Background to this inspection
Updated
3 October 2019
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 first day of the inspection visit was completed by two inspectors. The second day was completed by one inspector. Two inspectors made telephone calls to people supported by the service and staff members.
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 did not have a manager registered with the Care Quality Commission. The registered manager 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 the service 48 hours’ notice of the first day of inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection. The second day of inspection was unannounced.
Inspection activity started on 07 August 2019 and ended on 30 August 2019. We visited the office location on 07 and 14 August 2019.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. As the date of this inspection was brought forward the provider was not asked to complete a provider information return prior to this inspection.
During the inspection
We spoke with four people who used the service about their experience of the care provided. We spoke with the nominated individual, manager, a field care supervisor and two members of care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three 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 monitor how they were addressing risks identified during our office visits. We looked at risk assessments, call monitoring records and quality assurance records. We spoke with two professionals who regularly visited the service.
Updated
3 October 2019
About the service
Firstpoint Homecare Coventry is a domiciliary care service providing personal care to children, younger adults and older people who have learning disabilities or autistic spectrum disorder, mental health diagnoses or dementia. At the time of our inspection the service was undergoing significant change and was reducing the number of people they supported. On our first day of inspection the service was supporting 115 people with personal care. By the second day of our inspection this had reduced to 22 people.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
The provider had arranged the reduction in people supported by the service in conjunction with the local authority. Firstpoint Homecare had a contract to provide personal care to people arranged and funded by the local authority.
In early 2019 there had been a large increase in the number of people supported by the service which was arranged by the local authority. The provider acknowledged that they had not been able to manage the care of the increased number of people safely or effectively.
In May 2019 the provider had met with the local authority and gave notice to end the contract, at this point Firstpoint Homecare Coventry was providing support to approximately 200 people. Since May 2019 the provider has worked with the local authority to transfer people to other care providers and the intention was by the end of August all local authority care packages would be moved to other care providers.
On 30 August 2019 Firstpoint Homecare Coventry was supporting 22 people who intend to stay with the service as privately funded clients.
People’s experience of using this service and what we found
On day one of our inspection we found risks to people’s safety were not always identified by the provider. This meant staff did not always have information available to support people safely. People did not always receive their calls at the expected time and some calls were not attended at all.
We asked the provider to take action to improve the information available to staff about individual risks and to provide daily reports about when care calls were provided. The provider took immediate action to ensure information available to staff about risks was reviewed, updated and available. They also ensured measures were in place to ensure prompt action was taken in the event of missed or late calls.
People were supported by staff who understood how to recognise and identify abuse however the provider did not always follow their policies to protect people when concerns were raised. We brought two incidents to the provider’s attention. In response to this, the provider immediately took appropriate action to safeguard people.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People told us staff had the right skills and training to support them however we had identified occasions when staff had not supported people in line with their training . The provider had recently reviewed how new staff were trained and introduced a longer period for new staff to work alongside more experienced colleagues. This enabled the new member of staff to get to know the person they would be supporting.
People told us staff were caring and supported them in a respectful way. However, prior to our inspection we were informed of concerns raised by people when staff had not acted in a caring way. These incidents had been referred to the local authority to be investigated.
People told us they were not always supported by the same staff who they knew. The provider had already identified this and was working to improve the consistency of staff attending calls. People were involved in planning their care and had this information provided to them in a format they could understand.
People were asked for their feedback of the service, but this was not always used by the provider to drive improvement of the service. Due to management changes at the service people were not aware who the current manager was but they felt they could ask to speak to a manager and concerns would be acted on.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (Published 27 April 2019)
Why we inspected
The inspection was prompted in part due to concerns received about missed calls and the quality and safety of care provided. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
The provider has taken action to mitigate the risks identified and which has reduced the risk to people supported by the service.
Enforcement
We have identified breaches in relation to managing risks to people, taking appropriate action to safeguard people, monitoring process to ensure high quality care and failure to report incidents to us at this inspection.
Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from 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.