First Thought Care Services

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 good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s care provision started after a comprehensively planned and holistic assessment of their needs, preferences, and aspirations to ensure staff fully understood people’s care needs.

Bespoke training for staff had been developed around people’s support requirements to ensure staff approach was focused on the person from the start of their care provision. Staff worked with people, families, health and social care professionals and care providers already involved in their support to ensure staff could effectively support them and understood their needs.
 

The provider mainly planned and delivered people’s care and treatment with them, including what was important and mattered to them. The provider worked with staff, professionals and people to develop and deliver evidence-based good practice and standards.

We were not fully assured the provider had adequately addressed the impact on people whose home was integrated in a multipurpose building, where the design and signage of the service potentially could hinder their autonomy, independence and choice. This did not meet CQC’s Right Support, Right Care, Right Culture and other related tenancy guidance for people who live in supported living accommodation.

Systems were in place to review all incidents to ensure people had been supported using the principles of PBS and to ensure all interventions were underpinned by the Restraint Reduction Network practices to reduce restrictive practices. Detailed assessments were in place to guide staff on people’s choices and preferences around their nutrition, hydration and activities. Risk management and positive behaviour support plans were in place to guide staff on people’s support requirements in line with guidance. We saw evidence of reduced incidents and the reduction of people’s medicines as required by STOMP.
 

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.

There was a strong focus on working collectively as a team in the best interest of people.

Communication was reported to be good across all levels of the service. Concerns were quickly escalated internally, and advice was sought from internal specialists and positive behaviour support practitioners as needed. Staff told us they were involved in sharing information and giving updates on people’s care and their outcomes. The provider had developed an internal staffing structure which had improved the oversight and communication around people’s care.

Professionals reported the service communicated and worked well with them in a timely manner.
 

The provider supported people to manage their health and wellbeing to 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 supported people to live and maintain healthier lives. People were supported to attend routine and specialised appointments such as learning disability and mental health community teams as well as people’s GP and pharmacist. They used pictures and other forms of communication tools and strategies to support people to understand the purpose of their health care appointment and overcome any barriers or fears.

The complex service manager said, “We aim to have a multidisciplinary approach when providing to care to people and to ensure we are delivering care in people’s best interest.” Staff said they were aware of people’s individual health conditions and had the information they needed in peoples care plans to guide them on how to support people. Health action plans and appointments were recorded and monitored to ensure the appointments were attended and the outcomes of appointments were understood and known by all staff.

Relatives were mainly positive about how staff had supported to improve their well-being. People’s health care needs were regularly reviewed according to their changing needs. Most relatives told us staff understood people’s health needs and ensured they received appropriate support. A relative said, “[Person’s] reviews used to be monthly, now they are every 3 months which works well. We hear how he is getting on and it is heartwarming.” However, another relative expressed concerns about the inconsistent approach of staff in supporting their family to attend an appointment and catering for their family members allergy needs. This was raised with the provider who explained they were putting in measures and meeting with the person’s relatives to address their concerns.
 

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

The service focused on continually assessing people’s needs and wishes with the aim to consistently improve people’s quality of life. Relatives mainly felt people’s health and wellbeing had improved over time since using the service. Relatives shared examples of how staff improved people’s experiences and outcomes. One relative praised staff about their consistent approach in supporting their family member to understand healthy eating options, which had helped them lose weight and improve their outcomes. Monitoring systems were in place to monitor people’s emotional distress and any associated triggers to identify patterns and trends.
 

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

People were involved in day-to-day decisions about their care. We observed staff providing people with choice about their clothes and how they wished to spend their day. The provider worked closely with people’s families especially when they were transferring into the service. The provider explained they worked sensitively with relatives to help them understand the importance of positive risk taking and respecting people’s choices and wishes and accepting people’s decisions.

Applications to the court of protection had been made and monitored for people who were subject to restrictions.

Staff and managers had been trained in understanding consent and making best interest decisions in line with the Mental Capacity Act 2005. Although we found no impact on people, we noted the provider’s assessment and rationale for specific restrictions and decisions were not systematically recorded for all people. The provider agreed to review their assessment processes to ensure there was a consistent approach in assessing people’s mental capacity.