First Thought Care Services

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people’s needs were met through good organisation and delivery.
 

This service scored 82 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Feedback from relatives and professionals consistently highlighted the service’s commitment to supporting people to meet their needs and aspirations through a person-centred approach. People were treated as individuals and were actively supported by staff to learn new skills, explore new opportunities, engage in their community, and manage their daily tasks.

As a result of the exceptional staff support, people have been supported to become increasingly independent, create meaningful relationships, and live a more active life of their choice. The provider explained their approach always starts at the point of the initial assessment of people’s needs and to ensure detailed care plans are in place to support people to transition into their new home. People and staff were given the time to understand how people’s support provision would be provided.

The complex care manager explained the importance of carrying out a thorough initial assessment and understanding each person’s personal backgrounds and their care history to establish why previous placements had failed.

Relatives praised the team's commitment to improve the quality of people’s lives as well as maintaining important routines, even during holidays or special events. One relative explained staff had taken their relative out most days to various community-based activities and tourist attractions and said, “[Person] is doing things I never thought he would do.” Another relative said, “[Person] is managed well with no restrictions. [Person] now does things she wouldn’t previously do, such as ride her trike. She can be reluctant, but they reassure her. They meet her needs in every way; it is a weight off my mind.” Another relative explained that through the dedication and support of staff, their family member now has a good daily routine and sleep pattern which has had a positive impact on their physical and emotional well-being. They explained their relative was now socialising with other people of a similar age. They said, “[People] are eating and preparing meals together. The change in him has been fantastic.”

The provider had introduced a new internal staffing structure. People were assigned to a dedicated team which was overseen by a service manager, team leader and seniors. The provider explained the new system had been successful by providing staff with a clear line management structure, enhanced staff’s communication and had improved working relationships both internally and externally including people’s families. This was confirmed by staff and people’s relatives. Staff were supported to make suggestions about people’s support which had resulted in improved quality of life for people such as developing good health and sleeping routines. The complex care manager worked with a core staff to review incidents to ensure all staff remained aligned and confident in supporting the person. This approach had a notable impact on people, for example, there was clear evidence of reduced use of sedative medicines and the need for physical interventions when people became distressed. Staff said they focused on providing a stable staffing team, implementing realistic routines and ensuring sensory, least restrictive and personalised support as possible.

Through the dedication and commitment of staff, people had been supported to try new situations and to learn new coping strategies. For example, new activities, such as using public transport, visiting parks and wildlife centres. Relatives commented on the development of people’s skills such as meal preparations, managing their laundry and reducing their reliance on staff. For another person, tailored strategies and communication tools were used to help understand the person’s needs.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Systems were in place to ensure people were supported by staff who knew them well and could adapt to people’s social and emotional needs. The management team and staff demonstrated an in-depth understanding of people’s needs, including their challenges and their achievements. Staffing levels were adjusted according to people’s needs and level of support required to carry out their activity of choice. A floating staff member was available to intervene and provide support as needed. One staff member said, “Sometimes, we [staff] need to have a break, or the person needs a change in their support team. This can help to deescalate a situation.” Staff worked closely with people’s families and professionals to ensure continuity of care and to assist people to develop and achieve positive outcomes.

Staff consistently evaluated their approach and considered alternative strategies to better support the person in achieving their goals. Staff considered potential risks for individual people associated with new experiences, such as visiting a wildlife park, and identified measures to reduce these risks whilst promoting a positive experience for the person. Relatives praised the service. Several relatives expressed their appreciation and astonishment at the rapid progress and development of their family member during their time at the service.
 

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s quality of life had improved through creative use of communication systems. Most people who were supported by the service had specific communication and sensory needs. Time and resources were dedicated to help people to develop their personal method of communication such as increasing their vocabulary or using signs or picture cards to help people to express their wishes and views. People were given weekly easy read planners to help them understand their plans for the day to reduce any uncertainties about the day.

Managers had attended communication training and planned to deliver additional communication courses to staff. They explained they were creating a communication hub to help people and staff engage with each other using a selection of communication tools such as finger puppets and picture boards. The provider told us, as a result of better communication with people, they had noticed people feel more empowered and staff were more confident in understanding people’s needs and preventing incidents related to frustration or being misunderstood. They explained, staff were now able to respond more effectively and to meet people’s unmet needs.

Most relatives explained that communication from the service was good. They told us they were informed of any incidents or changes in people’s well-being. One relative said, “We have monthly reviews over teams, and discuss what’s going on. I get a phone call about incidents or seizures.”
 

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider valued feedback from people, their relatives, staff and other stakeholders. They said they used complaints and compliments as an opportunity to evaluate the service and make adjustments to resolve people’s concerns and implement improvements. Incidents of concerns or complaints were addressed in line with the provider’s complaints policy and discussed at the provider’s meetings.

Most relatives indicated they could contact the management team with their concerns and felt that their issues were acknowledged and addressed. One relative did not support this view. This was discussed with the management team, who outlined and confirmed the measures they had taken to address and resolve the relative’s concerns.
 

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Staff worked in creative ways to help people access and overcome barriers to ensure they attended routine and specialised health care appointments such as using social stories to help people to understand the purpose of their appointment. The service worked and liaised with external professionals and services to enable people to access health and social care services and any additional support they required.

Most relatives told us they were informed of changes in people’s needs and were involved in decisions to access health and social care services. One relative said, “Staff are on top of GP appointments, and at the moment he is waiting for a community dentist appointment.” However, one relative explained on one occasion, staff had not made the necessary arrangements to ensure their family member attended an appointment. They felt on another occasion; staff had not addressed the person’s minor injury in a timely manner. This was raised with the provider, who had addressed the concerns raised and explained the measures they had implemented to prevent future incidents.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff were dedicated in ensuring people were treated equally with the aim of achieving positive outcomes. People’s support needs were constantly reviewed to ensure the support people required met their needs and wishes without discrimination and prejudice.

Staff had received equality and diversity training and were aware of the inequalities that people may face. Through communication tools and strategies, staff assisted people to overcome barriers and discrimination made by others. They worked with people to help them understand dangers in the community and to support people to regulate their emotions in places which became overwhelming.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

The service supported young adults who were involved in planning for their future such as holiday, education and trips; however, they had not always been supported to consider and discuss their views and future plans around their end of life care. The provider acknowledged our feedback and explained that people were mainly new into the service and staff were focused on establishing and maintaining people’s daily routine and achievements before introducing discussions around people’s long-term plans and care preferences. They said people’s future care plans would be considered and put into place in their best interest.