Archived: Firstpoint Homecare - Leeds

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

We carried out an unannounced comprehensive inspection of this service on 18 May 2017. At that inspection we found the provider had breached two regulations associated with the Health and Social Care Act 2008. Medicines were not managed safely and our concerns regarding the management of people’s medicines had not been identified through the audits in place. We therefore concluded the audits on medication were not effective. At this inspection we found continuing concerns with the safe management of medicines and governance arrangements were still not robust enough.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC); however, they had left the service a few weeks previously. A new manager had been appointed and told us they would be making their application to become the 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 and associated Regulations about how the service is run.

We found the provider was failing to protect people using the service against the risks associated with the unsafe use and management of medicines. Clear and accurate records were not being kept of medicines administered by staff. Gaps in the medicines administration records meant we could not be sure people were always given their prescribed medicines. Care plans and risk assessments did not support the safe handling of people’s medicines.

Systems to monitor quality and identify issues and areas for improvement at the service were not always effective or recorded well. This did not demonstrate a commitment to continuous improvement of the service.

Staff understood their role and responsibilities for maintaining good standards of cleanliness and hygiene. However, people who used the service said staff did not always wear full personal protective equipment. We informed the manager of this and action was taken to address the concern.

People who used the service and their relatives were complimentary of the staff and manager. People told us they felt safe using the service and they had consistent staff who knew their needs and provided good care.

Staff had completed safeguarding training and knew the signs of abuse to look out for and how to raise any concerns. There were enough staff to deliver care safely, and staff were recruited in a safe way.

Staff spoke positively of the management team. They told us there was a positive working culture and they were given the support they needed to carry out their roles.

You can see what action we told the provider to take at the back of the full version of the report.

This was an announced inspection carried out on the 18, 19, 22 and 24 May 2017. Our last inspection took place in March 2016 where we found four breaches of the legal requirements relating to the safe management of medicines, good governance, the need for consent and person centred care. At this inspection we found on-going concerns with the safe management of medicines and governance arrangements around medicines.

Firstpoint Homecare-Leeds is registered to provide personal care to people in their own home.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

Medicines were not managed safely. Records of people’s medications were not accurate or up to date and it was not therefore possible to see if people had received their medications as prescribed. This put people’s health at risk. As and when necessary medication and creams were not administered as prescribed. Medication audits had not identified the concerns found during our inspection.

There were systems in place to monitor and improve the quality of the service provided. However, our concerns regarding the management of people’s medicines had not been identified through the audits in place. We therefore concluded these audits on medication were not effective.

Overall, people who used the service and their relatives told us they were happy with the support they or their family member received from the service. People told us they felt safe with their care workers and the care they were provided with. They said they received a good standard of care. One person told us; “We get the same people coming. It’s what we requested and it’s what happens.” People told us the service was reliable and staff were kind and caring. One person said, “They are very polite, nothing is too much trouble.”

There were systems and procedures in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice. They said they would have no hesitation in reporting any concerns. Recruitment was managed safely.

Overall, care and support was provided by appropriately trained staff. Training records showed staff had completed a range of training; however evidence of some training completed was not available. We recommend that copies of all staff’s training certificates are kept on staff’s files to show evidence of training completed. Staff said they received support and supervision to help them understand how to deliver good care.

Where needed, people who used the service received support from staff to ensure their nutritional and health needs were met. Staff were trained to respond to emergencies and said they felt confident to do so.

Staff knew to offer people choice and what to do in the event they refused care. The registered manager and staff we spoke with had an understanding of the principles and their responsibilities in accordance with the Mental Capacity Act (MCA) 2005.

People who used the service and their relatives were involved in planning the care and support received. Care plans now contained sufficient information for staff to follow and provide the care people wanted. Regular reviews were taking place to make sure people’s current needs were responded to.

There were procedures in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident the agency would respond and take action to support them.

People who used the service, relatives and staff all spoke positively of the registered manager and their commitment to the service and people who used it. People said they were frequently asked to comment on the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see some of the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Firstpoint Homecare-Leeds is registered to provide personal care to people in their own home. At the time of the inspection, the service did not have 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.

We received positive feedback from people who used the service and relatives. They told the care was personalised and they were satisfied with the service they received. They told us the same staff usually visited and they turned up on time.

People told us they did not have any concerns about the safety of the service. However, when we checked the arrangements for managing medicines we found they were not following guidance so some people were placed at risk. We also found they were not always assessing risk properly or taking action to prevent similar events from recurring.

Staff told us they felt well supported and had received more support and supervision in recent months. Staff were trained to help make sure they understood how to treat people with dignity and respect, and care for people safely. Training was generally not provided to help staff understand how to meet people’s specialist needs such as drug and alcohol misuse. The manager had identified this as an area they needed to develop to ensure staff were fully equipped to understand and meet people’s needs.

We found people were not always consenting to care. Some aspects of capacity were looked at during the initial assessment phase, which was around consenting to care. However, we saw sometimes there was a record that the person lacked capacity but there was no assessment to show how they had arrived at these decisions. Relatives were routinely signing care records rather than looking at how the person receiving care could be supported to be involved in this process.

Some staff didn’t understand the key requirements of the Mental Capacity Act 2005 despite attending training.

The provider’s system to monitor and assess the quality of service provision was not effective. Actions that had been identified to improve the service were not always implemented. Staff provided positive feedback about the new manager and felt they had already made improvements to the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.