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.