1st Central Care 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 service. This key question has been rated requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We found that care plan audits at the service were not consistent or completed to a reasonable level, care plan audits did not address concerns that were highlighted, for example, continence wear was identified as not being suitable, however there was no detail on how this would be addressed or who would be responsible.

Whilst the provider did carry out assessments before providing services, we found that people’s needs were not consistently and routinely assessed and care plans and risk assessments were not updated in a timely or effective way.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

In addition to other areas outlined in this report, we found that peoples call times were not always appropriate for their assessed needs, this impacted on their care and preferred outcomes. One family member of a person who uses the service told us, “We never get a call if they are going to be late, and sometimes they are very late, which affects [person] pain relief meds. There’s no rota.”

However, we found positive instances of care provided by staff, one family member told us, “I don’t think we could get better carers. They are dementia aware and get on with [person] very well.” We also found positive instances of pressure sores being managed effectively and improved outcomes for pressure area care.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider offered care to a large portion of persons under hospice care, we saw good evidence of positive and collaborative working relationships with the hospice services. They also engaged with other professionals such as pharmacies and social workers to improve services offered to people.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

We found that there were delays in updating peoples care plans and risk assessments, this led to staff unable to support in people in a consistent way and meet peoples changing needs. This led to negative experiences for some people, and they did not get safe, effective or consistent care that supported them to live healthier lives.
One person told us “It’s different carer all the time, not good. Sometimes the carers seem terrified to help him.”

One staff member told us, “Care plans are accurate and reflect the needs of the people using the service… However, there are times when care plans could be updated more promptly to reflect changes in individuals’ needs.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Whilst the service did monitor peoples care and treatment, and there were successful instances of pressure ulcer care, this was not consistent. A lack of governance arrangements meant that some individuals were at risk due to unclear care plans, for example a person using the service was under the care of district nurses, a long term pressure wound was not healing. The care plan stated that carers were to moisturize daily after personal care and apply barrier cream after every visit. Despite best practice guidance from NICE QS89 stating that repositioning is recommended every 4 hours this was not highlighted in the care plan. This could impact recovery and lead to poor outcomes.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Due to issues with governance, the provider could not provide evidence of signed consent for all people that they supported and therefore this could not be adequately measured in all cases.

However, when providing care people gave positive feedback on consent when they received care at point of delivery. People told us, “They do ask [person] and check beforehand.” Another person told us, “They always ask if they can do anything, and they do have a chat with [person]. [Person’s] comfortable with the care provided.”