Archived: Firstpoint Homecare Boston

At our earlier inspection we found that improvements needed to be made to the way in which people were supported to manage medication. In addition, we said that the provider needed to ensure that visits to people's homes were completed reliably and at the right time. Furthermore, we said that the provider needed to offer people who used the service more opportunities to give feedback about the service they received. Lastly, we told the provider that more robust quality checks needed to be completed so that problems of the kind we had noted could quickly be identified and put right.

We said that all of the shortfalls needed to be addressed so that people could be confident that they would receive the care they needed at home.

After our inspection dated 08 July 2014 the provider wrote to us and said that they had made the improvements that were necessary to address all of our concerns.

Our inspection dated 10 November 2014 examined the way in which people were supported to manage their medication, received planned visits at home and were invited to give feedback. In addition, we looked at the ways in which the provider quality checked particular aspects of the service people received.

We found that the provider had introduced all of the necessary improvements.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be kind and to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

Is the service responsive?

We found that the service was responsive. This was because people's individual needs for care had been assessed and met. Staff knew about each person's care needs, choices and preferred routines. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person's changing needs and wishes.

However, we have said that the provider may find it useful to make an improvement to further develop the service. This involved responding to concerns raised by some people who found that staff were sometimes rushed because they had to complete too many visits in a short time.

Is the service safe?

We found that the service was not safe. Staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse. This included having policies and procedures to guide staff in the correct application of the Mental Capacity Act 2005. This helped to ensure that people were supported to make decisions that were in their best interests.

However, the provider did not have a reliable and accurate system to record all medicines administered by staff. This increased the risk of errors occurring because there was no comprehensive account of what medicines people had been supported to take.

We have told the provider that it must make improvements. This is necessary so that people can reliably be assisted to safely take medicines that have been prescribed for them.

Is the service effective?

We found that the service was not effective. This was because there were inadequate arrangements to ensure that visits were always carried out, completed on time and lasted for the correct amount of time. These shortfalls significantly reduced the provider's ability to reliably and consistently support people at home.

We have told the provider that it must make improvements. This is necessary so that people can effectively receive the care they need at home.

Is the service well led?

We found that the service was not well led. This was because the manager had been in post for approximately four months but the provider had not submitted an application for her to be registered with us. The law says that the provider is required to have a registered manager. This is because we need to establish that there is someone in charge who has the knowledge and skills necessary to ensure that the service is caring and meets people's support needs.

In addition, there was not a robust system to receive feedback from people about their experience of using the service. We also found that quality checks had not been completed in a comprehensive and rigorous way. This had resulted in significant problems with the reliability of the service people received not being quickly identified and resolved.

We have told the provider that it must make improvements. This is necessary so that people can reliably receive the care they need at home.

We spoke with and observed a training officer and three new workers who were receiving training required to provide safe and effective care. We reviewed three care records and a number of documents relating to the management of the service.

People told us they were generally well supported by staff who were good at their jobs and who they trusted. One person said 'The girls are brilliant.' Another said 'They are looking after me alright.' They told us that they felt safe with carers but knew how to raise concerns and make complaints if this was required.

One person said 'I trust them, they're nice people.' Another said 'I've got the complaints line number.'

People said care staff listened to them and encouraged them to make choices and decisions about how their care was planned and delivered. The partner of a person who received support said 'They talk and engage well with us' and 'listen to our views.'

We saw from care records and from discussions with people and staff that care was planned and delivered according to individually assessed need.

Staff told us they enjoyed their jobs and felt well supported by the manager and office staff. They told us when they were working alone and out of office hours they had telephone support whenever they had concerns or needed advice.

We looked at records relating to the running of service including complaints, training records and reviews of working practice. We found that there were inadequate systems in place to ensure problems relating to the effective management of care visits were clearly understood and effectively addressed.