Archived: Firstpoint Homecare Ltd

Firstpoint Homecare Limited is a community-based care provider that provides personal care and support to people in their own homes. 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. At the time of our inspection there were nine people receiving personal care.

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

Improvements had been made to the quality and safety of the service since the last inspection. We identified a continued breach in relation to governance because these improvements were not yet embedded and effective.

Peoples’ risk assessments had improved since the last inspection, however, they did not consistently contain enough guidance to staff on how to safely support people. Staff did not consistently follow good infection control practices and this placed people at risk of cross infection. Whilst people and staff thought there were enough staff to support people, they did not consistently receive their calls at the times scheduled. Whilst staff had received training in how to keep people safe and could describe the actions they would take when people were at risk of harm, we found this was not always done effectively. Since our last inspection, medication audits had been implemented to check whether people’s medication had been administered as required. The provider had a recruitment process to ensure the appropriate checks were carried out when recruiting staff.

Staff received specialised training to give them the knowledge to support people’s individual needs. People told us they were generally supported by regular staff who knew them well. People’s religious and cultural beliefs were respected.

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 this practice.

We found some care practices did not always respect people’s privacy and dignity. People told us staff were caring and staff promoted independence.

There was no end of life care plans for people who wanted to express their wishes at the end of their life. A care plan and assessment were in place to show the support people needed. People knew who to speak to if they had any concerns.

The provider’s governance and auditing systems had improved but further improvement was needed to ensure that they were consistently effective in ensuring people consistently received safe care and treatment. There was no registered manager in post as required by law.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was inadequate (published 28 June 2019) and we found multiple breaches of regulations. At this inspection not enough improvement had been made and the provider was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 Good Governance.

This service has been in Special Measures since 28 June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

After our last inspection, we carried out enforcement action to remove the location on the provider’s registration. At this inspection we found improvements had been made and the provider had met all but one of the breaches identified at the last inspection. We found the provider was still in breach of one regulation related to governance because improvements to the quality and safety of the service needed to be embedded and sustained.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

¿ Firstpoint Homecare Limited is a community based care provider that provides personal care and support to people in their own homes. At the time of our inspection there were 164 people receiving personal care.

People’s experience of using this service:

¿ People were not always protected from the risk of harm. Conflicting, out of date and unclear risk assessments placed people at risk of receiving unsafe or inappropriate care as staff did not always have sufficient guidance to follow. Medication records were not filled out correctly and therefore we could not be assured that people had received their medication as prescribed. Systems in place to monitor call times were not effective and people did not consistently receive their calls at the times needed and on occasions did not receive a call at all. There were insufficient staffing levels at weekends which impacted on the quality and safety of the service. Care staff did not consistenly follow good infection control practices and this placed people at risk of cross infection. The provider had a recruitment process to ensure the appropriate checks were carried out when recruiting staff.

¿ People’s needs were not always accurately reflected in their care plans. Staff did not always receive the appropriate training they needed to meet people’s individual health needs. People did not always receive their food and drink at the correct times as calls were not always on time. People were not always supported by regular staff, care was inconsistent. The provider did not always work within the principles of the Mental Capacity Act 2005. People’s religious and cultural beliefs were respected. People told us that their regular carers knew them and how to support them.

¿ The provider’s systems did not always support the service to be caring as people were unsatisfied with the management of their call times and how their concerns were managed. Some people told us care staff were kind and caring whilst others’ views were not so positive. People’s dignity was not always respected. Staff promoted independence.

¿ People and their relatives told us they did not feel the provider listened to their complaints or concerns. Care records were not updated to reflect people’s current support needs. They were not always accurate and lacked sufficient detail to determine what peoples’ specific needs were. We found the provider’s systems did not always support the service to be fully responsive as people did not always receive their care calls at their preferred time and/or experienced missed calls.

