First Homecare - North London

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first inspection for this service. This key question has been rated requires improvement. 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.

The service was in breach of legal regulation in relation to safe care and treatment and safe administration of medicines.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service mainly had a proactive and positive culture of safety, based on openness and honesty. There were processes in place for the reporting of any accidents and incidents and the registered manager was aware of procedures to follow. There had only been 1 incident, and it had been reported and followed up appropriately with an action plan for staff to follow. However, information from the action plan had not been updated into the person’s care plan or risk assessment after the incident. The registered manager acknowledged this and said they would update this immediately.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety and there was not a proactive approach where necessary referrals could have been made. People’s care records were not always reflective of their current care and support needs. For example, a person’s care plan lacked sufficient detail about the support they required with their mobility and during mealtimes. This meant care records were not always accurate and increased the risk of healthcare partners not having access to updated information, such as visiting professionals or emergency services, when required. However, due to the nature of the care package the provider had regular communication with the person’s relatives and the service made sure there was continuity of care. A relative confirmed this and praised the service for their ability to provide staff that understood their family member’s needs so well.

The service worked with people and their relatives to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Although there had been no safeguarding investigations at the service, there were systems in place and the management team and care staff had a good understanding of their responsibilities. Staff completed safeguarding training and were confident the registered manager would respond immediately to any concerns they raised. A staff member added, “We are aware of the procedures and discuss this during supervision and training. The manager is very open, and we understand that safeguarding covers all of us so I would have no problem speaking up if I needed to.”

Although the provider worked with people and their relatives to understand and manage risks, the service did not always plan or record care to meet people’s needs safely. Risk assessments related to people’s health and safety had not been fully completed and lacked sufficient detail and guidance for staff to follow to help keep them safe. This included risks related to moving and handling, falls and support when in the local community. The registered manager acknowledged this and said they would look to review and update their care records and risk assessments accordingly. Despite this, care staff had a good understanding of people’s risks and explained how they supported the person during care tasks to keep them safe. A relative also confirmed this and told us staff had an excellent understanding of their family member’s needs which gave them a high level of reassurance.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider completed an environmental assessment within people’s homes during the initial assessment to check if it was safe for staff to carry out the necessary tasks. A relative said, “They checked every room to make sure it was safe and there were no concerns. It was very thorough.” Staff confirmed additional safety checks were carried out regarding the home environment during regular spot checks.

The provider did not always ensure safer recruitment procedures were being followed to ensure staff were suitable to work with people who used the service. Parts of the provider’s recruitment processes required improvement to ensure they obtained a full employment history and recorded any gaps in employment. The registered manager acknowledged this and took immediate action to address this for the current staff members. They sent evidence of this within 48 hours and confirmed they would update their recruitment processes going forward. However, the provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and were aware of the procedures to follow if any concerns had to be shared. The provider carried out infection control audits and observed staff followed best practice during regular home visits. This also included checks that staff wore the appropriate personal protective equipment (PPE). Staff confirmed this and said they had no issues or concerns with this support. A staff member added, “They provide everything for us, all the PPE and hand sanitiser. We give them a call if we are running low and they deliver it to us directly."

The provider did not always make sure that medicines were safe and met people’s needs, capacities and preferences. Although staff involved people and their relatives in planning, records were not kept in line with best practice guidance. For example, care records were not always updated with important information about people’s medicines and protocols were not in place for ‘as required’ medicines. Although staff had received training to administer people’s medicines and had a good understanding of their responsibilities, the provider had not undertaken formal competency assessments or signed them off as competent before providing individual support. This meant there was an increased risk of harm to people and the provider was not following their own policies and procedures. We shared The National Institute for Health and Care Excellence (NICE) guidelines for managing medicines in the community with the provider during the inspection to ensure they were aware of best practice.