Archived: First Choice Homecare and Employment Services Ltd

First Choice Home Care and Employment Services Limited is a domiciliary care agency which provides personal care and support to people living in their own homes. At the time of this inspection 182 people residing in the London Boroughs of Newham and Waltham Forest were receiving a service. We were informed by the branch manager that most people using the service were funded for their care package by their local authority.

We carried out this inspection to check that the provider had adhered to their action plan and to establish if they now met the legal requirement and the recommendation. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for First Choice Homecare and Employment Services Limited on our website at www.cqc.org.uk.

There was no registered manager in post at the service. 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 service was being managed by a branch manager who was present during the inspection.

Comments from people who use the service and relatives were predominantly positive. The remarks we received from people indicated that they felt their needs were being met in a safe way and they felt their care workers provided person centred care that respected their choices and wishes. One person told us, “They are very supportive, please put it on record that I am very grateful. The carers are excellent and bring me cheer when I feel at a low ebb” and another person said “I am very happy, they are very nice and never do nothing wrong.” One relative told us, “The care workers work hard, they (office staff) keep us informed, I couldn’t fault them” and another relative said, “[My family member is happy, they don’t treat [him/her] roughly, there is no rudeness and [care worker] is fantastic, always friendly. Some care workers are really good. We have asked for a change of one care worker and they (office staff) are sorting things out.”

We found that some improvements had been achieved with the quality of documentation for supporting people with their medicines, and the use of risk assessments to identify and mitigate risks to people’s safety and welfare. However, there were still some inconsistencies in this documentation. The branch manager told us he thought the service had made progress with staff training and supervision, with a particular focus on how to keep people safe.

Actions were being undertaken to make sure that people were asked for their consent to their care. We noted that people’s care plans were being updated to ensure that people signed their consent to care forms wherever possible or a relative with appropriate legal authority signed instead.

The branch manager informed us that the provider had decided to deregister the service. We noted that a formal application for deregistration had been submitted by the provider to CQC on the day before the inspection visit, after we gave notice of our intention to conduct an inspection. At the time of the inspection the provider stated that they had not informed employees about its plans but had set up staff meetings that week to engage in discussions about the closure. We were informed by the branch manager that plans were being developed with the two local authorities to ensure that people’s care packages were transferred to a different provider in a safe and seamless way, to ensure no disruption for people using the service and their care workers. The completion of this process was due by the end of October 2017 for people who use the service and live in Newham, and the end of November or early part of December 2017 for Waltham Forest residents. The commissioning representatives for both local authorities confirmed that arrangements were in place to make sure that people who use the service experience a smooth transition of their care to other organisations.

At the last inspection on 19, 20, 21 and 26 July 2016 we found breaches in relation to safe care and treatment, consent, person centred care, good governance and notification of incidents. The service was rated Requires Improvement overall. The provider sent in an action plan to tell us what they were going to do to make improvements. We found that not all improvements had been made.

First Choice Home Care and Employment Services Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our previous inspection the service was providing support to 332 people in the London Boroughs of Waltham Forest, Redbridge and Newham. The majority of the people using the service were funded by the local authority. At this inspection they were supporting 249 people, but were no longer supporting people in the London Borough of Redbridge.

There was a manager in post at the time of our inspection who had worked for the provider since December 2016 and was in the process of applying to be a registered manager. The previous registered manager had left in October 2016. 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.

People who lived with specific health conditions did not always have the risks associated with these conditions properly assessed and care plans were not always developed from these to ensure their safety and welfare. Although improvements had been made since the previous inspection, not all risk assessments we viewed contained sufficient detail and did not provide staff with information or guidance on how to minimise the risk.

We saw some improvements had been made in the management of people’s medicines however appropriate policies and procedures were not in place for all the records we reviewed. The branch manager was in the process of ensuring medicines records were checked on a monthly basis and was being implemented at the time of the inspection.

The provider had a good understanding of the policies and procedures in place to safeguard people from abuse and avoidable harm. Incidents were reported and followed up and apart from one incident, we saw evidence that disciplinary procedures were followed.

Where issues had been raised relating to late and missed visits, there was evidence that monitoring had been put in place to make sure people had their visits on time. The provider was working closely with the local authority to ensure care workers logged in and out and attended all of their visits.

The provider had a robust staff recruitment process and completed the necessary checks to ensure staff were suitable to work with people using the service.

Requirements of the Mental Capacity Act 2005 (MCA) were not always followed. Where family members had signed to consent to the care and support of their relatives, the provider was not always able to demonstrate that the relative had the legal authority to do so and was therefore not working in line with the MCA.

We saw that supervisions for staff were in the process of being carried out and saw evidence that showed staff who were overdue had been prioritised and scheduled in to receive one. Not all supervision records we viewed had been completed in line with the provider’s expected procedures.

