Background to this inspection
Updated
16 November 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection to ensure that arrangements could be made in line with current guidelines to manage social distancing measures and ensure that we could speak to the people we needed to.
Inspection activity started on 15 September 2021 and ended on 24 September 2021. We visited the office location on 16 September 2021.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed information we had received about the service since the last inspection. We asked the provider to supply contact information for staff and people using the service. We sought feedback from the local authority and professionals who work with the service.
We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service about their experience of the care provided. We spoke with nine members of staff including the provider, registered manager, quality manager, field care supervisor, care co-ordinator and support staff.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We sought feedback from professionals who regularly work with the service.
Updated
16 November 2021
About the service
FirstCol Services Limited is a domiciliary care agency. It provides personal care to both older people and younger adults living in their own homes. CQC only inspects the service received by people provided with 'personal care', which includes help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection there were 43 people who received personal care.
People’s experience of using this service and what we found
Since our last inspection the provider had made some of the improvements required to improve oversight and raise the standard of care people received One person said, “They give me my medicines, they take care of that for me. They come and give it to me and that's going really well”. However, not enough improvements had been made with managing medicines safely, which meant some people remained at potential risk due to shortfalls in the level of guidance and information available to staff.
People told us they felt safe and were confident to contact the office if they had any concerns. People were positive about the support they received from staff who had been recruited and inducted safely. People told us staff used PPE (Personal Protective Equipment) to keep them safe during the global COVID-19 pandemic.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems did not support this practice. People did not always have assessments of their capacity to make decisions considered in line with the principles of the Mental Capacity Act. The provider had not always assured themselves that those making decisions on people’s behalves had the legal authority to do so.
People’s needs had been assessed, considered and staff met people’s needs effectively. People were supported by staff who received appropriate training and support and worked with other agencies to ensure their health and social care needs were met. People’s care and support needs were documented effectively, the provider had implemented care management systems which ensured key information was available to staff.
There were effective incident reporting systems in place which ensured incidents were considered and monitored by the management team. The registered manager had recently joined the company and had demonstrated their focus on getting to know people and developing and improving the service and as part of this had ensured people received opportunities to feedback on the service provided.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 22 April 2021) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We carried out an announced focused inspection of this service on 17 February 2021. Breaches of legal requirements were found. We undertook this focused inspection to view the actions they had taken to address the previous breaches We have found evidence that the provider needs to make improvement This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for First Col Limited on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified two breaches of regulation. Medicine was not always being safely, or properly managed and the need for consent had not always been considered.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.