Background to this inspection
Updated
22 November 2019
The inspection
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 two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission as required by law. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. There was a care manager in post who told us they would apply for registration once the appropriate checks had been completed with the Disclosure Barring Service to ensure they were suitable to apply for the role.
Notice of inspection
We gave the service 48 hours’ notice of the inspection site visit. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
Prior to the inspection we reviewed information we held about the service since their last inspection. This included notifications received from the provider about deaths, accidents/incidents and safeguarding alerts which they are required to send us by law. We also contacted a number of local authorities who commissioned services from this provider. We used this information to help plan our inspection.
Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with one person who used the service and four relatives to gain their views around the care and support they received.
We spoke with seven members of staff including the nominated individual, care manager, scheduler, senior care worker and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found during our site visit.
Updated
22 November 2019
About the service
Firstpoint Homecare Limited is a community-based care provider that provides personal care and support to people in their own homes. 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 there were nine people receiving personal care.
People’s experience of using this service and what we found
Improvements had been made to the quality and safety of the service since the last inspection. We identified a continued breach in relation to governance because these improvements were not yet embedded and effective.
Peoples’ risk assessments had improved since the last inspection, however, they did not consistently contain enough guidance to staff on how to safely support people. Staff did not consistently follow good infection control practices and this placed people at risk of cross infection. Whilst people and staff thought there were enough staff to support people, they did not consistently receive their calls at the times scheduled. Whilst staff had received training in how to keep people safe and could describe the actions they would take when people were at risk of harm, we found this was not always done effectively. Since our last inspection, medication audits had been implemented to check whether people’s medication had been administered as required. The provider had a recruitment process to ensure the appropriate checks were carried out when recruiting staff.
Staff received specialised training to give them the knowledge to support people’s individual needs. People told us they were generally supported by regular staff who knew them well. People’s religious and cultural beliefs were respected.
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.
We found some care practices did not always respect people’s privacy and dignity. People told us staff were caring and staff promoted independence.
There was no end of life care plans for people who wanted to express their wishes at the end of their life. A care plan and assessment were in place to show the support people needed. People knew who to speak to if they had any concerns.
The provider’s governance and auditing systems had improved but further improvement was needed to ensure that they were consistently effective in ensuring people consistently received safe care and treatment. There was no registered manager in post as required by law.
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 inadequate (published 28 June 2019) and we found multiple breaches of regulations. At this inspection not enough improvement had been made and the provider was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance.
This service has been in Special Measures since 28 June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
After our last inspection, we carried out enforcement action to remove the location on the provider’s registration. At this inspection we found improvements had been made and the provider had met all but one of the breaches identified at the last inspection. We found the provider was still in breach of one regulation related to governance because improvements to the quality and safety of the service needed to be embedded and sustained.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
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.