First Choice Home Care (Norwich)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained the same. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. Risks associated with peoples care needs were not always assessed or guidance provided to staff to reduce the risk of harm. Peoples care plans did not contain sufficient information to support safe practice. Where incidents had happened, there was a lack of management oversight to ensure lessons were learnt and improvements made. The provider was in breach of the legal regulation relating to safe care and treatment. The provider was previously in breach of the legal regulation in relation to safe staffing levels. Improvements to staffing levels were found at this assessment and the provider was no longer in breach of this regulation.

This service scored 53 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Incidents and accidents were not reflected upon to drive service improvements. Findings from serious incidents were not shared with the staff team to encourage practice development. A staff member experienced an injury whilst providing care to a person, however the persons care plan was not reviewed in response. Incidents of a similar nature had happened since, however no additional support, guidance or training had been provided for staff. Some staff told us they felt unsafe at work.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. Peoples care records did not reflect a full and accurate assessment of the care they required. This meant there was a risk of information being shared with other health and care services which was incorrect. We received feedback from a healthcare professional, who told us the service could be difficult to speak with, however they felt communication had improved more recently. Referrals to external services, including the local authority and community nursing teams were made appropriately. However, records of the advice given by professionals was not consistently reflected within care records. Most people told us they found the service worked alongside healthcare professionals appropriately.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The service provided care to people with complex medical and mental health conditions. There were a high number of incidents of a safeguarding nature. In general, these incidents were investigated appropriately. Incidents of a safeguarding nature were recorded and analysed monthly by the management team at the service. However, findings from safeguarding enquiries and lessons learnt were not shared with the staff team to encourage continuous learning and improvement. Staff we spoke with understood their responsibilities to report concerns, however several staff members told us they did not receive feedback or updates.

The provider did not work in a way which identified, assessed and managed risks appropriately. All care records reviewed had a lack of robust and accurate risk assessments associated with people's care. This included but is not limited to diabetes, epilepsy, challenging behaviours, environmental risk assessments and moving and handling. There was a poor understanding overall of how to assess and monitor risks efficiently. One person’s relative told us they had raised concerns relating to the management of their loved one’s health condition but was still waiting several weeks later to hear back. The service had created risk assessments in response to our inspection visit for some people’s health conditions. However, these were of poor quality and lacked relevant information to guide staff on how to manage risks. This placed people at risk of harm.

The provider did not always detect and control potential risks in the care environment. Peoples care records did not consistently contain robust risk assessments which covered people’s environment. Environmental risk assessments are important to ensure the safety of both people receiving care and staff attending the visit. Where these assessments were not in place, this meant in the event of an emergency, staff would not know how to respond appropriately.

The provider did not always make sure staff received effective support, supervision and development. The provider offered most of their training as eLearning and had plans in place to implement practical training courses for moving and handling, medicines management and basic life support. Oversight of staff training was found to be poor, some staff were working with very low levels of compliance with their mandatory training. We spoke with staff, who told us they did not feel the training they received was sufficient to undertake their role in a safe way. People using the service and relatives told us they felt staff were not always sufficiently trained or knowledgeable. Staff supporting people with mental health conditions undertook additional eLearning courses, however this was not sufficient to enable staff to feel suitably skilled to deliver this specialist care to people. However, processes were in place to support the safe recruitment of staff, including background checks undertaken before staff began in their role.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People told us staff supported them to maintain clean living environments. Staff had access to Personal Protective Equipment and we saw evidence of this being used appropriately in people’s daily notes. Policies were in place to support safe infection prevention and control practices.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. Electronic systems had been introduced to improve the safe management of people’s medicines. This system had been successful, and the rate of medicine related incidents had reduced. However, medicine audits undertaken by the service identified repeated issues relating to stock counts. Action was not taken in response to audit findings in a prompt way, meaning the opportunity to rectify the issue had been missed. Most people told us they felt the service managed their medicines well, and said they received their medicines as intended by the prescriber.