First Choice Home Care (Norwich)

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained the same. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. Risks associated with peoples care needs were not always assessed or guidance provided to staff to reduce the risk of harm. Peoples care plans did not contain sufficient information to support safe practice. Where incidents had happened, there was a lack of management oversight to ensure lessons were learnt and improvements made. The provider was in breach of the legal regulation relating to safe care and treatment. The provider was previously in breach of the legal regulation in relation to safe staffing levels. Improvements to staffing levels were found at this assessment and the provider was no longer in breach of this regulation.

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. Care was not always delivered in line with best practice guidelines. For people living with a learning disability, the service had not followed the principles of Right Support, Right Care, Right Culture. Internal relationships amongst staff and managers were poor, and staff felt the high turnover of managers had impacted communication within the team. People’s health conditions were not monitored effectively to ensure peoples experienced good outcomes. There was a poor understanding of the principles of the Mental Capacity Act, with assessments not being time or decision specific.

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect. People told us that generally care staff were kind, respectful and treated them with compassion. However, they felt the management team were not as approachable or supportive. Several people said it was hard to get in touch with the office when they had concerns. Where they had raised concerns, people told us they did not always hear back in a timely way. We found evidence that call times were often delayed or changed without being communicated to people, and people told us this made it difficult for them to make plans or feel in control of their day.

Responsive – this means we looked for evidence that the provider met people’s needs. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained as requires improvement. This meant people’s needs were not always met. People were at risk of not receiving appropriate support due to the lack of an effective care planning system. Not all care plans contained sufficient information to guide staff to be able to meet people’s needs. Where people were living with complex physical or mental health conditions, there was a lack of individualised information relating to these conditions. We saw people were supported by large teams of staff, and without thorough guidance in place, this increased the risk of people receiving a poor standard of care.

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. Quality assurance systems had failed to identify the areas of concern we highlighted during our assessment. Audits had not been effective at driving improvements. Oversight and monitoring of risks was not always effective, and action taken to mitigate risk was not done in a timely way. People did not feel the service was well-led, and staff did not feel supported. People were not supported by a provider who prioritised people’s safety and wellbeing. The provider was in breach of the legal regulation relating to good governance.