First Choice Home Care (Norwich)

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. Quality assurance systems had failed to identify the areas of concern we highlighted during our assessment. Audits had not been effective at driving improvements. Oversight and monitoring of risks was not always effective, and action taken to mitigate risk was not done in a timely way. People did not feel the service was well-led, and staff did not feel supported. People were not supported by a provider who prioritised people’s safety and wellbeing. The provider was in breach of the legal regulation relating to good governance.

This service scored 36 (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 have a clear shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion and engagement. Whilst the management team told us of their expectations for the service, there was very limited assurance on how this was promoted and discussed with staff.

The management team were not aware of the significant shortfalls we identified within the service, and development plans did not reflect issues we found.

Staff we spoke with described the culture within the service as being poor, and did not feel confident in the management team to make improvements.

The provider acknowledged our findings and demonstrated a commitment to making improvements in response to our inspection process.

The service was not consistently led by capable, compassionate and inclusive leaders. The management team did not demonstrate sufficient knowledge or oversight of the service, resulting in them being unaware of shortfalls. This impacted the ability of the service to make improvements.

Not everyone was familiar with who the manager was due to the many changes of leadership. One person told us they were expecting the manager to visit them several weeks ago, but this had not happened.

When asked whether people felt the service was well managed, one person’s relative told us ‘Not really no. We have left lots of messages, but no one has gotten back to us’.

The service delivered care to both older people and people with mental health conditions. At the time of our assessment, a specialist mental health manager was in post. However, during our assessment this post was evaluated as no longer being required, despite care still being provided to people with complex mental health conditions. We were not assured this decision was made after careful planning and consideration of people’s complex mental health needs.

People and staff did not always feel they could speak up and that their voice would be heard. The provider had a whistleblowing policy in place, and staff were familiar with the process for raising concerns. However, staff we spoke with were not always confident in the management team to act in response to concerns they raised. One care staff member told us ‘I don’t always trust or feel [concerns] are dealt with correctly’. Another care staff member told us ‘I’d report concerns to the manager, but I have no confidence anything would change though’.

Staff meetings were held. We viewed minutes of these meetings. Staff who attended had been asked their feedback. However, we spoke with several staff who said they were not given adequate time between care calls to attend these meetings, despite wanting to. One staff member told us ‘I do think they need to properly rota in meetings, rather than only being able to come if you are free’.

There was a lack of clear audit trail relating to complaints people had raised. We found complaints which had not been managed as outlined within the providers complaints policy. People and their relatives told us they felt action taken in response to speaking up was slow.

The provider did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

There was limited support available for staff, and staff were not always given the resources they needed to work in a safe environment. For example, some staff felt unsafe lone working, and had asked for emergency assistance alarms, however this had not been provided.

Staff were not proactively engaged with and told us they did not feel respected or valued. Whilst we were provided with a supervision tracker for staff, most staff we spoke with said they did not receive supervision sessions with a line manager regularly. We were therefore not assured of the effectiveness of these supervision sessions.

Policies were in place to promote the diversity and equality of the workforce. Processes relating to recruitment were robust, and people were safely recruited. Staff had access to equality training to help them understand about protected characteristics, bullying and harassment.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes. Governance arrangements at the service were poor, and failed to ensure oversight of the quality and safety of the service was sufficient.

Incident analysis was undertaken monthly. However, these were inaccurate and failed to reflect all incidents. Incidents which did not appear on the monthly analysis did not have any recorded actions taken in response.

Governance processes had failed to ensure accurate and up to date records were being held for people. The providers quality assurance action plan did not reflect the significant shortfalls we found during our assessment activity.

The quality of care being provided to people was not monitored to drive improvements. Quality assurance processes in place were not always effective at identifying concerns, and action points which had been identified were not shared to promote continuous improvement.

People using the service and staff working at the service did not feel the service was suitably organised and well-managed. One person told us ‘I think it could be a lot better managed let’s put it like that’.

The provider did not work in partnership with people using the service and staff working for the service. There was a distinct lack of meaningful engagement, which resulted in people and staff not feeling included. We received a large amount of negative feedback from people and staff which the service was not aware of. This did not assure us there was a culture of working in partnership with people using the service and staff.

The service had built positive working relationships with healthcare professionals. One healthcare professional told us ‘Working with First Choice Home Care Norwich is always a positive experience’. Whilst another healthcare professional told us the service was sometimes difficult to speak with, they reported this had improved since raising their concerns to the Regional Manager.

People were supported to engage with their local communities, and care staff supported people to access the shops, medical appointments and social appointments as necessary.

The provider did not focus on continuous learning, innovation and improvement. There was little evidence available to demonstrate how lessons were learnt when things went wrong, and we found actions to be reactive rather than from learning and making improvements in response to incident.

Staff told us they did not feel the service to learn from its mistakes to drive improvements. We saw incidents were not discussed at staff meetings to share learning. One staff member told us ‘No, we never have debrief sessions or reflections or lessons learnt.’

The service supported people living with a learning disability and autism. Care records were not reflective of current best practice guidance including Right support, Right care, Right culture. Care records needed significant development to better reflect how they were enabling people to promote their independence, identify pathways to future goals and enjoy a full life. This area had not been identified by the service ahead of our inspection.