First Thought Care Services

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.
 

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There was a positive learning culture within the service. Staff demonstrated they knew people well and could describe how they had supported people during and after incidents such as when people had experienced a seizure.

Systems were in place to ensure all accident and incidents were reported, investigated and any areas of learning or improvement were identified and shared with staff. Staff confirmed they were given opportunities to debrief and discuss the incidents, providing suggestions of what could be improved to prevent further incidents.

Incidents relating to people’s emotions and distress were recorded to help staff identify people’s triggers and emotional responses and to learn from incidents. These were discussed at monthly internal review meetings and with the allocated staff team. Any learnings and actions from incident meetings were recorded but not always explicitly recorded in people’s care records. Whilst incident analyses were completed to identify themes, we found some inconsistencies in the data entry which prevented a comprehensive overview and a fully accurate analysis of trends. This was raised with the provider who agreed to review their analysis systems.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

There was a strong and focused approach to ensure people safely transferred into the service. The provider and staff prioritised people’s safety and continuity of care throughout their care journey. A dedicated referrals team screened new referrals to help assess if the service had the capacity and skills to meet people’s needs.

An initial assessment of people’s physical, emotional and social well-being was completed in collaboration with people’s relatives and health care professionals. Time was taken to meet people and to understand their wishes and needs. The service went out of their way to minimise the impact of people transitioning in and out of the service. A bespoke and individual transition plan was created for each person, describing how they should be supported into the service at their own pace. For example, for one person, staff visited and supported them in their previous care provision before they slowly transitioned into their new accommodation. This enabled the person to be become familiar with their new care staff. People were given opportunities to visit their new home and have overnight stays. This helped people to smoothly transition into the service and were provided with continuity of care. For another person, a book using pictures had been created for them, showing their family and their move to their new home. This was used to help the person understand their new surroundings and their move away from their family home. The relative of the person highly praised the staff and explained the creative approach of staff had eased their family member's transition to supported living.

A dedicated staff team was allocated to each person, and people were provided with a welcome pack. Staff were provided with bespoke and detailed training around people’s individual backgrounds, communication, emotional and support needs. The training was formulated and designed to help staff understand people’s routines, preferences and how to support people with their daily activities and the strategies to use of they became distressed.

The provider had not fully safeguarded people’s human rights. We found the human rights for people living in one supported living household was restricted. The design and use of the environment compromised people’s rights, choice and independence which did not meet CQC’s Right Support Right Care Right Culture guidance.

Some people lived in tenancies on the top floor of a multi-use building which also supported the provider’s children’s services. Due to the design of building, people and children were required to use the same entry and exit points in the reception area which increased the safeguarding risks for both groups. Visiting healthcare professionals also expressed concerns that the busy reception area could lead to increased safeguarding risk between children and adults with complex needs.

Risk assessments and control measures had been put in place to help mitigate this risk. Staff were required to contact the reception staff prior to people wanting to enter and exit their home, to ensure the reception area was clear. However, these mitigation measures had on one occasion proved to be unreliable. This exposed people and children to increased safeguarding risks and restricted people's human rights to freely leave or enter their own accommodation without permission or supervision; meaning people’s human rights were restricted. The provider has agreed to review their processes and explore the possibility of making reasonable adjustments. However, we were assured the human rights of people living in other supported living homes were upheld, as they had unrestricted access to come and go from their homes.

Relatives mainly felt their family member was safe and well cared for. One relative said, “[Relative] is100% safe.” However, one relative felt there was not a consistent approach in staff awareness of their family needs and inconsistency in the staff team which had impacted on the person’s safety and emotional well -being. This was raised with the provider who stated they were addressing the issue; they explained they had implemented measures and were meeting with the family to resolve their concerns.

Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. A safeguarding lead was in place to oversee the provider's safeguarding practices and concerns. The provider shared safeguarding concerns to the appropriate safeguarding organisations and notified CQC.
Staff and managers had received appropriate safeguarding training and had a good understanding of recognising abuse and protecting people and children from harm. Safeguarding incidents were discussed with staff. One staff member said, “Safeguarding is ensuring everyone is safe from harm and abuse and neglect. I would notify my seniors if I had any concerns.” The provider explained, any negative ratings and feedback from visitors and professionals were followed up as a safeguarding precaution.

Staff and managers had a good understanding of the Mental Capacity Act 2005 (MCA). They were knowledgeable about the importance of gaining lawful consent when providing personal care to people who were unable to make important decisions about their health and well-being. The Act provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.

Systems were in place to ensure people’s deprivation of liberty had been authorised. Staff approach was focused on supporting people in the least restrictive manner. Staff’s understanding of people’s preferences and communication and sensory needs had reduced incidents of restraint and people self-harming.

People were supported to understand the risk of abuse through life skills education. The provider agreed to review their safeguarding policies and protocols to align and reflect current risks to children and adults at risk.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a strong approach in managing and monitoring people’s risks as well as taking a balanced approach to reduce the need for restrictive practices and for people to increase their independence and explore new experiences and opportunities. Through a person-centred approach, staff had built up trustful relationships with people, which in turn had reduced restrictions on people’s lives, such as a reduction in their staffing support levels.

People had bespoke risk assessments in place which provided staff with information about people’s personal support requirements and the support required to reduce and monitor their risks. People had Positive Behavioural Support (PBS) plans in place which described how people presented when feeling safe and happy and the changes in people’s emotions and triggers which may indicate they had started to feel anxious. People’s PBS plans guided staff on how to support people when coping with changes in mood and distress.

Staff received accredited training by the managers who had been certified to train staff in delivering training in a holistic approach on de-escalation and crisis intervention with the aim to keep people safe. The provider explained their approach was to build people’s trust with a stable staff team and to develop a personalised approach around individual people.

