Archived: 1st Call Homecare Limited - 115 Beaumont Road

1st Call Home Care Limited is a domiciliary care agency which provides care to people over the age of 65 within Plymouth and the surrounding areas. The agency also has seven specialist supported housing units.

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 the inspection the agency supported 250 people.

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

Overall, people’s risks associated with their care were now detailed in their care plans so staff knew how to support them safely. People told us they felt safe when staff entered their homes to provide care and support to them. Staff were knowledgeable about what action to take if they suspected someone was being abused, mistreated or neglected. Staff had been recruited safely.

People told us staff were kind and caring, but sometimes they experienced late visits and communication about staffing changes did not always happen. The provider told us they continued to work hard to rectify this, and recognised action and improvement was still ongoing.

People were protected by good infection control processes, and people now received their medicine safely.

People had their needs fully assessed when they started to use the service, so a care plan could be created, and care and support could be provided in a personalised way. However, once created, people told us they were not always involved in reviewing it.

Staff received training and support to be able to meet people’s individual needs. People’s human rights were now protected by the Mental Capacity Act 2005 (MCA) because their care plans now detailed their mental capacity. However, staff’s knowledge about the legislative framework was limited. The provider told us they would act to help improve staff’s knowledge and confidence.

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.

Overall, people told us the service was well managed, however expressed a lack of organisation by office staff, at times, affected the overall quality of service delivery. The provider and registered manager had introduced a new governance framework to help highlight when improvements were required. But recognised the system still needed to be adjusted to ensure it was effective.

We recommended the provider strengthens their governance system, implements the care certificate as part of their induction process, and that they seek advice and guidance from a reputable source to improve staffs understanding of the Mental Capacity Act 2005.

More information is in Detailed Findings below.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 19 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and in six extra care housing units across Plymouth. It provides a service to older adults who may have dementia or a sensory or physical disability.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

A registered manager was employed to manage the service locally. 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. The owner, who was also the Nominated Individual was also involved in the day to day running of the service. Each extra care housing unit had a team leader in place who was responsible for the day to day running of the unit.

People often experienced calls that were too early or too late for their needs. They also weren’t always informed of changes to call times and didn’t always have consistent staff members. Staff told us they felt the organisation was short staffed and they or other staff were pressured to fulfil extra calls as a result.

Risk assessments were not always in place to guide staff how to reduce risks relating to people’s health and social care needs. Staff identified people’s changing health needs but it was not always clear whose responsibility it was to contact the relevant healthcare professional. People received their medicines safely from trained staff; however these were not always recorded or monitored in a safe way.

Safe recruitment procedures were in place, however when new staff shadowed experienced in people’s homes, people had not been told the staff member may not have an up to date DBS in place.

People’s care plans did not include information about how they liked their care delivering. Staff told us care plans were not always up to date. People preferred methods of communication had not always been sought. However, where these were known by staff they were respected.

Where staff had got to know people well, they used their knowledge of them to ensure their wellbeing was promoted and their preferred routine, likes and dislikes were respected. However this information was not always included in people’s care plans. Information about people’s gender, sexuality or communication needs had not been sought by the service. This meant staff may not have been protecting people’s human rights in relation to these characteristics.

The registered manager and provider had not ensured that when people lacked capacity, a mental capacity assessment was completed. This meant their rights may not have been respected.

The registered manager and provider had not ensured there was an effective quality assurance system in place that enabled them to have a clear overview of all aspects of the service. Where senior staff checked aspects of the service or information on the quality of the service was collected from people, there was no clear plan to improve any areas of concern.

People told us staff were caring and treated them with respect. Staff gave examples of how they supported people to maintain their independence and protect their privacy.

People told us they felt safe using the service and that staff followed safe infection control procedures. Staff received regular training including how to recognise and report abuse.

We made a recommendation about ensuring staff were trained to meet people’s specific needs.

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

1st Call Homecare Ltd provides a personal care service to people living in their own homes and within six extra care housing locations. On the day of the inspection 198 people were supported with their personal care needs.

A registered manager was employed to manage the service locally. 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. The extra care housing locations each had a team leader in place who were responsible for the day to day management of the staff team. The team leaders were overseen by one of two deputy managers. The part of the service which provided care in people’s private homes was overseen by another manager.

People told us they felt safe comments included, “I’ve been with them 10 years so that tells you how safe I feel.” All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

Staff told us they did not receive much travel time between calls which resulted in them starting their calls early or cutting the time they spent with people. The registered manager addressed this during the inspection.

People’s preferences were sought and respected but these were not recorded in detail in people’s care plans or risk assessments to enable staff to provide consistent care. The registered manager had begun to implement more detailed, personalised records by the end of the inspection.

People had their medicines managed safely. People were supported to maintain good health. Referrals were made quickly to healthcare professionals, such as GPs, physiotherapists and occupational therapists when people’s needs changed.

People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and staff treated people and their loved ones with respect. Staff were motivated to provide good care and appreciated the importance of respecting people’s privacy and dignity. Comments included, “I love my job, I’m passionate about improving things for people.”

Staff described the management as open, supportive and approachable and talked about their jobs in a positive manner. Comments included, “I think it’s great. If I’ve ever had any issues at all, I just call or pop in and they are supportive and help me.”

There were quality assurance systems in place. As a result of feedback from the inspection, the registered manager decided to implement a new quality assurance system to ensure any gaps were highlighted quickly and easily.

We considered our inspection findings to answer the following five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found.

Is the service safe?

