1st Homecare Solutions Limited

1st Homecare Solutions Limited is a domiciliary care agency providing support to 74 people of which 58 were receiving personal care. This service is provided to younger and older people, people with a physical disability and people living with dementia.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found.

People's care was exceptionally person centred and based completely on what mattered and was important to them. People lived lives they might not otherwise have done. One person said, “The difference staff make is that without them I wouldn’t be living at home.” Concerns were resolved before they became a complaint. Compliments were used to identify what worked well. Another person told us, “I have found a care service that truly meets my needs.” Systems and procedures were in place to support people with end of life care and in a dignified way.

Sufficient staff were recruited safely and deployed in a way which kept people safe. Staff implemented their knowledge of hygiene and safeguarding systems well. Risks were identified and managed well. One person told us, "There are two staff who help me. They arrive together. I feel safe in their hands. I need that assurance." Lessons were learned when things went wrong.

People's assessed needs were met by staff with appropriate skills and whose induction, supervision and training was kept up-to-date. The provider worked well with others involved in people's care, people benefitted from this. People ate and drank enough. Staff enabled people to access healthcare and support services. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported support this practice.

People's care was kind, dignified and staff were thoughtful about how they supported each person. Staff respected people's privacy and upheld their confidentiality. People who needed support from an advocate were given this. People had a say in developing their care and how it was provided.

The registered manager was aware of their responsibilities and sought to identify and drive improvements. The registered manager supported staff who worked well as a team. People, relatives and staff had a say in how the service was run. Quality assurance, audits and governance were effective in identifying and driving improvements. The provider worked well with others to provide people with joined up care.

Rating at last inspection.

The last rating for this service was good (published 3 August 2017).

Why we inspected

This was a planned inspection based on the previous inspection rating.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated as ‘requires improvement’ because there was inadequate travel time allowed between visits and the providers quality assurance systems had not been used effectively to identify and resolve this.

At this inspection we found the service was Good.

The service had a Registered Manager in place but not all people knew who the registered manager was. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service took safeguarding concerns seriously and followed the local authority policy and guidance when dealing with safeguarding people from harm.

Where appropriate the service had attended and contributed to safeguarding discussions and meetings.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people using the service.

Staffing levels were sufficient to provide the level of care required.

Risk assessments were in place and were regularly reviewed and updated.

Staff were trained to administer medicines safely. Regular checks were undertaken to help ensure on-going competency in this area.

There was a robust induction programme, which included mandatory training, shadowing and buddying with an experienced worker. Staff demonstrated a good understanding of their roles and responsibilities.

Supervisions were undertaken and Professional Development Reviews (PDR) was held annually to ensure learning was reviewed and training needs were met.

Care files were clear and comprehensive and contained relevant health and personal information. The service was flexible and responsive to changing needs, desires and circumstances.

Confidentiality was respected and independence was promoted. Communication with relatives was on-going throughout the duration of their relative’s involvement in the service.

Comments were encouraged formally and informally and there was a complaints policy in place. Literature given out to families gave the information and opportunity for people to raise concerns or make suggestions.

Feedback was regularly sought from families and users of the service. The service listened and took action to address any concerns and suggestions put forward by people who used the service and their families.

Team meetings were regularly undertaken, giving staff the opportunity to discuss any issues and to share good practice examples. The meetings were used as a forum to share current best practice guidance and keep staff up to date with new methods and innovation.

A number of audits were undertaken, results analysed and lessons learned from these to drive continual improvement in service delivery.

1ST Homecare Solution is a domiciliary care agency providing personal care and support for people in their own homes. There were eighty-eight people using the service at the time of our inspection.

The service had a registered manager who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider’s quality assurance systems were not always effective in identifying areas of improvement. People did not always know who the registered manager was but they found the office staff to be helpful and approachable. The people who used the service and their relatives were able to contribute to the development of the service by way of satisfaction surveys. Staff were also involved in the development of the service by way of weekly team meetings.

Staff were trained in safeguarding people and they knew how to keep people safe. There were enough staff to provide care to people who used the service, and people had individualised risk assessments in place to manage risks they were exposed to. However, the travel time allocated to staff from one care visit to the next was not always adequate causing rushed or late care delivery.

Some people raised concerns about the support they received in relation to their medicines management, and we found a lack of evidence to show that one member of staff had the right to work in the United Kingdom which the provider was required to ascertain before allowing potential staff to take up employment, in line with their recruitment policy and the law.

There were mixed feedback about the quality of training offered to staff but people and their relatives agreed staff were knowledgeable about people’s care needs. Staff understood their responsibility to sought people’s consent before providing any care in line with the requirements of the Mental Capacity Act 2005. They were supported in their roles by way of regular supervision and appraisals of their performance.

We received mostly positive feedback from people who used the service and their relatives about staff. We found staff to be knowledgeable about the people they cared for and they were respectful of people’s privacy and dignity. They respected people’s views and provided care that was personalised to people.