About the service:

¿ Firstpoint Homecare Limited is a community based care provider that provides personal care and support to people in their own homes. At the time of our inspection there were 164 people receiving personal care.

People’s experience of using this service:

¿ People were not always protected from the risk of harm. Conflicting, out of date and unclear risk assessments placed people at risk of receiving unsafe or inappropriate care as staff did not always have sufficient guidance to follow. Medication records were not filled out correctly and therefore we could not be assured that people had received their medication as prescribed. Systems in place to monitor call times were not effective and people did not consistently receive their calls at the times needed and on occasions did not receive a call at all. There were insufficient staffing levels at weekends which impacted on the quality and safety of the service. Care staff did not consistenly follow good infection control practices and this placed people at risk of cross infection. The provider had a recruitment process to ensure the appropriate checks were carried out when recruiting staff.

¿ People’s needs were not always accurately reflected in their care plans. Staff did not always receive the appropriate training they needed to meet people’s individual health needs. People did not always receive their food and drink at the correct times as calls were not always on time. People were not always supported by regular staff, care was inconsistent. The provider did not always work within the principles of the Mental Capacity Act 2005. People’s religious and cultural beliefs were respected. People told us that their regular carers knew them and how to support them.

¿ The provider’s systems did not always support the service to be caring as people were unsatisfied with the management of their call times and how their concerns were managed. Some people told us care staff were kind and caring whilst others’ views were not so positive. People’s dignity was not always respected. Staff promoted independence.

¿ People and their relatives told us they did not feel the provider listened to their complaints or concerns. Care records were not updated to reflect people’s current support needs. They were not always accurate and lacked sufficient detail to determine what peoples’ specific needs were. We found the provider’s systems did not always support the service to be fully responsive as people did not always receive their care calls at their preferred time and/or experienced missed calls.

¿ The provider did not have effective governance or audting systems in place to ensure that people received safe care and treatment. Governance and oversight systems had failed to ensure risk assessments provided sufficient guidance to staff to ensure people received safe care. There was no robust system in place to ensure risk was appropriately managed. The provider did not have sufficient oversight of training to ensure care staff had specialist training to support people’s individual needs. The provider’s infection control systems were not effective and meant people were being put at avoidable risk of cross infection. The provider’s call monitoring system was not effective in ensuring people received their calls at the time they required them. The provider did not have an effective system in place to monitor missed calls. The provider’s scheduling system did not give care staff enough travel time in order to arrive at service users calls at the scheduled times. The providers on-call system was not effective. There was a lack of oversight of safeguarding concerns. There was no registered manager in post as required by law.

Rating at last inspection:

¿ Rated requires improvement overall (report published 16/05/2018). For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected:

¿ This was a planned

Firstpoint Homecare Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults, younger adults and children. It operates across Solihull, West Midlands. There were 173 people using the service at the time of this inspection.

We visited the offices of Firstpoint Homecare Ltd on 8 March 2018. This was the first inspection of the service since registering with the Care Quality Commission in August 2017. We gave the registered manager 48 hours' notice of the inspection visit because we wanted to make sure someone was available in the office to meet with us.

Prior to our inspection we received information of concern in relation to the service. These related to people not feeling safe because they received care and support from care workers they did not know. Some people’s medicines had not been administered by care workers when they needed them and people were dissatisfied because their care workers arrived later than they expected them. Also, some people’s key safe numbers had been accidently shared with a person’s relative which was unsafe.

The service is required to have a registered manager in post. 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 and associated Regulations about how the service is run. A registered manager was in post.

Prior to our visit the service had been through a period of instability caused by staff changes and some staff not working in line with the provider’s procedures. Some of the governance systems in place to assess, monitor and improve the service had not been effective. Improvement actions plans were in place to monitor and drive improvements. People and staff told us stability was returning to the service and we saw a number of improvements had been made in a short period of time. The changes needed to be embedded and sustained over a longer period.

People felt safe with their regular care workers because they trusted them. However, when their regular care workers were off work some people continued to feel unsafe. Action was being taken to address this.

Some people had been dissatisfied with the service they had received because communication between then and the service had been poor. Action had been taken to improve this and people had noticed improvements in the two weeks prior to our visit.

Some people had not received their medicines when required. We saw improvements had been made in this area and only trained competent care workers supported people to take their medicines.

Staff felt listened to and supported by their managers. Procedures were in place to protect people from harm. All staff had received safeguarding training and understood their responsibilities to keep people safe. Staff were confident to raise any concerns with their managers. A system was in place to record accidents and incidents and to reduce any reoccurrence.

The provider’s recruitment procedures minimised, as far as possible, the risks to people safety. Enough staff were employed but the deployment of staff required improvement because care workers often arrived later than people expected them and their arrival times were unpredictable. Action was being taken to address this.

Risk assessments were in place to identify potential risks to people's health and wellbeing. However, some lacked information to inform staff how to manage risks. Despite this care workers assured us they knew how to manage risk safely.

People had confidence in the skills and knowledge of their regular care workers to provide the care and support they required. New staff members were provided with effective support when they first started work at Firstpoint Homecare. Care workers provided positive feedback about their training. A pr