First In Care Services

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People received safe care and treatment from staff who understood their needs and followed healthcare guidance from professionals. Staff knew how to safely support people around their individual risks and how to protect people from abuse and neglect. Staff ensured people’s rights were protected. Medicines were managed safely by competent staff. Staff received appropriate training and were recruited safely. People’s care visits were planned, and their completion was overseen by managers.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they were happy with their care and there were no issues which would require addressing. One person explained to us how the provider made appropriate changes to how their care was planned, so no visits were delayed anymore. They commented their care was managed like 'clockwork' since.

Staff told us the communication in the service was good and they would be informed about any changes and lessons learnt.

The provider had processes in place for reviewing incidents, accidents and wider information in the service to identify and act on lessons learnt. There were no incidents or accidents since the new group of people started using the service. The registered manager made improvements in how the electronic care planning and visits rostering systems were used in the service to improve their effectiveness which they identified as a lesson learnt from their experience of providing care to people.

People and their relatives commented their care addressed their needs and was well-organised as per individual circumstances.

Staff knew how to support people to receive consistent and timely care, including when people needed to use a range of different services.

There was evidence of good communication with partners around people’s individual care.

The provider had clear and robust systems for care planning, review and working with other partners involved in people’s care which were implemented by staff and overseen by the registered manager.

People and their relatives said they felt safe with staff and knew how to raise concerns if needed. People told us, “I feel completely safe with the staff, there has never been a time where I have felt unsafe” and “I feel very safe, I like to have visitors it breaks up the day. I have never felt unsafe at all.” A relative commented, “I would raise (any concerns) with the agency first and then contact the social care team.”

Staff knew how to recognise and report safeguarding concerns. Staff members told us, “I escalate any concerns to my line manager, for example, if I see a client with bruises on them or they tell me something with regards to financial or sexual abuse. Anything that could be a potential safeguarding needs to be escalated”, “I will raise anything that I am worried about.” and “Safeguarding is about protecting a client in every way. I made a referral [about a specific issue]. Manager dealt with this.”

The provider had clear policy and process for reporting, investigating, and acting on safeguarding concerns. Staff received appropriate safeguarding training.

People and their relatives felt staff knew people’s individual risks and supported them safely. People said, “[Staff] are there just for when I have a shower, to make sure that I am safe. I do everything myself, but it is reassuring to know that they are there in case anything happens” and “If there is someone new (staff), they normally know what needs to be done but I always go through my requirements.” A relative commented, “[Staff] know all of [person’s] risks and they always use the equipment that she has safely.”

Staff were aware of individual people’s risks, how to support them safely and the process in place around reviewing and flagging up new risks and changes to current risks. Staff members told us, “If I find a client not looking good due to illness or a fall, I would call an ambulance straight away. If there was anything not usual for the client, I would escalate to line manager before contacting the GP. I ensure that I make a meal on every call and get them a drink. Even if they say that they are okay, I will still prepare something and put it aside so they can get it later. If I notice that they are eating or drinking properly, I will escalate to line management”, “Usually risks are reassessed every three months. People’s needs can change and if I notice this, and their needs are different, I will contact the manger and request a new risk assessment.”

People’s care plans were individualised and detailed the support their needed to stay well and safe. Care plans included relevant, up to date risk assessments, for example, around their mobility, personal care, eating and drinking, skin care, physical and mental health needs.

People and a relative told us staff knew how to provide safe care in people’s homes and were competent to do so.

Staff were aware of environmental risk assessments and health and safety at work. Staff members told us, “I check the environment around [the person] to ensure it is free from anything that could cause harm. If it is a client that is known to self-harm, I will also check with them. I also check the food that they have is fresh and cooked correctly”, “I make sure that their home is safe and secure and there are no hazards. I also ensure any doors that need to be locked are”, “I look out for tripping and slipping hazards, this is probably the most common; also, electrical hazards. I put everything (for example, drinks) within easy reach of the client.”

The provider had a clear business contingency plan which helped them to plan for any emergencies to ensure people’s care was not disrupted. People’s home environments were assessed, and each person had a bespoke environmental risk assessment in place guiding staff how to safely provide their care in their own home. Staff discussed safety in team meetings.

People told us staff overall came on time and completed visits as planned. If staff were running late, they would be informed. The registered manager acted if there were any issues with visit completion. People found staff to be competent for their roles. One person told us, “There seems to be (enough staff). I don’t think it has ever happened, but if they are late, it will be a few minutes.” A relative said, “They are sometimes quarter to half an hour early which isn’t ideal, but it can’t be helped. If they are running late, we get a phone call. We always get our carer; they never not turn up so doesn’t seem to be an issue with the number of staff.”

Staff told us there were enough of them to visit people as planned, rosters were well-coordinated and allowing enough time to travel between the visits. Staff could always access on call management support. Staff felt supported in their roles and told us they had regular training and supervision. Staff members said, “Shifts are always covered and there is time to travel; the double handed (2 staff required) shifts are fine because we communicate well enough to make sure we get there to the client together. The manager rings the client if we are going to be more than 15 minutes (late). We always tell the client about this”, “We get enough training, and we also do recaps to keep us well informed of what is best practice”, “The training I do has definitely helped me to do my job better. I have so many certificates. I am working on a health and care diploma. The company has agreed to support me to do this” and “I had supervision during my induction and the manager does spot checks (observes staff practice when providing care).”

The registered manager used electronic rostering and visit completion monitoring systems effectively. This supported them to ensure people received their care as planned. No visits were missed and where visits were running late due to unforeseen circumstances, there was a clear system for escalation and good communication with people using the service and staff. New staff were recruited safely. Staff training and supervision were monitored, and staff were supported to complete all relevant to their roles training courses. Staff also completed a range of competency assessments.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they received good support with their medicines which was on time and as prescribed. People said, “I always get the correct medication and always on time with my meals.” and “There is never an issue with my medication. I always get it on time, and it is always checked to make sure it is the correct amount.”

Staff we spoke with were aware of people’s individual needs, including when people required support with their medicines.

The provider had good, clear systems for safe management of medicines. People’s records included medicines administration charts, medicines care plans and risk assessments. Staff could access information around people’s health needs and medicines they required support with, including ‘when required’ medicines. Staff received appropriate training and support around medicines and safe medicines administration was discussed in staff meetings.