Archived: 1st Choice Nursing and Care Services Limited

The service is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our inspection 36 people used the service.

The service did not have a registered manager. 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 provider was advertising to recruit a new manager at the time of our inspection.

People told us that they felt safe in their own home. Risks associated with people’s needs and providing care in the home environment had been assessed. Staff understood their responsibility to make checks within people’s home and of equipment to keep themselves and people safe.

Where accidents and incidents had occurred action had not always been taken to investigate and prevent further occurrences. The provider told us they would make improvements.

The service was not consistently working to the requirements of the Mental Capacity Act 2005.Where people had the capacity to make decisions about their care and the support that they received they were involved and their opinions sought and respected.

There was a recruitment policy in place which the provider followed. We found that all the required pre-employment checks were being carried out before staff were to commence work to make sure they were suitable.

Staff received training to meet the needs of the people who used the service. Staff felt supported and received guidance from the deputy manager.

People received their medicines as required and medicines were managed and administered safely. People were supported to maintain their health and wellbeing. People’s health needs were met and when necessary, outside health professionals were contacted for support. People were supported to have sufficient to eat and drink.

Staff knew people well and treated them with kindness and compassion. People received a consistent level of support and received their care at agreed times. People that we spoke with said that they would recommend the provider to others.

The care needs of people using the service had been assessed. Care plans included information about how people would like to receive their support. Staff had a clear understanding of their role and how to support people who used the service as individuals. People’s care requirements were reviewed.

Staff felt supported. They were clear on their role and the expectations of them. Most people who used the service and staff felt they could talk to the office staff and had confidence that they would address issues where required. People told us that they knew how to make a complaint if they needed to.

There were systems in place to monitor the care that people received however these were not always consistently followed. The provider demonstrated that they were keen to improve systems to develop the service.

The provider was not clear about their responsibilities to report significant incidents to CQC. The provider had updated all of their policies and procedures as well as the staff hand book and service user guide to ensure that staff and people using the service had current and relevant information about the service and how it was run.

We did not speak with people who used the service as part of our follow-up inspection. That was because the improvements we required were concerned with staff and how they could be better supported. We found that the provider had made improvements. All staff now had scheduled supervision meetings at which they could discuss their performance and training and development opportunities. The provider was in the process of finalising a training plan.

People told us that care workers had usually called at times they expected. One person told us, "They're punctual and do let me know if they are running late. They are never very late but it doesn't really bother me." Another person told us, "They usually let me know if they are running late."

The most important thing that people wanted was to be visited by a regular care worker, or to be told who would be calling if a regular care worker could not visit. Three people told us that they had not always been informed. One person told us, "I'm not always told if a new person is coming. That has happened twice." Another person told us, "I'm not really satisfied because the carers keep changing." People told us that on occasions when a different care worker came they had to explain to them how to carry out care routines. One person told us, "Very often I have to tell them what to do."

People told us that care workers had carried out the care routines that were in their care plans. Two people told us that they read the notes that care workers made at the end of a visit and that those notes accurately recorded the routines that had been carried out.

We found that the provider's policy for supporting staff through supervision, appraisal and training had lapsed into informality and that staff were not as well supported as they would have been had the policy been adhered to.