First Choice Medical Solutions Ltd was rated Inadequate overall following a focused inspection in November 2022–January 2023, with breaches of regulations covering safeguarding, recruitment, staffing, and governance resulting in warning notices and special measures. Widespread failures included unsafe recruitment, poor safeguarding processes, inadequate staff training for learning disability and dementia care, ineffective governance and audit systems, and a lack of transparent leadership.
Concerns (13)
criticalSafeguarding: “The registered manager failed to report to CQC when they were made aware of a safeguarding concern where a person had their body hair shaved without seeking their consent.”
critical
Staff training
: “Staff supported people with dementia, people with learning disability and autistic people, but they had little understanding about how to effectively support people.”
criticalMedication management: “Relatives told us they found medicines on the floor or some medicines not administered as prescribed although staff signed to indicate they had administered these.”
criticalGovernance: “The lack of effective auditing of the service meant they failed to identify where improvements were needed around recruitment, training, supervision, keeping people safe.”
criticalLeadership: “The registered manager failed to ensure they had a full understanding of their management responsibilities. They had little oversight of the service.”
moderateStaffing levels: “Staff arrival times for care call visits varied by up to an hour. Relatives told us it was a regular occurrence that they were not alerted when staff were running late.”
moderateStaff competency: “Staff had not had their competency assessed regularly and had no meaningful one to one support, supervision to discuss their performance, agree training needs.”
moderateIncident learning: “There was no analysis done by the registered manager to understand the nature of incidents happening across the service. They had not looked for trends and patterns.”
moderateRecord keeping: “There were no records kept within the service to evidence that concerns were recorded, and actions were implemented to make the necessary improvements.”
moderateConsent / capacity: “Some people's care records detailed they lacked capacity around their finances, personal care or understanding risks, however there was no MCA assessments in place.”
moderateCare planning: “Care plans did not give enough guidance to staff to know people's likes and dislikes or meal preferences. Risk assessments were not always clear or coordinated.”
moderateSupervision / appraisal: “Some staff said they did not receive additional training in specific areas such as dementia, they had not received supervision and some staff had not received an appraisal.”
minorCommunication with families: “Relatives told us they had limited access to daily care records since these were electronic, therefore they felt less involved in people's care to support decision making.”
Strengths
· People were generally happy with the support they received and felt safe with staff present in the supported living environment.
· Staff worked with health professionals involved in people's care.
· Staff followed good infection control measures and adhered to PPE policy.
· The registered manager carried out regular medicine audits.
· Evidence that the service worked in partnership with other health and social care professionals.
Quality-Statement breakdown (8)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and management; Using medicines safely; Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink; Assessing people's needs and choicesRequires improvement
well-led: Promoting a positive culture; Continuous learning and improving careInadequate
well-led: Managers and staff being clear about roles; Quality performance and regulatory requirementsInadequate
First Choice Medical Solutions provides personal care and support to people living in their own homes and in supported living accommodation in the community. This service is a domiciliary care agency. At the time of our assessment twenty-one people were being supported by the service seven people of whom were in supported living settings. CQC only inspects where people receive support with personal care. This is help with tasks related to personal hygiene, eating and support with taking medication. Where they do, we also consider any wider social care provided. The assessment was a follow up to the previous assessment on 28 November 2022 when the service was rated inadequate. During the previous assessment Safe and well led were both rated inadequate. Effective was rated as requires improvement. We conducted our on-site responsive assessment on 25 October 2024, offsite activity started on 11 October 2024 and ended on 12 November 2024. This assessment was announced. We checked if the service had met the three breaches of regulation identified during the previous assessment 28 November 2022. We found the service had made improvements in all areas including compliance the three breaches of the legal regulations and two requirements. Registration Regulations 2009 - Notifications of other incidents ( The provider had established a robust system to notify all relevant parties of any incident and or events that are required to be notified. HSCA RA Regulations 2014 - Safeguarding service users from abuse and improper treatment (Response - Warning notice) People were protected from abuse and or improper treatment. All staff completed safeguarding training, had regular knowledge checks, and knew how to identify and report abuse. HSCA RA Regulations 2014 - Good governance (Response Warning notice) The registered manager and provider had established a range of quality assurance systems and processes to check the quality of care provided to people.
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First Choice Medical Solutions Ltd, a domiciliary care agency supporting 18 people, was rated Good across all five key questions at its first inspection. Inspectors found safe, effective, personalised care with strong MDT working, robust governance and a positive, person-centred leadership culture.
Strengths
· No missed visits reported; people alerted promptly when staff were running late.
· Safe recruitment with pre-employment checks including references and criminal record checks.
· Staff trained in safeguarding and confident in escalating concerns internally and externally.
· Medicines administered following best practice with competency observations and regular audits.
· Strong multi-disciplinary team (MDT) working with health and social care professionals.