First Choice Home Care (Norwich)

Updated 11 January 2022

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 undertaken by one inspector and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes. 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

This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be available to support the inspection.

Inspection activity started on 11 October 2021 and ended on 10 November 2021. We visited the office location on 22 October 2021.

What we did before inspection

We reviewed information we had received about the service since registration. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 19 people who used the service and six relatives about their experience of the care provided. We spoke with the registered manager, deputy manager (mental health) and received feedback from four staff members. We also received feedback from three professionals with whom the service works alongside. We checked three people’s care plans and risk assessments and spot-checked various documentation for other people, including medicines records. We reviewed a variety of records relating to the management of the service, including policies and procedures. We also looked at training data and quality assurance records.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 11 January 2022

About the service

First Choice Home Care (Norwich) is a domiciliary care service providing personal care to people living in their own homes. The service provides a domiciliary care service for adults, including people living with dementia, and for people living with mental health conditions. The mental health service was run separately, with its own deputy manager in post, with the registered manager having overall responsibility for all services provided from the location.

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. At the time of inspection, the service was supporting 118 people in total, 42 of whom were in receipt of personal care.

People’s experience of using this service and what we found

People, and their relatives, told us they were not always supported by a consistent staff team. The registered manager was aware of this and was in the process of implementing various recruitment initiatives. We received mixed feedback regarding staff punctuality, attendance and communication about changes to the rota. Rotas were sent out to people and contact made when there were changes, although sometimes this was short notice. The management team told us this was often due to short notice changes made by the people supported. However, people told us changes were not always their choice. Gaps in the provider’s governance system meant that management oversight of the service was not robust and the impact on people was not clearly assessed.

A quality monitoring system was in place, which included various audits and the monitoring of safeguarding concerns, complaints, accidents and incidents. However, there were some gaps in this system, which meant issues found during this inspection had not been identified.

The majority of risks to people’s health, safety and well-being had been identified and assessed but risk management plans were variable in detail. However, staff told us they knew people well and were aware of risks in relation to their care and support. This helped mitigate some of the gaps identified in documentation.

People were encouraged to be involved in making decisions about their care and to take part in reviews. Care plans were detailed with regards to people’s preferences, although were not always updated promptly. We have made a recommendation about updating care plans.

Staff had a good understanding of the people they supported. They took the time to get to know people’s individual likes and dislikes and spoke about people with kindness and compassion.

The registered manager understood their responsibilities to safeguard people from abuse. They had systems and processes in place to ensure any concerns were recorded and reported. Staff received training in medicines administration and their competency was regularly assessed.

People were protected from the risk of infection because staff had been trained in infection prevention and control (IPC)and followed the current infection prevention and control guidance.

Staff told us they received appropriate training to carry out their role effectively, including training specific to individual people’s needs. Staff and the management team worked well with other agencies to ensure that people received appropriate care.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 07 April 2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to staffing at this inspection.

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.