Date of Assessment 25 March 2025 to 25 April 2025. We undertook this assessment in response to information of concern we held about the service. First Choice Home Care Norwich is a care at home service providing support to older people, people with a learning disability and people living with mental health conditions. We found 2 breaches of regulation in relation to safe care and governance. The provider was previously in breach of the legal regulation in relation to safe staffing. Improvements were found at this assessment and the provider was no longer in breach of this regulation. People did not always receive care in a safe way, and their care needs had not been fully assessed. Risks relating to peoples care needs had not always been identified, and staff were not supplied with sufficient guidance to keep people safe. We found systems for people to raise concerns were not always effective, and complaints were not always managed in a timely or caring way. Some people felt their concerns were dismissed. The provider did not always support staff wellbeing, and staff did not feel they were treated with respect. Information was not always provided to people in a way which they could access easily. People were not involved in planning their care, and the outcomes people experienced were not always monitored to promote continuous improvement. Oversight from leaders was poor and had not identified the concerns we found during this assessment. People and staff did not feel confident in the management team to lead the service safely or with transparency. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We found the provider had failed to fully meet the principles of it. There was a lack of management and provider oversight to review shortfalls of care to make improvements. The provider did not always focus on people’s quality of life. The provider and staff did not always recognise how to promote people’s rights, choices and plan to ensure their independence.
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First inspection of this newly registered domiciliary care service rated Requires Improvement overall, with a breach of Regulation 18 (Staffing) due to insufficient and inconsistent staffing causing late and missed visits. Governance gaps limited management oversight, though medicines, IPC, caring practice and partnership working were rated positively.
Concerns (11)
criticalStaffing levels: “staffing was either not sufficient or consistent enough to ensure people's needs were met in a timely manner. This placed people at risk of harm.”
criticalMissed or late visits: “Between August and October 2021, one late visit and 22 missed visits were recorded. Most missed visits were where a single member of staff attended a visit instead of the two staff required.”
moderateMissed or late visits: “'[Staff] are always 10 minutes late. They have never missed a call, but sometimes they are 2-3 hours late. They will let me know then, but it's too late by then.'”
moderateGovernance: “Gaps in the provider's governance system meant that management oversight of the service was not robust and the impact on people was not clearly assessed.”
moderateGovernance: “we saw no evidence this information was reviewed on a regular basis, in order to identify patterns and trends.”
moderateCare planning: “we found that these changes were not always promptly recorded in care plans and did not always contain pertinent information that had been shared by people and relatives in care review meetings.”
moderateCommunication with families: “People told us they were not informed when changes were made to the rota. A relative told us, '[Staff] don't let you know about any changes. I don't like this really.'”
moderatePerson-centred care: “the lack of consistency in staffing at the time of our inspection meant that some people were receiving care from staff who were not known to them or familiar with their preferences.”
moderateRecord keeping: “Risk management plans were variable in detail. For example, one person required the use of bed rails, but a full assessment of their use had not been completed and there was no plan in place to mitigate any identified risk.”
minorLeadership: “'I sometimes feel supported by my manager, but I personally don't feel management is approachable.'”
minorIncident learning: “It was not clear how the classification of an event was determined.”
Strengths
· Staff received training in medicines administration with regular competency assessments and monthly MAR audits
· Robust infection prevention and control practices with adequate PPE supply
· Safe recruitment process with appropriate criminal record checks and references
· Staff spoke about people with kindness and compassion and respected privacy and dignity
· Effective partnership working with social workers, mental health specialists and other professionals
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience
Not rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated