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 75 (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 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 good 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.

Time was taken to meet people and to understand their wishes and needs and how to support people to remain living in their family home. An initial assessment of people’s physical, emotional and social well-being was completed in collaboration with people’s relatives and health care professionals. The service worked with people’s relatives and carers to understand their needs and how staff could support people to enable relatives and carers to have a regular short respite break.

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 provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. 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. The provider shared concerns quickly and appropriately.

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, “We know who the safeguarding leads are. They have introduced themselves to us and we know what to do in this kind of scenario.” The provider explained, any negative feedback from relatives 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.

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. Relatives raised no concerns about their family member’s safety while being supported by staff. We received relative’s comments such as “[Person] is safe with 2:1 support. Some staff know him well”; “He is 100% safe” and “He is safe with 2:1 support.”

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 had helped people to develop their potential and explore new activities.

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.

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.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Risk assessments included consideration of people’s home environments and in the community to promote people’s safety, and safety of care staff. Staff raised no concerns about their working environment. We received comments such as, “Yes they make sure that parents and guardians provide us with everything that is needed and keep us safe” and “Most people in the community are 2:1 and there is the on-call as well and they are quick to respond to call for back up.”

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 remotely by a team leader who provided additional support when required. Relatives mainly praised the consistency of the staff team, however relatives felt that on occasions their family member was supported by unfamiliar who did not understand their needs or know how to engage with their family member. One relative said, “If staff don’t know him it is difficult and he gets less out of the interaction. This occurs maybe 10-20% of the time.” However, another relative said, “Most of the time she has the same staff, or staff she has known in the past. They are reliable.” 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, “I am very confident in PBS. I have a lot of experience in my previous role, but First Thought have provided me with all the information I need to know. The materials we are given is very detailed.”

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.

Personal protective equipment (PPE) was readily available. Staff had been trained in infection control and had access to the provider’s policies to reinforce good infection control practices. They understood their responsibilities in managing infections and good infection control practices in people’s homes and the community. People were encouraged and supported to be independent with their personal hygiene to minimise risk of infection. One staff member said, “I have also completed online training in infection prevention and control (IPC), including homecare–specific modules, which support safe working practices.” People’s relatives raised no concerns about staff’s infection control practices.

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.

Staff worked with people’s relatives to ensure people received their medicines in line with their prescription and in a person-centred manner based on their needs.

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 had received training in medicines management, and their competency was assessed before they were authorised to administer medicines. Staff confirmed they were confident supporting people with their medicines. Medicine practices were monitored through regular spot checks, and staff demonstrated good awareness of the required procedures.

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.