The inspection took place on the 12 October 2017 and was announced. The provider was given 48 hour’s notice because the location provides a domiciliary care service. We wanted to be sure that someone would be in to speak with us.

Firstcol Services Limited – Domiciliary Care is a domiciliary care agency providing personal care to a range of people living in their own homes. These included people living with dementia, older people, people with a physical disability and young children. At the time of our inspection, the service was supporting 78 People.

People remained protected from the risk of abuse because staff understood how to identify and report it. Staff had a firm understanding of how to keep people safe and there were appropriate arrangements in place to manage risks. One person told us “I feel very safe with the girls, they’re absolutely marvellous. I have regular girls and we’ve got to know each other really well”.

People remained supported to receive their medicines safely. The provider had arrangements in place for the administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff told us they had continued to receive training and updates and were confident to meet people’s needs. Staff were happy with the level of support they received and told us that communication from the registered manager was good. One member of staff said "The induction prepared me for my role and have on going training updates”. Staff had a good understanding of the responsibilities with regard to the Mental Capacity Act 2005 (MCA).

People remained supported at mealtimes to access food and drink of their choice. Some people’s food preparation at mealtimes was completed by relatives or by people themselves and staff ensured meals were accessible to people.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment when required.

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person told us “No complaints there at all. I’ve never had any issues with anything and no faults anywhere”.

People and relatives felt staff were kind and caring. Staff spoke warmly about the people they supported and provided care for. Staff were able to detail people's needs and how they gave assurance when providing care. One member of staff told us "We know that sometimes we are the only person our customers will see, so you have to make it a good experience for them”.

People, staff and relatives found the registered manager and provider approachable and professional. One person told us “I can always speak to the manager about anything that concerns me. She pops in every couple of months to check everything is going okay. She’s very approachable”. Staff comments included “She would do anything for you. I know. She is very kind.” Another said “I could go to her about anything, she will drop what’s she is doing to help you”.

Further information is in the detailed findings below:

We inspected Firstcol Services Limited - Domiciliary Care on the 17 November 2015 and it was an announced inspection. Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available. Firstcol Services Limited – Domiciliary Care is a domiciliary care agency providing personal care to a range of people living in their own homes. These included people living with dementia, older people, people with a physical disability, people with a learning disability, young children and people receiving end of life care. At the time of our inspection, the service was supporting up to 72 people and employed 20 members of staff.

A manager was in post but not yet registered with the Care Quality Commission. They had submitted their application and were awaiting their registered manager’s interview. 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 2008 and associated Regulations about how the service is run.

People, relatives and care workers spoke highly of the service. One person told us, “The service we get is excellent.” A relative told us, “We are very happy with the service we get. The office is very helpful and they will ring if the carers are going to be late because they have been held up with the previous call.”

People received safe care, however documentation such as risk assessments were not consistently robust. Risks to people’s safety were undertaken and risk assessments in place. However, risk assessments lacked sufficient guidance and information for care workers to provide safe care. Moving and handling risk assessments failed to include guidance on the sling size, whether the person could participate in the transfer and what may prevent a safe transfer. Medicine risk assessments were generic and not personalised to the individual. We have identified this as an area of practice that needs improvement.

Where restrictive practice was taking place, the provider was unable to demonstrate if the restriction was in line with legal requirements. Care workers provided care and support to young children and also attended households where children were present but had not received child protection training. We have identified this as an area of practice that needs improvement.

The ethos, values and visions of Firstcol Service Limited – Domiciliary Care was embedded into everyday care practice. The provider, manager and management team were committed to providing high quality care. A robust quality assurance system was in place and the provider encouraged people and care workers to feedback about how the service was run. The provider demonstrated a commitment to quality and was passionate about influencing the delivery of home care in the local area.

People were assured that care workers had been appropriately recruited as their employment procedures protected people by employing care workers that were suited to the job. There were sufficient numbers of care workers that had the skills they needed to provide people with safe care and support.

People confirmed care workers respected their privacy and dignity. One person told us, “The care I get is excellent. The staff are really caring and always think of me first. They treat me with real respect, not just doing it, it’s genuine.” Another person told us, “The care I get is excellent. They know exactly how to care for me and how to do it. They certainly treat me with respect which is nice.”

Staff had a firm understanding of respecting people within their own home and providing them with choice and control. The service had identified people’s needs and preferences in order to plan and deliver their care. People said the service met their needs and encouraged them to be as independent as possible. People were asked for their views of the service and said they knew how to make a complaint about the service if they needed to.

We spoke with three people who used the service of three relatives. They were all happy with the care provided by the agency. One person said, "I can't fault them." Another said about the staff, "They are very friendly and polite." They said the care workers usually arrived on time and stayed for the amount of time required. They were happy that they usually had the same carer workers who were familiar with their needs.

We saw that the agency had effective recruitment and selection processes in place. There was evidence that appropriate checks were undertaken before staff began work.

We looked at the care records of five people. We saw evidence that people's needs had been assessed and that care plans were in place. However care plans were not signed. Whilst the people we spoke with said they had agreed to the care provided there was no written evidence that people or their representatives had formally agreed with the plan of care..

We saw that all staff had completed medication training. We spoke with five members of staff who demonstrated a good understanding of their role in this area.

We found that people who used the service had been asked for their views about their care and treatment and that their comments were acted on. The provider had systems in place to monitor the quality of the service it provided.

We spoke with three people who used the service who told us that they were consulted about the care they were provided with. One person said, “They (care workers) always do what I ask them to do.” Another person said, “Before the carers leave they always ask me if I need anything else they can do for me.”

We looked at the care records of four people who used the service and found their needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We saw the training records of four care workers which showed that they were provided with training in safeguarding vulnerable adults from abuse. They were further provided with information regarding their roles and responsibilities in safeguarding and whistleblowing in the handbooks for all employees and for care workers.

We spoke with three people who used the service who told us that there had never been instances of missed calls. Two people told us that if care workers were running late they were always informed. People told us that they were provided with a regular group of care workers who were known to them.

We looked at the care records of four people who used the service. These told us that there were systems in place to further gain people’s views about the service provided. These included quality monitoring visits to people who used the service. The records showed that they were asked for their views about the service.

One person told us that their relative’s needs had been met by Firstcol Services Limited. They told us that they had been responsive to their relative’s needs and that they did not feel their relative could have been cared for better. They told us staff were attentive and caring and that the care delivered was never rushed.

Assessments and care plans were in place for each person the agency provided a service to. A relative confirmed they had been involved in the planning of their relatives care and that they had been kept informed of any changes in their relatives condition.

Feedback from a Trust that commissions with the agency was positive.

Staff told us they felt supported and had the training they needed to carry out their role.