Background to this inspection
Updated
26 May 2023
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 Health and Social Care Act 2008.
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 provides care and support to people living in one ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
The inspection activity started on 28 November 2022 and ended on 15 January 2023. We visited the office location on 28 November 2022 and 05 December 2022. We also visited the one supported living service on 15 January 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We received feedback from social care professionals about the care people received. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We spoke with commissioners and local safeguarding authority to gain feedback about the service. We used all this information to plan our inspection.
During the inspection
We spoke to 2 people and 6 relatives of people using the service. We spoke with 8 staff members including the compliance manager, the registered manager and care workers. The registered manager was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We looked at 3 people’s care plans, medicine administration, 19 employment files, supervision and training records and various other management related documents.
Updated
26 May 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
First Choice Medical Solutions Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats and supported living. It provides a service to older adults, younger adults and children who may live with sensory or physical disabilities, people with dementia or learning disabilities and autistic people. At the time of this inspection 28 people were using the service.
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.
People’s experience of using this service and what we found
Right Support
People were not always supported to have maximum choice and control of their lives. Staff had not supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff needed further training to develop their skills and understand how to support people with a learning disability or dementia in their best interest.
Staff were not recruited through safe recruitment processes. This increased the risk that people were not supported safely by staff with the right skills and experience.
Staff were at times late arriving to support people. Relatives told us the office staff failed to alert them of staff lateness, which caused upset. This was not improved even after they repeatedly raised this issue with the office staff.
Right Care
Staff needed further training to understand how to provide people with safe and personalised care. People were not always protected from the risk of abuse. This was because safeguarding systems and processes were not embedded in staff’s daily practice. Risk assessments needed further developing to ensure they gave enough guidance for staff in how to mitigate risk.
The registered manager carried out regular audits to help ensure medicines were administered safely. They failed to identify in their audits concerns reported by relatives of people who repeatedly found medicines on the floor. Staff were not retrained in medicine administration or had their competencies checked when they made an error.
Right Culture
The registered manager failed to ensure they had a full understanding of their management responsibilities. They had little oversight of the service and they failed to ensure people received support safely. They did not promote a positive culture through their leadership and support for staff. The provider did not evidence organisational visions and values to underpin the principles of ‘Right support, right care, right culture.’ This guidance provides a framework for the planning and delivery of care and support for adults with learning disabilities and autistic people.
The registered manager did not demonstrate an open and transparent approach. Information requested during the inspection was not always accurate and, in some circumstances, had been developed only in response to us raising concerns.
People were in general happy with the support they received and felt safe. However, we found that not all processes and systems operated by the provider promoted safe and quality care.
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 30 April 2022)
Why we inspected
We received concerns in relation to unsafe recruitment processes, lack of support and training for staff. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for First Choice Medical Solutions Ltd on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safeguarding, recruitment, staffing skills, notification of incidents and good governance.
Please see the action we have told the provider to take at the end of this report. 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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.