Archived: Firstpoint Homecare - Leicester

When we last visited the service on 9 January 2018, we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was, at that inspection, rated as Requires Improvement.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well Led. At this inspection we found the provider was no longer in breach of regulations, but still required further improvements. We will assess this at a later date.

At this inspection we found that people using the service were protected from harm as the provider had processes in place to ensure their safety. Staff were aware of their responsibilities in relation to protecting people from abuse. They had received appropriate training to support their understanding of any safeguarding issues.

The manager currently overseeing the service was aware of their responsibility to report any issues of concern to both the CQC and the local safeguarding teams. There were clear processes in place to ensure lessons were learnt following any incidents or events, however, it remains to be seen if these are sustainable over time.

Any risks to a person's safety were clearly identified with measures in place to eliminate or reduce such risks. In the main, there were sufficient numbers of staff to keep people safe, however, more recently this has not always been the case due to staff absence.

People's medicines were managed safely and people were protected from the risk of infection through good hygiene practices and staff knowledge of reducing the risks of cross infection.

Recruitment processes ensured only staff who were suitable to work in the care sector were employed. This supported the safety of people using the service.

Staff knew what to do if they had concerns about the safety or well-being of any of the people using the service.

The people we spoke with said they felt safe as a result of the care and support they received.

The service was currently being led by an interim manager who had visited people to gain their views on the service. People and staff told us that regular spot checks were completed on the quality of the service.

There were quality assurance systems in place to monitor the efficiency of the service being provided, however, these were not always robust enough to show shortfalls in a timely manner.

There was 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 2008 and associated Regulations about how the service is run.

People were not protected from abuse. People told us that staff were often late for calls and that they had missed calls completely. We found that there had been missed calls. The irregularity of visits meant that people did not receive the care they needed. This is neglectful practice but had not been recognised as such by the registered manager or provider. Incidents of missed calls had not been reported or investigated appropriately. There was no monitoring in place to ensure people received their care despite people having raised this consistently through their feedback to the service.

People’s care was provided by staff who had received some training and support to carry out their roles. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. However, the potential neglectful practices taking place due to missed or late visits were not recognised or reported.

There were not enough staff deployed to meet the needs of the people who used the service. Staff were often late to visits and sometimes missed these completely as they were visiting other people.

People’s medicines were not recorded adequately to ensure staff knew what medicines they had given. The provider had a form which was used in other branches which was more detailed and agreed to implement this. People did not always receive their medicine when they should due to staff not arriving for visits or being late.

People were not adequately monitored where they were at risk of poor nutrition and hydration.

People were not always treated with dignity and respect. This was due to them not receiving the care they needed. People’s preferences about staff were not respected.

There was a complaints procedure in place. However people and their relatives felt that their concerns were not listened to. Where people had raised concerns these had not been recognised as a complaint, investigated or responded to.

People did not always receive their care at the times they preferred. Staff did not always arrive at the time specified on the rota or stay the whole allocated time.

People’s views were listened to; action was not taken to address their concerns when they provided feedback.

There were insufficient systems in place to assess and monitor and improve the service. Where the registered manager had identified issues with the quality of the service they had failed to implement changes

People were protected from the risk of infection by staff that complied with the provider's infection prevention policy.

People were assessed for risks associated with them receiving care and had care plans to mitigate their known risks. They were supported to access healthcare services.

Staff ensured that people consented to receiving care. People were supported to have choice about their care.

People felt they built good relationships with staff who knew them well when they were supported by these staff.

People’s personal information was kept secure to maintain their confidentiality.

People had been involved in developing their care plan and reviewing this.

This is the first time under this registration the service has been rated Requires Improvement.

We identified the provider was in breach of seven of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.