Care First 24 Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this newly registered service. This key question has been rated outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 96 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

People, their relatives and healthcare professionals told us that the impact of the support from Care First 24 had been life changing. The provider worked with all stakeholders to assess people’s needs from the initial assessment, throughout the package. This included regularly reviewing people’s care to make sure it met guidance and legislation to enable staff to deliver high quality tailored support.

A person initially reluctant to accept support agreed to a small care package after collaborative work with staff. With their input and consent, this support grew over time, and staff were able to evidence their increased need to those funding the care. Staff told us, “It was happening to him, so it was important that he was in control of making decisions about the care package and we respected his right to do this, whilst assessing and re-assessing the risks to ensure he remained safe.”

People’s needs had been fully, holistically assessed prior to support being provided with tailored care packages then being created with the person at the centre. Staff knew people well, because they had detailed care plans and risk assessments to learn about people. When people’s needs changed, this was documented and communicated with staff and people’s care plans evolved with them. People were supported to receive annual health checks and any associated follow ups including blood tests.

People’s communication needs were clearly set out within their care plans. Some people were not able to communicate verbally and where this was the case, guidance clearly set out how to communicate with the person. For example, some people used communication aids including picture exchange communication system (PECS), or Makaton. PECS allows people to communicate using pictures. Makaton is a language programme that combines signs (hand gestures), symbols (pictures), and speech to help people communicate.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards and worked with stakeholders including the NHS to develop good and improved practice in relation to hospital discharges.

People received care which was evidence based, and in line with good practice standards. Within care plans there was good practice guidance and reference sheets to remind staff on best practice when supporting people. This included the FLACC pain scale which had been implemented to inform staff how to identify and asses if a child was in pain and unable to communicate this. The FLACC tool is an observation tool used to assess pain in children who cannot communicate their pain verbally. Other guidance included visual guides on how to observe if people were dehydrated, and actions to take to support them to be well. There was also guidance in people’s care plan’s to remind staff about safe medicines administration practices, and actions to take if a person choked. People were told about current good practice that was relevant to their care and were involved in how this was reflected in their care plan.

Staff were aware of good practice guidance when it came to supporting people living with dementia. As part of this staff empowered people to make decisions about their care and support. For example, one person was distressed when staff supported them. Staff identified this was due to the colour of their uniform and changed the colour of the uniform for the team supporting this person. Staff also recognised that some of the persons distress came from reverting to their first language. Staff implemented flash cards in the person’s first language to ensure the person’s voice could be heard. The provider told us, “They have been misunderstood for so long.” Staff told us they found through the use of the communication aids that the person loved mango, encouraged their loved one to ensure they purchased this for them.

People and their loved ones were at the heart of planning their care. People and their relatives told us that their needs and wants were prioritised by staff. Staff understood how to read people’s individual communication needs to understand how they wanted their care delivered. Before packages of care started staff took time to get to know people and understand how they wanted their care planned, and this was regularly reviewed by staff to ensure it met people’s needs.

Healthcare professionals told us they had confidence staff and the provider could support people in an effective way. A healthcare professional told us, “If I have a reason to call Care First 24 regarding a package, they are quick to respond and knowledgeable about what is happening in the package.”

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

People and their loved ones told us that staff had been exceptional in working with other stakeholders to deliver people meaningful outcomes. For example, one person told us their loved one had deteriorated in health. When they mentioned to staff they wanted to bring a special occasion forward to ensure their loved one could be present, staff went above and beyond to support this, telling them they would ‘make it happen.’ Staff supported the family with sourcing safe transport which meant a lot to them. The relative told us, “That’s not out of the ordinary for them, it’s not unusual for them. They do these things.”

Staff helped a child who had never been home finally return and thrive with Care First 24’s support. Working closely with the hospital and commissioners, they planned a safe transition and supported the child at home while managing risks. Staff told us that coming home allowed the child to experience family life for the first time, and with support in place, their loved one was able to focus on parenting all their children together. Staff told us, “The voice of the child and their loved one was central. Their personality is now really shining through, she is sleeping more, playing more and their cheeky personality now shines.”

A relative told us that staff worked with other professionals to meet people’s needs. For example, when a person wanted a shower rather than a strip wash they worked with professionals to ensure this could be done safely to meet the person’s needs. Another relative told us, “They always work really well as a team.”

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff were passionate about supporting people to live as healthy lives as possible. The provider instilled a culture of supporting people’s mental and physical health and did so through supporting people to gain weight when needed and reduce the use of physical interventions which the provider recognised was distressing for people and staff.

The provider had a nutrition champion who was responsible for supporting people to increase their nutritional intake. As a result, the provider took part in a pilot project to support older people living at home to increase their weight. 12 people were supported to purchase slow cookers, and staff supported them to use these over a period of time. Staff said having the smells of food cooking throughout the house, helped increase people’s appetite, and over the pilot people’s weights increased by 7%. One person fed back that they were ‘thrilled’ with the project and the support received from Care First 24. People said they would continue to use their slow cooker, and staff encourage new people to the service to use slow cookers.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

People and their loved ones told us that they received consistent, high levels of support with their health needs. A relative told us that their loved one was supported to see the dentist with Care First 24. The person had been supported by Care First 24’s oral health champion who worked with staff to improve the quality of oral care that was delivered. Following this, the person’s teeth were in such good condition the dentist was able to extend the time in between visits, due to the effective support the person received from staff.

A relative told us that the Care First 24 staff had been acknowledged for their kindness, compassion and dedication to the person they supported. They told us, “This week one of the physios in the hospital, said they were very impressed with one of the [Care First 24] nurses, she was wanting to learn, she is passionate about her job, that was reflective of our entire team, it was nice for someone else to recognise.” Another relative told us that staff had been incredibly supportive with their loved one, and that with their support their outcomes had improved. They said, “She recently came out of hospital, [Care First 24 staff] they have been amazing, without their help she wouldn’t be as well as she is now.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s capacity had been assessed and documented within care plans to inform staff. Care plans contained reminders for staff to seek consent when carrying out care. People and their relatives told us that their loved ones were given choices and their right to decline was understood and respected by staff. Relatives told us, “He’s given a choice of meal, and his clothes.”

A healthcare professional told us, “The provider showed that they were caring, and their knowledge of mental capacity legislation and multidisciplinary working was exemplary.” Relatives told us that when people could not always explicitly consent, staff understood and acted in their best interest. A relative told us, “I think everybody generally asks her, she’s given choice, she might give an answer, if they aren’t confident [in her response] then they do what’s in her best interests.”