Firstpoint Homecare - Harpenden

Firstpoint Homecare – Harpenden is a domiciliary care service providing personal care to older people and younger adults who may live with dementia, sensory impairments or physical impairments. At the time of the inspection 38 people were using the service.

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.

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

People felt safe with the care they received, and staff were knowledgeable about when to report concerns to safeguard people. Risk assessments highlighted people's individual needs, and professionals were referred to when staff needed input for people. Where things went wrong, this was shared with staff and lessons were learnt and changes implemented.

Medicines were given to people when they needed them, where discrepancies were identified these were actioned appropriately. Infection prevention control measures were in place and staff were wearing appropriate personal protective equipment (PPE).

People felt they were able to express how they wanted to be supported and staff were skilled and knowledgeable about their role. The provider ensured that staff went through a recruitment process and all relevant employment checks were completed.

People and relatives felt staff were kind and people were happy with the support they received. One relative said, “They are good, gentle and kind. They maintain her dignity at all times. The carers have been her family.” People had the opportunity to shape the support they received through giving feedback. People were supported to talk about decisions about their preference for their support, in addition if they wanted to speak about end of life care.

There were enough staff to support people at the time of the inspection. The service had a change in management since the last inspection, the overall feedback was positive. The registered manager had systems in place to manage complaints. Overall, people and relatives said they felt listened to when they raise any concerns.

People gave mixed views about the communication between them and the management team. The management team acknowledged this and were putting additional communications in place such as a newsletter for people.

The registered manager had implemented a lot of changes since the last inspection which had been acknowledged by the staff team. Systems had started to be used in a robust way and there were clear outcomes from the quality assurance systems in place. However, at the time of the inspection these changes had only recently been implemented. The registered manager understood the need to ensure the quality of care continued, and to ensure the systems and culture of the service is sustained.

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 and update

The last rating for this service was requires improvement (published 12 March 2019) and there were 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.

Rating at last inspection: At the last inspection in November 2016 the service was rated as ‘Requires Improvement’. The provider had not always ensured accurate records were maintained and had not ensured there was sufficient travel time allocated between care visits. Office staff did not always respond to people with care and attention. People had told us there were a lot of changes in care staff and that they did not know who the registered manager of the service was. Staff had mixed understanding about safeguarding matters and gave us mixed feedback about the support they received from the management team.

Why we inspected: This was a scheduled inspection based on the previous rating to assess improvements the provider had made.

People’s experience of using this service:

• Some improvements had been made since our previous inspection in November 2016. However, the provider’s quality assurance processes had not been effective in assessing if the changes made had improved people’s experiences of using the service.

• People had informative care plans that detailed the care and support they needed. However, some staff did not refer to the care plans for guidance.

• People and their relatives told us the care and support provided was not always safe. This was because there had been some missed care calls and late care calls.

• Staff received training in safeguarding and they knew how to report their concerns internally but needed further guidance about how to report externally to safeguarding authorities.

• Staff received training to help them support people safely however, their practical knowledge and competencies were assessed by their colleagues and not by management.

• People and their relatives were not always confident to raise a concern with the management team if they needed to. This was because they felt they were not always listened to.

• People’s medicines were managed safely.

• Staff supported people to eat and drink as needed.

• People received health care support from external professionals when needed.

• People felt well cared for and treated with respect and dignity by their regular care staff.

• When required notifications had been completed to inform us of events and incidents that happened in the home. This helped us the monitor the action the provider had taken.

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

The inspection took place on 19, 21 and 27 October 2016. The visit was announced which meant that the registered manager was given 48 hours’ notice of the intended inspection. This was to help facilitate the inspection and make sure that people who used the service and staff members were available to talk with us. At our last inspection on 14 November 2014 the service was meeting all the required standards in the areas we looked at. We found that at this inspection the service required improvements.

There was a registered manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The registered manager was supported by service and assistant service managers responsible for the day-to-day operation of each location where people received care and support.

People told us that staff helped them stay safe, both at home in their home and when out and about in the community. Staff received training for how to safeguard people from abuse and were knowledgeable about the potential risks of abuse and how to report their concerns. Robust recruitment practices were followed and there were sufficient numbers of suitable staff available at all times to meet people’s needs. People where necessary and appropriate were supported to take their medicines safely and at the right time by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

People who received support, relatives and health care professionals were positive about the skills, experience and abilities of staff who received training and refresher updates relevant to their roles. Staff supported people to maintain good health and access health and social care services when necessary.

Staff obtained people’s agreement to the support provided and always obtained their consent before helping them with personal care. People told us that staff supported them in a kind and caring way that promoted their dignity. We found that staff had developed positive relationships with the people they supported and where were clearly very knowledgeable about their needs and personal circumstances.

People who received support were involved in the planning and regular reviews of the care provided and this was accurately reflected in their individual plans of care. The confidentiality of information held about people’s medical and personal histories was securely maintained.

People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences and routines. People were supported to pursue social interests relevant to their needs. They told us that the registered manager and staff listened to them and responded positively to any concerns they had. People were encouraged to raise any concerns they had and knew how to make a complaint if the need arose.

People, their relatives, staff and professional stakeholders were all complimentary about the management team and how the service operated. The management team monitored the quality of services and potential risks in order to drive continuous improvement.

During this inspection we found that the provider was meeting the standards we had inspected. People were involved in the decision about their care and support and that their privacy and dignity was respected. People's care needs were met appropriately. There were suitable arrangements in place for responding appropriately to any allegation of abuse. The staff were supported in their roles and relevant training had been provided including regular formal supervision. There was a system in place to assess and monitor the quality of service.