First Choice Home Care (Norwich)

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. Care was not always delivered in line with best practice guidelines. For people living with a learning disability, the service had not followed the principles of Right Support, Right Care, Right Culture. Internal relationships amongst staff and managers were poor, and staff felt the high turnover of managers had impacted communication within the team. People’s health conditions were not monitored effectively to ensure peoples experienced good outcomes. There was a poor understanding of the principles of the Mental Capacity Act, with assessments not being time or decision specific.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care was not always delivered in line with best practice guidelines. For example, where people exhibited distressed behaviours, care plans were not always in place to support the person and to offer guidance to staff delivering their care. Where a person had been identified as being at risk of choking, their care plan stated they required a staff member to sit with them whilst they ate. However, we identified occasions where the staff member allocated to sit with the person had not received training in basic life support or First Aid. This meant there was a risk they would not be able to take effective action in the event of the person choking.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care was not always delivered in line with best practice guidelines. For example, where people exhibited distressed behaviours, care plans were not always in place to support the person and to offer guidance to staff delivering their care. Where a person had been identified as being at risk of choking, their care plan stated they required a staff member to sit with them whilst they ate. However, we identified occasions where the staff member allocated to sit with the person had not received training in basic life support or First Aid. This meant there was a risk they would not be able to take effective action in the event of the person choking.

The provider did not always work well across teams and services to support people. We spoke with healthcare professionals who worked in conjunction with the service. Feedback received was generally positive and described how communication had improved more recently. Relatives and people told us First Choice Home Care (Norwich) worked well with other health and care services. However, internal relationships between management and staff were poor, with staff describing the high turnover of managers having negatively impacted internal communications. Staff told us when they raised concerns, the management team did not take action to make improvements in a timely way. We saw evidence in support of this.

The provider did not consistently monitor peoples care to continuously improve it. They did not ensure that outcomes for people were reflected upon to drive improvement. There was a distinct lack of action in response to incidents and changes in peoples care needs, which meant there had been missed opportunities to improve outcomes for people had the service responded more promptly. Peoples care records were not completed with a view to support people to achieve goals. Several care records we viewed lacked any information relating to future goals or wishes, including for people living with mental health conditions and learning disabilities.

The provider did not consistently monitor peoples care to continuously improve it. They did not ensure that outcomes for people were reflected upon to drive improvement. There was a distinct lack of action in response to incidents and changes in peoples care needs, which meant there had been missed opportunities to improve outcomes for people had the service responded more promptly. Peoples care records were not completed with a view to support people to achieve goals. Several care records we viewed lacked any information relating to future goals or wishes, including for people living with mental health conditions and learning disabilities.

There was a poor understanding of how and when to complete an assessment of a person’s capacity to make their own decisions. Except for one, all care records we viewed contained assessments of people’s capacity which were not time or decision specific. This did not demonstrate that the service worked in line with the principles of the Mental Capacity Act. Daily notes for people demonstrated that staff sought peoples consent at the point of care. Whilst this is positive, it was not clear how this was managed for people who lack capacity to consent, as guidance for staff within care records to support this decision specific process was not robust.