First Choice Care Agency improved from Inadequate to Good overall following significant remediation of prior regulatory breaches in safety, staffing, consent, recruitment and governance, and was removed from Special Measures. Well-led remains Requires Improvement as new audit and governance systems, though implemented, require further time to become fully embedded and consistently applied.
Concerns (4)
moderateRecord keeping: “the provider's audits had not ensured a person's fluid balance and their urine presentation, was consistently recorded as per guidance in their care plan and risk assessment.”
minor
Governance
: “systems that monitored reviews of care plans and other care documents, had been consistently dated when completed.”
minorStaff training: “3 staff who were required to complete stoma and catheter care. The management team told us these staff were not required to provide this training.”
minorCommunication with families: “some staff felt further improvements were required such as an increase in face to face training and in some areas of communication.”
Strengths
· No missed calls; late calls were minimal and within agreed tolerance, with staff travel time added to rota.
· People received care from regular staff who knew their needs, routines and preferences well.
· Safe recruitment checks completed before staff commenced employment, including DBS checks.
· Medicines managed safely with care plans, risk assessments, medicine assessment documents, and monthly management review of MAR records.
· Staff received safeguarding training and were aware of their responsibilities; people told inspectors they felt safe.
Quality-Statement breakdown (16)
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
First Choice Care Agency Limited was rated Inadequate overall following a focused inspection in November 2022, with repeated breaches of regulations relating to safe care and treatment, staffing, fit and proper persons, consent, and governance identified across three consecutive inspections. The provider was placed in special measures due to persistent failures to sustain improvements, including unmitigated risks, late care calls, incomplete DBS checks, inadequate mental capacity assessments, and ineffective governance systems.
Concerns (12)
criticalCare planning: “Risks of supporting people to move using equipment were not always assessed and staff were not guided as to how to support them safely.”
criticalStaffing levels: “The schedule for people's care calls often overlapped. One person was scheduled a 45 minute care call at 8.30am, the same staff member was expected at another person's home at 8.45am.”
criticalStaff training: “Only 2 staff members had specific training in health conditions that people who were being supported had such as; catheter or stoma care.”
criticalConsent / capacity: “Where people were known to lack capacity to make certain decisions the provider had failed to assess their decision-making ability.”
criticalGovernance: “This is the third consecutive inspection where the provider has failed to meet the regulations. There have been repeated breaches in relation to safe care and treatment, good governance and staffing.”
criticalIncident learning: “The majority of the issues identified during the inspection were similar to issues we identified at the previous inspection. Quality assurance processes had failed to ensure that improvements made had been sustained.”
criticalSafeguarding: “Three staff had not been subject to Disclosure and Barring Service (DBS) checks prior to providing people's care.”
moderateMissed or late visits: “They are certainly not always on time by any means and they don't let me know if they're going to be late.”
moderateMedication management: “Medication care plans were not always detailed. People's preferred method of taking their medicine or confirmation of their level of compliance when taking their medicine was not recorded.”
moderateInfection control: “People and relatives told us face masks were not always worn by staff. One person told us '[Staff] come in with a mask but take it off.'”
moderateRecord keeping: “Care records contained information that was not always up to date. One person's care plan contained information about a pressure sore that was no longer correct.”
moderateCommunication with families: “The office is not good at communicating with client or staff.”
Strengths
· Staff members had a good understanding of how to safeguard people from abuse and records showed up-to-date safeguarding training.
· People told us they felt safe with carers.
· Newly recruited staff completed an induction, shadow shifts and were introduced to people using the service.
· Staff received supervision and were positive about support from the registered manager and care coordinator.
· The provider worked in partnership with GPs, district nurses and community health professionals.
Quality-Statement breakdown (17)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
First Choice Care Agency was rated Requires Improvement, having improved from Inadequate and exited Special Measures, but remained in breach of regulations 12, 17 and 18 covering safe care, governance and staffing. Key concerns included unsafe medicines management, insufficient staffing, incomplete care records and weak audit oversight, with a warning notice issued for governance failings.
Concerns (11)
criticalMedication management: “Medicines were not always managed safely. Medicines used to thin the blood, to prevent clots, were not always accompanied by a risk assessment”
criticalMedication management: “'As and when required' (PRN) protocols did not always contain enough detail. This put people at risk of receiving the wrong dose of medicines.”
criticalRecord keeping: “The provider failed to maintain accurate and complete care plans, risk assessments and daily records.”
criticalStaffing levels: “There were not always enough staff. Staff told us they worked multiple days in a row without a day off”
criticalGovernance: “The provider did not have robust systems in place to effectively monitor and improve the quality and safety of the service.”
moderateCare planning: “We saw a care plan for a person who required catheter care, which did not direct staff how to manage the person's catheter.”
moderateMissed or late visits: “The care is brilliant, but the timings is not brilliant, they are sometimes late.”
moderateInfection control: “The provider did not always ensure personal protective equipment (PPE) was being used effectively and safely by their staff.”
moderateLeadership: “The registered manager lacked oversight of the rota for care workers.”
moderateIncident learning: “Lessons had not always been learnt. Since the last inspection, there remained areas of improvement which had not been addressed such as PRN protocols”
minorCommunication with families: “The service did not have systems in place to formally ask for people's views on the service such as customer satisfaction surveys.”