¿ The provider did not have effective governance or audting systems in place to ensure that people received safe care and treatment. Governance and oversight systems had failed to ensure risk assessments provided sufficient guidance to staff to ensure people received safe care. There was no robust system in place to ensure risk was appropriately managed. The provider did not have sufficient oversight of training to ensure care staff had specialist training to support people’s individual needs. The provider’s infection control systems were not effective and meant people were being put at avoidable risk of cross infection. The provider’s call monitoring system was not effective in ensuring people received their calls at the time they required them. The provider did not have an effective system in place to monitor missed calls. The provider’s scheduling system did not give care staff enough travel time in order to arrive at service users calls at the scheduled times. The providers on-call system was not effective. There was a lack of oversight of safeguarding concerns. There was no registered manager in post as required by law.

Rating at last inspection:

¿ Rated requires improvement overall (report published 16/05/2018). For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected:

¿ This was a planned inspection based on the rating from the last inspection.

Enforcement:

• Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

¿ As we have rated the service as inadequate, the service will be placed in 'special measures'. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. For adult social care services, the maximum time for being in special measures will usually be no more than12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We visited the offices of Firstpoint Homecare Ltd on 8 March 2018. This was the first inspection of the service since registering with the Care Quality Commission in August 2017. We gave the registered manager 48 hours' notice of the inspection visit because we wanted to make sure someone was available in the office to meet with us.

Prior to our inspection we received information of concern in relation to the service. These related to people not feeling safe because they received care and support from care workers they did not know. Some people’s medicines had not been administered by care workers when they needed them and people were dissatisfied because their care workers arrived later than they expected them. Also, some people’s key safe numbers had been accidently shared with a person’s relative which was unsafe.

The service is required to have a registered manager in post. 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 and associated Regulations about how the service is run. A registered manager was in post.

Prior to our visit the service had been through a period of instability caused by staff changes and some staff not working in line with the provider’s procedures. Some of the governance systems in place to assess, monitor and improve the service had not been effective. Improvement actions plans were in place to monitor and drive improvements. People and staff told us stability was returning to the service and we saw a number of improvements had been made in a short period of time. The changes needed to be embedded and sustained over a longer period.

People felt safe with their regular care workers because they trusted them. However, when their regular care workers were off work some people continued to feel unsafe. Action was being taken to address this.

Some people had been dissatisfied with the service they had received because communication between then and the service had been poor. Action had been taken to improve this and people had noticed improvements in the two weeks prior to our visit.

Some people had not received their medicines when required. We saw improvements had been made in this area and only trained competent care workers supported people to take their medicines.

Staff felt listened to and supported by their managers. Procedures were in place to protect people from harm. All staff had received safeguarding training and understood their responsibilities to keep people safe. Staff were confident to raise any concerns with their managers. A system was in place to record accidents and incidents and to reduce any reoccurrence.

The provider’s recruitment procedures minimised, as far as possible, the risks to people safety. Enough staff were employed but the deployment of staff required improvement because care workers often arrived later than people expected them and their arrival times were unpredictable. Action was being taken to address this.

Risk assessments were in place to identify potential risks to people's health and wellbeing. However, some lacked information to inform staff how to manage risks. Despite this care workers assured us they knew how to manage risk safely.

People had confidence in the skills and knowledge of their regular care workers to provide the care and support they required. New staff members were provided with effective support when they first started work at Firstpoint Homecare. Care workers provided positive feedback about their training. A programme of training supported staff to keep their skills and knowledge up to date. Staff had not received on-going individual support (supervision) to help guide them with their work and action had been taken to address this.

People were supported to manage their health conditions and to access other professionals when required. Care workers had completed infection prevention and control training in- line with best practice recommendations.

The provider was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible.

People told us their regular carers were kind and caring. We found competency checks of care workers practices had not taken place in line with the provider’s procedure. Action was being taken to address this.

Staff understood the importance of maintaining people's confidentiality. People were treated them with respect but their personal care was not always provided in ways which upheld their dignity. People were supported to retain their independence.

People’s needs had been assessed when they had started to receive a service and action was being taken to ensure people had opportunities to be involved in making ongoing decisions about their care. Some people’s care plans lacked detail information to support care workers to provide person centred care. Further detailed information was being added to improve this.

People and their relatives told us they felt they were listened to because complaints they had made about the service had been investigated and resolved in line with the provider’s procedure to their satisfaction.