FirstCol Services Limited - Home Care - Worthing remains rated Requires Improvement following a focused inspection in September 2021, with continued breaches of Regulation 12 (medication management) and a new breach of Regulation 11 (consent/MCA). Improvements were noted in safeguarding, recruitment, infection control, and overall governance, but audit systems failed to identify key shortfalls in medicines and capacity assessment practice.
Concerns (6)
criticalMedication management: “People prescribed as required medicines (PRN) did not have protocols in place to ensure medicines were given consistently by staff.”
critical
Medication management
: “Records did not always contain adequate information for staff about short term medicines...Staff had not been provided with guidance to inform them of the health concern.”
criticalConsent / capacity: “Capacity assessments were not always completed with people to detail their capacity to consent to specific decisions relating to their care.”
criticalConsent / capacity: “The provider was unaware if some people making decisions on people's behalves had Lasting Power of Attorneys for Health and Welfare.”
moderateGovernance: “Audits were in place, but these did not always identify areas for improvement...medicine audits were completed but had not identified shortfalls about the lack of person-centred PRN information.”
minorCare planning: “Some risk plans which were generic. The provider acknowledged this system was in the process of being embedded within the service.”
Strengths
· Safeguarding incident reporting systems improved; concerns now reported to local authority in line with statutory responsibilities.
· Safe recruitment processes reviewed and embedded following previous breach of Regulation 19.
· Online care management system implemented providing staff with accessible, up-to-date information about people's needs.
· Staff received appropriate training and described positive support from the newly appointed registered manager.
· Infection prevention and control policies updated to reflect COVID-19 guidance; PPE use confirmed by people and staff.
Quality-Statement breakdown (15)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA)Requires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Supporting people to live healthier lives and access healthcare servicesGood
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
well-led: Promoting a positive culture; continuous learning and improving careRequires improvement
well-led: Governance and quality assurance systemsRequires improvement
well-led: Engaging and involving people, staff and partnersGood
FirstCol Services Limited was rated Requires Improvement overall following a focused February 2021 inspection, with five regulatory breaches identified spanning safeguarding, medication management, risk assessment, safe recruitment, and governance. The Well-Led domain was rated Inadequate due to widespread failures in quality assurance, absence of a registered manager, and failure to report statutory notifications to CQC and the local authority.
Concerns (12)
criticalSafeguarding: “two incidents that had not been managed safely. Not all had been identified or reported in accordance with the providers policy or the providers statutory obligation to report allegations of abuse”
criticalMedication management: “A person had not had access to their prescribed regular pain medicine for thirteen days and this had not been identified by staff and as a result this was not acted on promptly.”
criticalGovernance: “medicine audits did not always reflect what the records had noted. The audits completed in December 2020 and January 2020... The audit result was marked 'yes', however, this was not evident on MAR sheets reviewed.”
criticalGovernance: “The provider did not have effective quality systems in place or have effective oversight of the service.”
criticalStaff competency: “A staff member had been employed ahead of receipt of DBS certification. This placed people at risk of harm as the character and suitability of staff had not been fully considered.”
criticalIncident learning: “The provider had not demonstrated that they had a robust system in place to ensure that statutory notifications to CQC had been completed or demonstrate lessons learnt as a result.”
moderateMedication management: “People's medication administration records (MAR) did not always show that an 'as required' medicine (PRN) was given in accordance with their prescribed guidance.”
moderateCare planning: “Care and risk records lack personalised detail and did not always contain guidance for staff to help ensure people remained safe.”
moderateCare planning: “Risk assessments for people were generic and not personalised. They lacked detail and personalised information relating to specific health care needs.”
moderateRecord keeping: “This failure to identify ongoing poor record keeping increased the potential impact poor practice could have on the person.”
moderateSupervision / appraisal: “Management records had shown that a staff member required feedback on their conduct. There was no evidence that this had been completed and this comment was repeated through several meeting minutes.”
moderateLeadership: “The nominated individual had day to day management of the service from mid-December 2020 following the Registered Manager resignation.”
Strengths
· People were positive about the support they received from staff, describing them as 'amazing', 'brilliant' and 'very helpful'.
· Staff had received safeguarding training and could demonstrate understanding of safeguarding principles.
· Effective infection control measures were in place during the Covid-19 pandemic; the provider was selected as an example of good practice in Covid-19 management.
· Staff received PPE throughout the pandemic and people confirmed staff wore masks and gloves at all times.
· Professionals noted the service worked positively as an equal partner with the local authority and responsive health services.
Quality-Statement breakdown (8)
safe: Systems and processes to safeguard people from the risk of abuse and lessons learnt when things go wrongRequires improvement
safe: Using medicines safely and assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Engaging and involving people using the service, the public and staffRequires improvement
FirstCol Services Limited is rated Good overall, with four of five key questions rated Good and Responsive rated Requires Improvement due to absent end-of-life preferences for three people receiving palliative care and insufficiently personalised care plans following a records system migration. The service demonstrates strong safeguarding, medicines management, staff training, and a positive open culture, with an action plan in place to address care plan personalisation by November 2019.
Concerns (3)
moderateEnd-of-life care: “the service was providing end of life care to three people. Care records showed all three people, and/or their relatives had not been consulted about their preferences and they did not have advance care planning in place”
moderateCare planning: “they did not contain enough information about preferences and life history to provide an insight into them as an individual.”
moderatePerson-centred care: “Peoples history, their background, aspirations, goals, likes and dislikes were not always included. Examples of where this was included, lacked detail.”
Strengths
· Medicines managed safely by trained staff with updated auditing tool and PRN protocols in place
· Staff had a good understanding of safeguarding procedures and people felt safe
· Consistent staffing with punctual visits; people contacted promptly if delays occurred
· Staff received regular supervision, appraisals and spot checks to monitor care quality
· People were treated with dignity, respect and kindness; high satisfaction reported by people and relatives
Quality-Statement breakdown (24)
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood