Archived: First Choice Home Care & Employment Services Limited - Hackney

At the last inspection on 24 and 25 May 2016 and 1 and 3 June 2016 we found multiple breaches in relation to person-centred care, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaints, good governance, staffing, the employment of fit and proper persons and notification of incidents. The service was rated inadequate and placed into Special Measures as a result. We imposed a condition on the provider’s registration restricting them from providing personal care to any new Service User from First Choice Home Care and Employment Services Limited Hackney without the prior written agreement of the Care Quality Commission. The provider sent in an action plan to tell us what they were going to do to make improvements. However during this inspection we found that insufficient improvements had been made.

First Choice Home Care and Employment Services Limited Hackney is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our previous inspection the service was providing support to 429 people in the London Boroughs of Hackney and Camden. The majority of the people using the service were either funded by the local authority or the NHS. After the inspection the local authorities arranged for people to be transferred to alternative care providers and at the time of this inspection, there was only one person being supported with personal care by the service.

There was a manager in post at the time of our inspection who had worked for the provider since October 2016 and had applied to be a registered manager. The previous branch manager had left after the last inspection and the last registered manager in place left in April 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People who lived with specific health conditions had not had the risks associated with these conditions properly assessed and care plans were not developed from these to ensure their safety and welfare. Risk assessments were not detailed and did not provide staff with information or guidance on how to minimise the risk.

Appropriate policies and procedures were not in place to ensure that people received their medicines safely and effectively. People’s medicines were not being recorded correctly or checked. There was also no evidence that staff had received regular competency training to ensure that they were able to prompt and administer medicines safely.

Safeguarding incidents had started to be logged however people were still not always protected from the risk of potential abuse because the provider did not always act appropriately to safeguarding concerns or follow them up to ensure people’s safety.

Staff files had been checked and a system was in place for Disclosure and Barring Services (DBS) checks. However robust recruitment procedures were still not in place to minimise the risk of unsuitable people being employed.

Staff still did not have a clear understanding of the principles of the Mental Capacity Act 2005 (MCA). Where family members had signed to consent to the care and support of their family member, the provider was unable to demonstrate that the relative had the legal authority to do so and was therefore not working in line with the MCA.

The action plan that had been submitted told us that staff had received refresher training in a number of areas since the last inspection, however we found that it had not been done. We saw that staff supervisions had started to be carried out however they did not always have an accurate record of what had been discussed.

Relatives commented positively about their regular care workers’ caring attitude and said they had built up a positive relationship. There was evidence that people’s privacy and dignity was respected. However, training in this area that we had been told had been completed had not been done.

We saw evidence of improved personalisation in people’s care plans, however they still lacked detailed information and were not specific to people’s needs which put them at risk of receiving unsafe or inappropriate care. We were not assured they reflected people’s wishes and how they wanted to be cared for.

Records showed that people were not always involved in making decisions about their care and the support they received, when they were able to do so.

Systems to record and investigate complaints, incidents, accidents and serious events had been introduced however such events were not always recorded, followed up or resolved before being signed off by managers. Information was not used as an opportunity to learn and improve the service.

Quality monitoring systems that had been introduced did not identify or address shortfalls in the operation of the service. Shortfalls identified at our last inspection had not been satisfactorily addressed by the management team.

The action plan that was submitted to us by the provider had not been followed through effectively to improve the service. It was not clear if all staff had access to the plan to work towards achieving the outcomes highlighted.

The provider continued to not meet their legal obligations to notify the CQC about serious incidents and allegations of abuse.

We found continued breaches of regulations in relation to consent, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing, fit and proper persons employed and notifiable incidents. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'.

The service was kept under review and we have found that not enough improvement was made. Therefore we are now considering what action we will take in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

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 it will no longer be in Special Measures.

First Choice Home Care and Employment Services Limited Hackney is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing support to 429 people in the London Boroughs of Hackney and Camden. The majority of the people using the service were either funded by the local authority or the NHS.

There was a manager in post at the time of our inspection who had applied to be a registered manager. The previous registered manager had left recently and the current manager had been in post for two weeks. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The service did not have appropriate systems in place to protect people from harm. People who lived with specific health conditions had not had the risks associated with these conditions assessed and care plans were not developed from these to ensure their safety and welfare. Risk assessments were not detailed, did not provide staff with guidance and had not been reviewed if people’s needs changed.

