Archived: Firstpoint Homecare - Leicester

The service provides personal care and support to people who live in their own home in parts of Leicestershire. At the time of our inspection 31 people were using the service. The service was run from an office located in a small business park. When we arrived for our inspection we found that the service had moved from Suite 1 & 2 to a new location, The Dairy, within the business park.

The service has not had a registered manager since June 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A manager who intended to apply to be a registered manager left the service in September 2016. The provider has arranged for a director to run the service. At the time of our inspection no person had applied to be registered manager.

People who used the service told us they felt safe. They were supported and cared for by staff that had been recruited under recruitment procedures that aimed to employ only staff that were suited to work at the service were employed. Disciplinary procedures were used after the provider had identified unsafe and dishonest actions by staff. Staff we spoke with understood their responsibilities for protecting people from abuse and avoidable harm. However, some people’s care and support was neglected because care workers were not punctual or because some home care visits were missed.

People’s care plans included risk assessments of activities associated with their personal care and support routines. The risk assessments provided information for care workers to support people safely without restricting their independence.

Enough suitably skilled and knowledgeable staff were deployed to meet the needs of the people using the service. However, care workers were often too early or late for home care visits. Relief care workers who were less knowledgeable about people’s needs had to be allocated home care visits at short notice when regular care workers were absent.

People were supported to take their medicines by staff that were trained in medicines management. However, people were not always supported with their medicines at the right times.

Care workers were supported through supervision and training. The provider used staff meetings to remind staff about safe practices and the standards that were expected of them. However, people told us that care workers who visited them less regularly did not appear to know how to support them. Not all care workers acted in accordance with the provider’s guidance about treating people with respect.

The director understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff we spoke with had little awareness of the MCA but they understood they could provide care and support only if a person consented to it.

People were supported with their meals. Care workers supported people to make meals or by heating ready prepared meals.

People were involved in decisions about their care and support but their preferences, for example about times of home care visits, were not always respected. They told us they were treated with dignity and respect by their regular care workers but not by care workers who visited them occasionally.

People contributed to the assessment of their needs and to reviews of their care plans. Their care plans were centred on their individual needs. However, not all care workers provided care and support that was in line with people’s care plans. This meant people did not consistently experience care and support that met their needs. People knew how to raise concerns but they were not always confident their concerns were acted upon by the provider.

The provider had arrangements for monitoring the quality of the service. These arrangements included asking for people’s feedback about the service and a range of checks and audits. Although the provider had a process for monitoring and reporting about punctuality of home care visits this was not consistently used. This meant shortfalls in the delivery of care were not promptly identified and acted upon. A director had been sent to run the service and make improvements. There was no action plan of what those improvements were or how they would be achieved.

We found one breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Firstpoint Homecare provides personal care to people in their own homes. At the time of our inspection 53 people were using the service. The service is run from an office in Newtown Unthank, Leicestershire.

It is a condition of registration that the service is managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the service was without a registered manager for seven months, but a person managing the service had applied to be registered manager.

Staff understood their responsibilities for protecting people from abuse and avoidable harm. Enough staff were deployed to cover home care visits. However, people felt vulnerable when care workers were late or because they didn’t know which care workers were going to visit them. The provider’s recruitment procedures ensured as far as possible that only people suited to work for the service were employed.

Since our last inspection in April 2014 there were eight occasions when people did not receive support with their medicines. They were either not given their medicines, or were not given the right medicines at the right time.

People using the service felt that most staff were suitably trained and had the skills to provide them with the support they needed. However, some people we spoke with told us that they had to tell care workers what to do and that some care workers had to be told how to use equipment such as hoists. Those people did not tell us they felt at risk because of that.

Staff we spoke with were aware of their responsibilities under the Mental Capacity Act 2005. Staff understood that they could only provide care and support if a person gave their consent.

People using the service were supported with their nutritional and health needs. They were supported to access health services when they needed them.

People told us that staff were caring. People had access to information about their care and support. A relative and a care worker we spoke with told us that during home care visits they heard care workers talking about other people who used the service. That was a breach of confidentiality. The provider was taking action to address this.

People’s preferences about the times of home care visits were not always met. Approximately a quarter of home care visits were more than 30 minutes earlier or later than people expected. People preferred to receive support from the same care workers and more people were experiencing that. People we spoke with sometimes felt their concerns were not listened to and some felt discouraged from raising concerns.

People using the service, relatives and staff had opportunities to be involved in developing the service. The management and staff we spoke with had a shared understanding of the challenges facing the service and what the service wanted to achieve.

The provider had arrangements for monitoring the service and had identified areas that required improvement.

Below is a summary of what we found. The summary is based on evidence we collected from speaking with people using the service, their representatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe. The provider had safeguarding procedures that were robust and staff understood how to safeguard people they supported. People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Staff knew about risk management assessments in people's care plans. This meant that people were not put at unnecessary risk and remained in control of decisions about their care and lives.

The provider had effective procedures that ensured people were cared for by staff who had the right skills and experience.This helped to ensure that people's needs were met by staff who understood people's needs and who were well known to people who used the service.

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The provider had procedures in place that identified poor practice. Staff received refresher training when required. The provider had an effective complaints procedure that ensured complaints were thoroughly investigated. The provider ensured that lessons were learnt from complaints and incidents and risks to people were effectively managed.

Is the service effective?

People's health and care needs were assessed with them and their representatives. People and their representatives were involved in the development of their plans of care. Specialist input into care plans had been provided by other health and social care professionals. Care plans were up to date and reflected their current needs.

Is the service caring?

We spoke with relatives of four of the people who used the service. We asked them for their opinions about the staff that supported their family members. People's comments were positive, for example; 'They [staff] are absolutely wonderful", 'they explain what they do" and "I'm most impressed with the carers."

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We spoke with care workers who demonstrated that they genuinely cared for and understood the needs of the people they supported.

People who used the service, their representatives provided feed-back through twice-yearly satisfaction surveys. The provider had responded to what people had said. Where shortfalls or concerns were raised these were taken on board and dealt with.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We looked at a complaint that had been received shortly before our inspection. We saw that the complaint was in the process of a thorough investigation in line with the provider's complaints policy. People can be assured that complaints are investigated and action taken as necessary.

The provider worked closely with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The provider had an effective quality assurance system. This system generated much useful information that allowed the provider to monitor and assess the quality of care provided. Problems that had been identified were addressed promptly. Opportunities to improve things were acted upon. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service. Staff were supported through supervision and training and had opportunities to further develop their knowledge and skills. This helped to ensure that people received a good quality service at all times.

People using the service all told us that they were satisfied with the care they received. They described having regular carers who generally arrived on time and who carried out the tasks required of them. People told us that staff referred to their care plans and that they made records each time they visited. One person told us: "The care is fine. Because I have the same carers every time they know what I need." Another person who used the service commented that: "The regular carers are really really good. I am very happy with them."

Staff working at the service felt adequately trained to carry out their roles. They told us they had received an induction into the service and that recruitment checks had been carried out on them before they started working for the agency. One staff member said: "What they said to us at the interview is exactly how it has been. We are more than happy with them."

We reviewed the care plans in place for people using the service. The care plans we looked at contained risk assessments which did not provide clear enough guidance to staff about how to deliver care that was safe and appropriate. We found that there was a robust recruitment process in place at the service and that staff were being adequately trained.