First City Nursing Services

Updated 19 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of three inspectors and three Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection took place on 29 September 2021 and was announced. We informed the provider a week before our inspection as we needed to ensure they are able to accommodate us in the office and make the arrangements for us to phone people, staff and healthcare professionals.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us with key information about the service, what the service does well and improvements they plan to make. This information helps support out inspections. We used all of this information to plan our inspection

During the inspection

We spoke with 19 people and 17 relatives. We also received feedback from 15 members of staff. We spoke with the customer experience, quality and compliance lead, the registered manager and the provider. In addition, we also contacted number of external health and social care professionals and commissioners to obtain their views about the service. We looked at six care plans, four staff files, records relating to medicine management and quality assurance.

Following the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 19 November 2021

First City Nursing Services are a large domiciliary care agency (DCA). The service provides personal care to people living in their own houses and flats in the community. First City Nursing Services have been operating for almost 20 years and are well known and an established local provider. 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. On the day of our inspection 650 people were being supported by the service.

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

The providers tireless work during the pandemic influenced Government policy, facilitated a steady supply of personal protective equipment (PPE) across the sector and helped to enable hospitals discharge patients on time, avoiding backlogs and waiting lists. For this work the provider was awarded the MBE in the new year’s honours list.

The service also responded to the pandemic to ensure partners, local care homes and hospitals in the Swindon area were supported. The provider sourced and distributed PPE and hand gel to services in the area and supported the drive to provide updated information to staff and people using services. This work helped to ensure the latest information and guidance was shared across the local care sector. The service also ran a charity to support people from being socially isolated. It also raised funds that were used to ensure people leaving hospital were equipped to return home safely, thus reducing discharge time from hospital.

People told us the service was extremely caring. We were repeatedly told staff, “Went the extra mile” in providing compassionate care. People were respected and their diverse needs were championed by staff, enabling people to improve their well-being and quality of life. One person told us, “Caring staff, really incredible with a great capacity to care.”

The service continued being very well-led. Staff remained extremely positive about the team work and support they received from the management and about the positive and empowering culture that was promoted within the team. There was a strong emphasis on staff skill development and keeping the team motivated and enthusiastic. Staff had clear roles and responsibilities and they were constantly being upskilled so they could step up or act in other roles should this be required. Staff complimented the training provision and the support received from the management.

We found the management's vision was imaginative, innovative and put people at the centre of service delivery. The provider's governance was well-embedded and there were robust quality assurance systems that remained highly effective. Information was shared with service partners which enabled improvements to be made across the local care sector.

People’s independence was actively promoted improving people’s well-being and reducing social isolation. For example, one person was supported to travel to and maintain a job.

Staff also benefited from the services culture of compassion and care. Adjustments were made to facilitate staff’s religious beliefs and practices; staff rotas were altered to allow staff time to pray and specialised PPE was sourced for some staff on religious grounds. Staff told us they were extremely well supported.

The service was extremely responsive. The provider's long standing "The No / How pledge" continued to underpin the service's responsive ethos. The team demonstrated they successfully adopted 'you don't say 'no' you say 'how' can we do this' approach. The registered manager told us the pledge, “Is so deeply embedded in our culture it is just second nature.”

The service went the extra mile to ensure people’s communication needs were met. Time was spent with people to enable staff to fully understand people’s needs and worked with them to find solutions. Some staff spoke foreign languages and documents were available in the language of the person’s choice. Alternative communication methods were used such as Makaton or technology, all of which was tailored to people’s individual needs and choices. Makaton is a form of communicating where people use signs and symbols either as a main method of communication or as a way to support speech.

People were supported to take their medicines safely and as prescribed. People's care files contained risk assessments surrounding people's well-being, falls, mobility and other conditions. Where people had been identified at risk in certain areas of their lives; management plans guided staff on how to keep the person safe.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. For example, the provider ensured people’s needs were assessed before they were supported to ensure those needs could be met and individual care plans put in place. One relative said, “They (provider) came out and spent a lot of time listening to what he (person) needed,” Another person who lived with autism had a dedicated support team of staff who had received specific training in relation to their needs and condition. This ensured the person received individualised care that met their needs. The service had an exceptionally person-centred culture and welcomed feedback.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We checked whether the service was working within the principles of the MCA

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to access health services when required and the team worked closely with a number of external health and social care professionals where needed. People were supported to maintain good nutrition and encouraged to have a diet that met their dietary needs and preferences.

Rating at last inspection

The last rating for this service was Outstanding, published 1 August 2018.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

Follow up

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.