Date of assessment 18 March to 2 April 2024. First In Care Services is a homecare agency providing care to people with physical, health and dementia related support needs in their own homes and flats. This assessment looked at the improvements made in the service since the last inspection. The rating at our last inspection (published 24 January 2023) was requires improvement. At this assessment, the rating changed to good. We reviewed quality statements in Safe, Effective and Well-Led only. The registered manager employed since the last inspection now maintained a good oversight of the quality and safety of the care provided to people. There were now enough safely recruited staff in place to provide timely care to people and no visits were missed. People and relatives were now asked for feedback and there were quality assurances processes in place. Staff now completed initial needs assessments with people which addressed their needs, individual risks, preferences and wishes and informed their care plans.
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First In Care Services received an overall rating of Requires Improvement at its first inspection, with three regulatory breaches identified covering good governance (Reg 17), fit and proper persons employed (Reg 19), and staffing (Reg 18). Key failures included absence of a registered manager, inadequate oversight of missed calls and staffing levels, and inconsistent safe recruitment practices, though care staff were noted to be kind, respectful, and person-centred in their day-to-day delivery.
Concerns (10)
criticalStaffing levels: “There's been a few missed calls, where they just haven't turned up. / staff had not attended care calls for an extended period of 5 days.”
criticalGovernance: “The lack of management oversight of quality performance, staffing and recruitment meant people were placed at risk of harm. Breach of regulation 17(1).”
criticalStaff competency: “Safe recruitment systems had not always been followed. This placed people at risk of harm. Breach of regulation 19.”
criticalLeadership: “The manager had not begun the CQC registration process... no registered manager to be held accountable and legally responsible for any failing.”
criticalMissed or late visits: “They're often late to calls and rushing off to the next, they've missed calls completely and I just think they haven't got enough staff.”
criticalPerson-centred care: “A person had been left without care support calls for a number of days. This meant the person had to rely on friends and family members to support with personal care.”
moderateCare planning: “They don't really know how to support [person]. They seem to have not really assessed her needs at the beginning.”
moderateStaff training: “The manager did not have oversight of staff training at the beginning of the inspection. This meant staff training could have expired without the manager's knowledge.”
moderateCommunication with families: “The manager does not answer her phone and the communication is very slow.”
moderateSupervision / appraisal: “There were no systems to obtain feedback about the running of the service. No way for the manager to have oversight of quality assurance feedback.”
Strengths
· People told us staff were compassionate and respected people's dignity, treating them with kindness and respect.
· Care plans were personalised with details about how people liked to receive their care and promoted independence.
· Staff were knowledgeable about respecting equality and diversity.
· Complaints were responded to promptly; a complaints tracker was maintained for oversight.
· Accident and incident logs were maintained and signed off by the manager to identify trends.
Quality-Statement breakdown (19)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Supporting people to express their views and be involved in making decisions about their care; respecting dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles; understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture; continuous learning and improving care; duty of candourRequires improvement