Strengths
· Staff were recruited safely with DBS checks completed
· Care workers were up to date with their training
· People's capacity had been assessed in line with the Mental Capacity Act 2005
· Staff understood safeguarding and were confident to raise concerns
· Complaints recording processes had been improved
Quality-Statement breakdown (8)
safe: Using medicines safely; Assessing risk, safety monitoring and management; Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Promoting a positive culture; duty of candourNot rated
Geraint House was rated Inadequate overall and placed into special measures following a focused inspection that found breaches of Regulations 11, 12, 16, 17, 18 and 19 covering medicines, risk, capacity, complaints, staffing, recruitment and governance. Warning notices and Notices of Decision were issued in response to widespread shortfalls in care planning, infection control, call monitoring, audit oversight and leadership.
Concerns (22)
criticalCare planning: “one person had a catheter but there was no guidance for staff to follow to ensure they were supporting them safely and mitigating risks.”
criticalCare planning: “Another person's risk of developing skin damage was not identified in care plans and so staff did not have guidance to follow to ensure this was monitored.”
criticalMedication management: “People were at risk of not receiving medication as prescribed as there was no record of whether the medicine was given or refused. Medication administration records (MAR) also did not include the name or dose”
criticalMedication management: “it was not possible for the care workers to reliably know when the patch was to be removed and a new one applied.”
criticalInfection control: “The provider's infection prevention and control (IPC) policy had not been reviewed to include COVID-19.”
criticalMissed or late visits: “we saw evidence staff attended calls up to three hours earlier than the agreed time. This meant some people were supported in the morning as early as five o clock”
criticalMissed or late visits: “the impact of this for one person was that they are missing meals, as the morning call was so late...as a result, they would not eat lunch and have lost weight.”
criticalStaffing levels: “There was not sufficient staff who had been appropriately trained employed at the service, this put people at risk of harm.”
criticalStaff training: “Staff were not up to date with Basic Life Support (BLS) training. This put people at risk of harm should they require BLS care when they are being supported by care workers.”
criticalSafeguarding: “another safeguarding incident we and the provider had been notified of by a member of the public, was not recorded in the safeguarding log.”
criticalGovernance: “We requested audits but the provider failed to produce any completed audits during our inspection.”
criticalGovernance: “there was no record of staff testing... The provider did not have any system in place to monitor calls.”
criticalLeadership: “the provider, who is also the registered manager, refused to attend the service on day one of the inspection or to facilitate access to records on day one”
criticalRecord keeping: “Records reviewed were not always complete or legible. The provider did not have effective systems and processes in place to identify this”
criticalConsent / capacity: “one service user's records said they could not make any decisions, but their consent to care had not been assessed in line with the Mental Capacity Act (MCA) 2005.”
criticalComplaints handling: “Whilst complaints were recorded in a logbook, there was no action as a result of this, meaning lessons were unlikely to have been learnt.”
criticalOther: “we reviewed four people's staff files and there was appropraite references completed in just one staff file.”
moderateStaff competency: “The staff member completing the checks had not received training in medicines, according to the training matrix. This meant staff competency in medicines may not be accurately assessed.”
moderateInfection control: “One person told us their care worker was not wearing masks from "when things relaxed a bit this year".”
moderateIncident learning: “Lessons had not always been learnt when things went wrong. Complaints were not logged in an effective way.”
moderateSafeguarding: “One staff member was not aware what whistleblowing meant or what the whistleblowing policy and procedures was.”
moderateRecord keeping: “Records relating to former employees and the planning and delivery of care had not been stored securely and in line with legislation and guidance”
Strengths
· Feedback received from people and their relatives mostly reflected they felt safe being supported by the care workers
· One person said about their relative, 'Yes she is safe' and about the care worker, 'She is very friendly and very good'
· Disclosure and Barring Service (DBS) checks were made before staff began work
· Staff were mostly knowledgeable about safeguarding adults and told us how they would identify and respond to allegations of abuse
· Some care workers felt the manager was a good listener and a responsive leader
Quality-Statement breakdown (9)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongNot rated
safe: Staffing and recruitmentNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Continuous learning and improving careNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering