8, 10 and 11 July 2015
During a routine inspection
The inspection visit to the domiciliary agency care office was carried out on 8 July 2015. Telephone contact was made with people using the service and staff on 10 and 11 July 2015, this included weekend and evening calls in order to catch people in. We gave the provider 48 hours’ notice of the inspection in order to ensure people we needed to speak with were available.
First to Care is owned by First to Care Limited. The agency is registered to provide personal care to support people who want to retain their independence and continue living in their own home. The agency office is located in Skipton town centre and staff provide services to those living in Craven and the surrounding areas. The agency also provides companionship, domestic, gardening and handyman services. They also provide escorts to accompany people to medical appointments.
We last inspected this service on 3 October 2013 where we found them to be fully compliant with the areas we reviewed, including health and welfare, management of medication, complaints and recruitment and training.
At the time of this inspection, 35 people were receiving support with personal care by the agency. The agency employs fourteen staff and also a registered manager. 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.
Care and support was provided to people in their own home and the level of support was arranged in accordance with each individual’s needs. People who received care and support from the agency and their relatives provided us with positive feedback. They told us the service was reliable and that staff were respectful, pleasant, caring and extremely kind. People told us they trusted the staff who visited them and felt safe in the way staff supported them.
Risks to people’s safety and welfare had been assessed and information about how to support people to manage identified risks were recorded in people's care plans. We looked at the records held in the agency office, and were told that these were duplicated in the persons home, reflecting any changes or up to date information.
People were involved in making decisions about their support and signed to say they agreed with their care plan. People’s care plans were subject to review, to meet their changing needs. People received effective care that met their individual needs. Staff told us they felt well informed about people’s needs and how to meet them. The care plans we reviewed were very detailed and included information which was specific to the person. For example, security and entry to the house, how they liked to be supported when bathing or how they preferred their meals serving.
Some of the people who used the service were supported with taking their prescribed medication and staff told us they were trained and competent to assist people with this. Staff also had regular contact with other healthcare professionals and at the appropriate time to help monitor and maintain people’s health and wellbeing. People were provided with care and support according to their assessed need.
Sufficient numbers of staff were available to meet people’s needs, for example, some people required two care assistants to help with their moving and handling or personal care needs. The manager and business manager (also known as the nominated individual) also carried out visits and were available at short notice if there was a shortfall in staff available. Both have the skills and qualifications to provide personal care.
Recruitment checks were in place. These checks were carried out to make sure staff were suitable to work with vulnerable people. The training programme provided staff with the knowledge and skills to support people. We saw systems were in place to provide staff support. This included staff meetings, supervisions and an annual appraisal. The agency had a whistleblowing policy, which was available to staff. Staff told us they would not hesitate in using the whistleblowing policy and felt confident that appropriate action would be taken if they raised concerns.
Staff had received relevant training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff had a good balance of skills, knowledge and experience to meet the needs of people who used the service.
The manager had a good understanding of the Mental Capacity Act (MCA) 2005 and their roles and responsibilities around this. They were able to explain how they would ensure a decision was made in a person’s best interests, if this was required and the service worked alongside other health and social care professionals and family members.
Staff we spoke with told us how much they enjoyed working for the agency and that they were committed to providing a bespoke and quality service for people. Systems and processes were in place to monitor the service and make improvements where they could. This included internal audits and regular contact with people using the service, to check they were satisfied with their care packages.