The provider did not have a good understanding of the policies and procedures in place to safeguard people from abuse and avoidable harm. There system in place to report and follow up incidents was not followed and ineffective and disciplinary procedures were not followed to ensure people’s safety.

There was not an effective system in place to monitor staffing levels and ensure that there was always enough staff in place to meet people’s needs. Calls were not being monitored and there was no effective system to make sure people had their visits on time. The provider did not follow a robust recruitment process to ensure staff had the necessary checks and were suitable to work with people using the service.

Appropriate policies and procedures were not in place to ensure that people received their medicines safely and effectively.

Whilst a new trainer had been recruited and was starting to deliver their training programme, training records were inconsistent. Staff did not receive the required induction, training, supervision and support to undertake their role. There were staff working at the service without the knowledge and skills to provide people with safe care and treatment.

Requirements of the Mental Capacity Act 2005 (MCA) were not followed. The provider did not have a clear understanding that people should consent to their care and support to ensure that their rights were protected. There was limited evidence that the provider had sought people’s consent such as signed consent forms and care plans, and there was no indication that people’s capacity had been assessed and decisions made in their best interests where they were unable to make a specific decision for themselves.

People were supported to have sufficient food and drink however people’s preferences were not recorded and care plans did not identify risks or nutritional needs. People with diabetes were not monitored or managed effectively to minimise the risk of their health being compromised.

People and their relatives told us that their regular care workers were kind and caring and knew how to support them. However, when replacement care workers were used people were not happy as late and missed visits became more of a problem and people received inconsistent levels of care.

Care plans lacked detailed information, were incomplete, not specific to people’s needs and in some cases, not in place. We were not assured they reflected people’s wishes and how they wanted to be cared for.

The investigation and review of complaints, incidents, accidents and serious events which occurred within the service was ineffective and did not support learning. Information was not identified and acted upon to ensure the safety and welfare of people.

The provider did not meet the CQC registration requirements regarding the submission of notifications about serious incidents, for which they have a legal obligation to do so.

There was no overall leadership of the service in place. Quality assurance and management systems were not in place to monitor the care provided to people who used the service.

We found a number of breaches of Regulations in relation to person centred care, safe care and treatment, safeguarding, consent, good governance, staffing, fit and proper persons employed and notifications. You can see what action we told the provider to take at the end of the full version of this report. We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

At this inspection records showed that the provider had taken action to ensure that people using the service were protected against the risk of receiving care that is inappropriate or unsafe by means of carrying out a review of every person's care needs.

The relative of one person using the service said, 'the staff provide extensive personal care with dignity and respect for my relative. All staff, including the replacement staff, are polite and respect our family home.'

People's consent was sought before care was given. One person said, 'my choices and issues were taken into account when the care was set up.'

Most of the people we spoke with were happy with the care they received. Comments included, 'my service is perfect,' and 'the care worker carries out tasks properly and seemed to be very well trained. However, replacement staff are not as good.' Some people felt the service was less reliable during the weekend. One person said, 'it annoys me when the staff do not let me know when they are going to be late, Sunday is worst. Also I need two staff and if only one arrives I don't get my personal care until the other one comes.'

Staff were supported in their work through supervision meetings, annual appraisals and team meetings. They were able to obtain further qualifications appropriate to their work.

People were asked for their opinion of the service through telephone spot checks and a yearly survey.

People were positive about the quality of the service and felt they were treated in a respectful manner. People told us the agency provided individual care and support, which took into account their preferences and cultural needs. One person said, 'I like the way my care workers look after me. They have taken the trouble to find out how I like things to be done.' Another person told us, 'I think that my care is good and they are helping me to stay in my own home, which is what I want.'

The care needs of people using the service were assessed and recorded in their care plans. Risk assessments were carried out to ensure people were safely cared for. The agency had appropriate systems for recruiting staff, which meant that people using the service were cared for and supported by suitable staff.

People using the service said they felt confident the agency would respond in a professional and supportive way to any complaints they might make.