Staff supported people to attend specialised health appointments and implement their recommendations. People’s physical needs and risks were managed well such as the management of people’s seizures. One health care professional said, “First Thought Care Services provide an excellent standard of safety for an individual with highly complex and frequently changing epilepsy. Staff have demonstrated exceptional understanding of seizure related risks and are highly skilled at recognising subtle early signs of deterioration.”
One relative said, “He knows the staff and they know him well. His epilepsy is managed well, with face-to-face meetings with the epilepsy nurse. She is always informed when he has break through seizures.”

Whilst we found a small number of discrepancies on the complete and accurate detail of some people’s care records which had not been identified as part of people’s care plans reviews, we found no impact on people. Incidents relating to people’s emotions were recorded, monitored and tracked to identify patterns and trends. Regular review meetings were held to discuss incidents and consider different support strategies. However, whilst internal reviews meetings were recorded and shared with staff, the outcome of the reviews were not explicitly reflected in people’s care records. For example, the outcome of an internal review identified and addressed an issue around one person requesting snacks, however the agreed outcome was not clearly recorded in their care plan.

In supported living settings, CQC does not regulate the environment in which people live; however, we require the provider to consider and support people to recognise potential risks in their care environment. The provider had not always supported people to address issues with their living environments to ensure they were safe and adapted to their needs.

We visited one supported living household and found some concerns about people’s care environment as the upkeep of some areas had not been maintained. We observed the design, lack of passenger lift and dual use of the buildings and some maintenance issues created potential risks to people. This was raised with the provider who promptly addressed our maintenance concerns and agreed to review how they could improve the design of the building to ensure people remained safe. They said they were committed to review the impact of building on the people who use it.

However, we were assured by another person’s home which was well maintained and had been decorated and personalised to the taste and preferences of people living there.

Staff and visitors were required to sign in and out on a visitors digital and facial recognition software system. This enabled the provider to monitor visitors and staff entering and leaving the building which assisted with fire events.

We visited people’s accommodation and found people had been involved in decisions about the décor of their home and were supported to live in a clean environment. Where required, people’s home had been adapted to meet their physical and sensory needs. The provider employed a maintenance team to assist them in managing and monitoring the safety of people’s homes such as carrying out fire and safety checks.

The provider had ensured equipment, facilities and technology supported the delivery of safe care in all the supported living households.
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Sufficient staff were made available to meet people’s needs and assessed hours. Each shift was supported and overseen by a team leader who provided additional support when required. Relatives mainly praised the consistency of the staff team. One relative said, “He [person] is familiar with the staff. He always has one staff member with a good knowledge of him, and new staff always shadow.” Regular meetings were held to review and discuss people’s support needs and associated staffing levels. On occasions, when agency staff were used, they were vetted and worked alongside experienced staff.

Staff raised no concerns about the staffing levels and their personal development. Staff complimented the support and the training they received from the start of their employment. Induction included training, reviewing the provider’s policies and processes and shadowing experienced colleagues. Key managers had been trained to deliver accredited training to staff which promoted a holistic approach to assist staff in building strong relationships with people they support and their colleagues through consistent teamwork and communications. One staff member said, “We work together and listen to them [people] closely, and ensure everyone feels supported and understood, especially when they may become upset.”

Whilst most staff had received training in core subjects; we noted some gaps in the training records of some staff. Management attributed these oversights to a recent change in managers and confirmed they were currently being addressed. Staff had completed or plans were in place for staff to complete statutory training in learning disability and autism awareness in line with statutory guidance. However, we found no impact on people as staff had received bespoke training in understanding people’s individual support needs. Managers had supported staff with additional internal training such as providing senior staff with supervisory and management related skills.

Safe recruitment practices were being used. The provider said they only recruited staff who shared their values to ensure people were supported by staff who were compassionate and person centred. However, to support safe recruitment, the provider agreed to improve the documentation of discussions and exploration of staff employment histories, to demonstrate that all conduct and background checks had been carried out. The provider was considering ways of involving people in the recruitment decisions moving forward.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had been trained in infection control and had access to the provider’s policies to reinforce good infection control practices.

People were involved and supported by staff to maintain the cleanliness of their home and communal areas. One relative said, “He is encouraged to hoover and clean his room. Staff try and involve him in food preparation and he washes up.” To sustain the cleanliness of people’s homes, staff were assigned cleaning tasks and communal spaces were regularly deep cleaned.

Infection control audits were completed. Managers and senior staff routinely carried out spot checks to ensure staff infection control practices were maintained. Staff had access to personal protective equipment (PPE). The provider immediately acted on our concerns about PPE storage and some areas of maintenance which could increase infection related risks.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines in line with their prescription and in a person-centred manner based on their needs. This was confirmed by relatives. One relative said, “[Person’s] epilepsy medication has been reviewed and changed. They now swallow tablets, which they never used to do, and signs for the medication.” Safe medicines arrangements had been put into place to ensure staff could access ‘rescue’ type medicines when supporting people in the community in an emergency such as medicines for seizures.

The provider and staff were aware of the STOMP principles (Stopping Over Medication of People with a learning disability, autism, or both, with psychotropic medicines) and worked with people and staff to ensure people were not over prescribed with medicines which negatively affected their well-being.

Staff and relatives both confirmed there was a commitment to reduce people’s medicines. One relative said, “There have been no serious incidents of self-harm, [staff] know them and are working well with [person]. [Person] used to have PRN (as required medicines) every other day. Since August last year it is rarely used.”

Staff had received training in medicines management, and their competency was assessed before they were authorised to administer medicines.

We found some discrepancies in the recording of the safe management of people’s medicines which were raised and addressed immediately by the management team. The provider agreed to review their medicine’s policy and audits to ensure they were underpinned by the medicines arrangements in each person’s home.