All of the people we met during this inspection received care and support in their own homes. Everyone told us that they felt safe and that the staff visiting them always ensured they had their alarms on before they left them and that they left their properties secure. In the questionnaire responses we received, 96% of people told us they always felt safe when 1st Call Homecare visited them.

We found care plans and risk assessments in relation to people's care, their medicines and their environment were in date and in most cases reflected their current needs. Staff felt able to request reviews of people's care when their needs had changed. In the questionnaires we received, 60% of families told us they had felt involved in care planning, 30% feeling they did not need or wish to be involved.

We saw that where people needed support to manage their medicines safely, arrangements were in place to protect people for example by using lockable safes.

The personnel records we reviewed were well organised and contained the necessary information required to ensure staff were of a good character. References and police checks had been conducted prior to new staff commencing work, staff received an induction and there was on-going monitoring of the quality of their work. 100% of respondents to our survey felt care workers had they right skills to support their care. This told us people felt staff had the right qualities and training to support them to meet their needs.

Is the service effective?

People told us "I'm happy, I have good care"; The carers are kind"; "Things are okay"; "They walk in...hello, can I make you a tea?...They must know I'm a tea addict!" and "I have never met one (carer) I didn't like."

People were happy with the care and support they received. Some people and staff mentioned the organisation of visits, consistency of staff visiting and communication with them could be improved when changes were made to their schedules. One person who had complained felt listened to and was confident similar issues would not arise in the future. Our survey responses indicated that 90% of people were satisfied with their care, 40% stating the service and support they received was excellent.

Is the service caring?

People told us "I'm happy with the care....we get on well and have a giggle". Another person told us "They are polite, caring, never missed a visit" and "They are very sympathetic". In the questionnaire responses we received people told us that staff were "friendly, helpful and very caring".

People told us all of the staff were kind and caring when they visited. Our conversations with staff indicated they cared about the people they worked alongside and they enjoyed their jobs. Staff were knowledgeable about the people they supported and we saw staff speaking with people with respect and treating them with dignity. 88% of people told us they were always treated with respect by the care workers and had never experienced any kind of discrimination.

Is the service responsive?

People's needs were assessed prior to them receiving care from the provider. Care plans were developed alongside people and their families as soon as possible. Care plans reflected people's preferences and diverse needs. Where necessary the provider liaised with external agencies to support people's changing needs such as occupational therapists as people's mobility declined.

People told us they felt able to complain if they needed to and we saw that complaints had been thoroughly investigated and learning had taken place following complaints. 84% of people who responded to our questionnaire knew what to do if they had a concern about the service and 20% had felt able to raise a complaint with the provider. 80% of families who responded to the survey we sent to them knew how to make a formal complaint. This told us people and their families were familiar with the complaints process and felt able to raise a complaint when they needed to.

Is the service well-led?

There were quality assurance processes in place to monitor and improve aspects of service provision. People had the opportunity to feedback through quarterly questionnaires and through regular residents' meetings in the housing projects. There were policies in place to support staff in their work. Regular audits of medicines had helped to improve the management of medicines in people's homes. Staff told us they were clear about their roles and responsibilities and felt supported by colleagues. There were systems in place to monitor the quality of staff's work such as one to one meetings, group supervision sessions and spot checks.

People told us "The regular girls delivering the care are exemplary, outstanding but some of the girls come in with a scrap of paper in their pocket, don't read the care plan, have no knowledge about me or my diabetes."

We found that improvements had been made in the community and people were having their needs assessed and had care plans in place which reflected their individual needs. In one of the sheltered accommodation projects we visited this was not the case although work was in progress to rectify this.

We found people did not always receive the medicine they were intended to. This occurred particularly when people's regular care workers were away and staff were unfamiliar with people's medicine prescription and the system for medicine administration varied across the organisation.

Staff were supported when they joined 1st Call Homecare and felt they had an induction and training which met their needs.

The monitoring of the quality of service provided occurred through annual service user questionnaires, having a complaints policy in place and staff supervision and training. However the systems in place had not identified concerns found during this inspection.

We found that people felt respected and were given choices about the care they were receiving. They felt the staff were good and provided care in a dignified way. We found there could be greater involvement with people in the care planning process.

We found that in many cases care plans and risk assessments were out of date and did not reflect the care people were receiving or needed. This placed some people at risk. Staff felt they needed greater information about people's needs and time to read care plans.

We found a consistent system was needed across the organisation to safely manage the administration of medicines. We saw different practices occurring during our visit which was confusing.

We found there were sufficient staff in one project we looked at based on people's social care support packages. We found staff appeared to have regular supervision when we saw the records but the staff we spoke too felt differently and told us they had not had one to one meetings and appraisals recently. Staff in the community felt pressured by the lack of travel time between home visits.

There was a system in place to monitor service provision but with the recent expansion of the company it had not identified the areas that required improvement.

We found that the service had implemented a new assessment and care planning system. This system was individual to each person and provided information and instructions to staff on how to meet people's needs. People told us they were involved in their care planning. Staff told us care plans helped them to meet people's needs.

We saw that the service had a training matrix. We saw 69 staff had received safeguarding training in 2012, 13 staff in 2011 and three staff in 2010. From this we could see that the majority of staff (85 of 94) at the service had received recent training. People told us that they felt safe. Staff told us what procedure they would follow if they needed to report abuse. Staff told us that they felt supported and we saw that they had received supervision and appraisals.

We saw that the service had sent questionnaires out to people who used the service and had collated the information. We saw from the audits that there was an improvement in the service. We saw evidence that the service had discussed areas of concern raised by people using the service and in response had put together action plans to find ways to address the issues.