” Staff had a good understanding of their responsibilities with regard to the Mental Capacity Act 2005. They asked people for their consent before providing care. Where people lacked capacity, best interest decisions were documented in line with the legislation.

People were supported to have enough to eat and drink. Where risks and nutritional needs were identified staff monitored their food and drinks and checked their weight regularly to manage the risks. Staff told us they offered people a choice depending upon what food they had available. People told us that staff supported them to access health care services if they needed to. One relative said, “They have been excellent, the physiotherapist showed the carers what to do and they encourage (person’s name) to move. They pick up on little things and bring it to my attention in case I need to speak to the doctor.”

People spoke very highly of the care they received. One person said, “You can’t run people down who are wonderful.” A relative commented, “The way they speak to (person’s name) is lovely. They are always gentle and kind, but never patronising, they speak to him like a person.” Staff told us they had developed positive relationships with people and knew them well. One care worker told us about someone who loved music and enjoyed a dance, saying, “You have to be able to multi-task, they enjoy a waltz around the room, so we combine that into the routine.” People told us they had been involved in planning their care and felt their views were listened to. One person said, “I feel that I am in charge and they listen to what I want.” People told us they were treated with dignity and respect. They said that staff were never rude and always kind. Staff spoke about people positively, one staff member said, “The best part of my job is seeing people smile and knowing that they are happy with what I’ve done. That’s the best reward.”

People’s care plans were personalised and guided staff in how people wanted to have their care needs met. People told us that staff were flexible and responsive to their needs. One person told us, “They adjust things when needed, for example, when I wasn’t well they were very good, they put in a lunch call to make sure I was alright.” Staff told us that they used information about people’s personal history and interests to engage with them when providing care. One staff member told us about one person saying, “I know they love Elvis, so we sing Elvis songs together and that distracts them from their worries.” Staff said they made time to talk to people at each visit. One staff member said, “One person likes to get their photo box out sometimes and we have a cup of tea and look through them, to them that is more important than anything else we do.”

People knew how to make complaints and they were confident that their concerns would be acted upon. They spoke highly of the management of the service, their comments included, “It’s a well- managed, reliable service,” and “It’s a very good service, we have no complaints and I would recommend it to anyone.” Staff spoke highly of the new manager and the provider. There was clear leadership and staff described an open and positive culture with “no blame culture” and high morale. One staff member said,“FirstCol really cares about its workers, they care about whether we are happy.” Staff told us they were able to contribute to the development of the service and that their views were valued.

There were systems in place to monitor the quality of the service and to drive improvements. This included feedback from people who used the service as well as a number of audits and checks. The new manager and the provider were committed to ensuring high quality care.