People were supported to have sufficient food and drink and specific information, including people’s cultural preferences had been recorded in people’s files. Care workers told us they notified the office if they had any concerns about people’s health and we saw evidence of this in on call reports and action that had been taken.

People and their relatives told us that their regular care workers were kind and caring and knew how to support them. Staff understood the importance of respecting people’s privacy and treating people with dignity and respect.

Care records had been improved since the previous inspection as more person centred information had been included, including people’s cultural and religious needs. The provider was in the process of reviewing and updating all care records since the recruitment of a new branch manager.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. There were monitoring systems in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

Improvements had been made and the provider now met the CQC registration requirements regarding the submission of notifications about serious incidents, for which they have a legal obligation to do so.

We could see that there had been an improved approach to quality assurance since the previous inspection and audits were in place to monitor the quality of the service, but were not always consistent to monitor the care provided to people. A number of audits to improve the service were in the process of being implemented at the time of the inspection.

We found one continued breach of the regulations relating to safe care and treatment and made one recommendation relating to consent. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

First Choice Home Care and Employment Services Limited is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was providing support to 332 people in the London Boroughs of Newham, Waltham Forest and Redbridge. Support provided to people in Redbridge was usually a six week re-ablement service when they were discharged from hospital or if their health needs suddenly changed. The majority of the people using the service were either funded by the local authority or the NHS.

There was a registered manager in post at the time of our inspection. 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.

People who lived with specific health conditions did not always have the risks associated with these conditions assessed and care plans were not always developed from these to ensure their safety and welfare. Risk assessments lacked detail and did not always provide staff with guidance on how to minimise risk. There was no guidance around the provider’s rating of risk and it was difficult to see how risks to people had been calculated.

Appropriate policies and procedures were not in place to ensure that people received their medicines safely and effectively. The registered manager told us that they were implementing a new process to check all medicines records on a monthly basis however this was not in place at the time of the inspection.

Where issues had been raised previously relating to late and missed visits, there was evidence that enhanced monitoring and risk alert notifications had been put in place to make sure people had their visits on time. However there were still inaccuracies between scheduled visits and actual visits where without daily log records or time sheets, we could not be fully assured certain visits had taken place.

The provider had a robust staff recruitment process and the provider completed the necessary checks to ensure staff were suitable to work with people using the service.

The provider had a good understanding of the policies and procedures in place to safeguard people from abuse and avoidable harm. Incidents were reported and followed up and we saw evidence that disciplinary procedures were followed.

Requirements of the Mental Capacity Act 2005 (MCA) were not followed. The provider did not have a clear understanding of the need to demonstrate that people had consented to their care and that there should be an assessment of their capacity if they were unable to do this.

People were supported to have sufficient food and drink however people’s preferences were not always recorded and care plans did not always identify risks or nutritional needs.

There were gaps in staff training which was acknowledged by the registered manager. A refresher training programme had just started for all care workers within the service. Care workers received regular supervision where they were able to discuss issues relating to their role, including any issues or concerns they had for the people they supported

People and their relatives told us that their regular care workers were kind and caring and knew how to support them. People felt that they were given choices in their care and staff understood the importance respecting people’s privacy and treating people with dignity and respect.

Care plans for people lacked detailed information, were incomplete and not always specific to people’s needs. We could not always be assured they reflected people’s wishes and how they wanted to be cared for.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. There were quality monitoring visits and phone calls in place to allow people and their relatives the opportunity to feedback about the care and treatment they received however it was not consistent. There was a lack of evidence to show that concerns were always followed up.

The provider did not meet the CQC registration requirements regarding the submission of notifications about serious incidents, for which they have a legal obligation to do so.

Quality assurance and management systems were not consistent throughout the service to monitor the care provided to people who used the service.

We found five breaches of regulations relating to person centred care, consent, safety, good governance and notifiable incidents. You can see what action we told the provider to take at the end of the full version of this report

We found that people who used the service had initial assessments and care plans in place. People's needs were agreed and consent was obtained before any care or support was provided. Care plans were then reviewed on a regular basis. This showed the provider had systems in place to gain and review consent from people who used the service.

Most of the people we spoke with were happy with the care they received. Comments included, "I've had no problems at all with any one of them whoever they send. They're all good" and "I have a regular chap, he's really good, I wouldn't want to change him.

There were sufficient skilled and experienced staff to safely meet the needs of people who use the service. In the staff files we looked at we saw evidence staff had received appropriate training.

There were quality monitoring processes in place. People were asked for their opinion of the service through telephone spot checks, reviews and a yearly survey. People understood how to complain and any complaints were addressed appropriately.

People told us they were satisfied with the quality of care offered by the agency. One person told us, "The agency is very good. They are very helpful." One relative said, "my mum likes her carer very much." Another person told us their care worker was "very good" and they were "very pleased" with them.

People who spoke with us said care workers treated them with dignity and respect. They also told us care staff respected their decisions in relation to day-to-day tasks. People experienced care, treatment and support that met their needs and protected their rights.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.