Firstcall 247 Limited (Gloucestershire)

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 requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care.
 

This service scored 61 (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 were at the centre of their care and treatment choices, and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The provider had not consistently ensured people received coordinated, person-centred care from a stable staff team who knew them well. Improvements were needed to ensure people received care that was provided by staff who were fully informed of people’s needs and preferences.

People told us they did not always receive care from a consistent staff team who were knowledgeable about their personal routines, preferences and support needs. People reported and records showed, people’s care calls were occasionally delivered late or for shorter durations than planned, which limited staff ability to provide responsive, person-centred support.

The provider had strengthened their systems to improve their workforce management to ensure people received care form regular staff. However, people reported they did not consistently receive care and support from staff who were familiar with their needs. This was due to high number of staff turner prior to our assessment. One relative felt the service was good but added, “It’s not consistently good” and said they frequently had to check if staff had carried out the required care to their family member.

Staff did not always have access to person-centred care records to support them to deliver appropriate and individualised care. People’s care records did not consistently contain sufficient information about their preferences, choices, mental capacity, levels of independence, or medicine support needs to support staff in delivering consistent, person-centred care. Care records lacked clear guidance on risk management measures, signs of deteriorating health associated with known risks, and when concerns should be escalated, limiting staff access to the information needed to provide safe and effective care.

Feedback from people and their relatives regarding involvement in care plan reviews was mixed, with some reporting greater involvement than others.

The provider had recognised ongoing concerns about the quality of people’s care records and reliability of people’s care call times and had included this within the provider’s service improvement plan. However, sufficient improvements had not yet been embedded, as people continued to report concerns about the punctuality of care visits and the quality of their care.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider had not ensured people received consistent personalised care. Staff rotas and feedback from people showed the provider had not ensured people were supported by a consistent staff team. People and their relatives reported receiving support from a large number of different staff and were not always informed in advance which staff members would be providing their care. This meant people were supported by staff who were not familiar with people’s health needs and may miss opportunities to recognise and respond promptly to changes in people’s health and wellbeing.The acting manager explained they had experienced a high number of staff turnover, however where possible they worked flexibly around people’s preferences and lifestyles and would assist people to attend appointments.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Feedback from people and their relative indicated care was not always provided based on their personalised needs as some staff did not fully understand or respond to their wishes, preferences, and requests. Some people and their relatives attributed this to language barriers between themselves and staff which had impacted on their wellbeing and staff ability to fully understand and respond to their needs effectively.

Information about people’s communication needs were known by staff but were not always comprehensively recorded in line with the Accessible Information Standards (AIS). (AIS is a legal requirement in England to ensure people with a disability, impairment, or sensory loss receive health and social care in a format they can understand) However, the acting manager provided examples of how staff had adapted their communication techniques when supporting people.
 

The provider did not always make 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.

Some people and their relatives felt they were not listened to, and their concerns had not been fully resolved. Whilst several people described office staff as approachable, responsive, and easy to contact, others reported that although their concerns and complaints were acknowledged, actions taken were not always sustained or effective in addressing the issues raised.

The provider had a system to record and manage complaints, including a complaints log and said they welcomed feedback from people.

The provider provided some evidence to demonstrate they carried out feedback and courtesy calls to gain views about people’s experiences and acted on people’s concerns. However, feedback from some people and their relatives was mixed regarding opportunities to discuss their care and support needs. Some people told us they could not recall their care being formally reviewed by the provider.

However, the provider said they valued people's feedback to help them identify concerns early and to drive improvement. The registered manager said they were committed to ensure there was a responsive culture in acting on all concerns quickly to help ensure continuity of care

The provider had completed a ‘service user survey’ which identified people’s satisfaction about the service, trends and areas that required improvement. The provider had completed a trends analysis of people’s feedback including lessons learnt and follow up actions. The acting manager described some of the actions taken in response to identified issues; however, these actions had not been consistently documented to demonstrate how the provider had used this information to drive improvements in people's care and support.

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

The acting manager said they referred people to health and social services where required and worked with external healthcare professionals to support people's wellbeing and independence. For example, people were referred to services such as district nurses and GP when changes in people’s needs were identified. This helped to ensure people received appropriate support in a timely manner.
 

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.

People were supported to overcome barriers and encouraged to live as independently as possible. Staff said they helped to build people’s confidence and strength, for example after a hospital admission. Staff actively promoted choice and supported people to maintain and improve their independence across all aspects of daily living. Staff had completed equality and diversity training.
 

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

Most care records had recorded people’s Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) status. However, the provider had not ensured people’s care records contained information about people's preferences and decisions relating to end-of-life care or future care planning. We found the lack of future planning had not negatively impacted on the care people received and staff had received end of life care training.