Fosse Healthcare - Derby

Fosse Healthcare - Derby is a domiciliary care service. It provides care for people living in their own houses and flats. People are supported in their own homes so that they can live as independently as possible. CQC regulates the personal care and support. There were 87 people who received personal care at the time of the inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Systems and processes were in place to help people receive safe care and be protected from abuse and harm. Staff were trained to administer medicines safely and checks were made to ensure people received their medicines as prescribed. Recruitment processes were in place and followed to ensure the provider was satisfied the staff they appointed to work in care were suitable. Staffing levels were monitored and staff rotas were planned to help ensure people received safe care. Risks were assessed and actions to reduce identified risks were followed by staff. Infection prevention and control practices were followed to help prevent infection transmission, including those from COVID-19.

People had their health and care needs assessed and care plans and risk assessments were kept under review. Staff completed regular training relevant to their job roles. New staff completed an induction programme, which included learning from more experienced staff. Where care staff helped people with their meals and drinks, their dietary preferences and choices were known and respected. Other health and social care professionals were involved in people’s care when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care that respected their privacy and promoted their dignity and independence. Care staff understood how to make people feel comfortable and took account of people’s different needs when providing care. People told us they thought the care staff were compassionate and kind. People were supported to be involved in their care and information on how to access advocacy services was available.

People’s decisions about their care were respected. Staff understood the importance of supporting people to have as much choice and control as possible in their lives. People received personalised care that was responsive to their needs and people’s relationships were valued and supported. Communication needs were assessed and understood. Complaints and feedback processes were available and followed should people wish to make a complaint or offer their feedback.

There was no registered manager at the time of our inspection, however the recently appointed manager had begun the process of registration. Audit and quality assurance processes were in place, however some of these required more time to fully embed improvements in the service. Policies were up to date and a range of oversight checks on the quality and safety of services were in place by the provider. People, relatives and staff were able to contribute their views to the development of the service and this supported a positive and open culture. The provider worked in partnership with others to help ensure good care outcomes for people using the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was ‘Requires improvement’ (published 15 December 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will work continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fosse Healthcare - Derby is a domiciliary care service. It provides care for people living in their own houses and flats. People are supported in their own homes so that they can live as independently as possible. CQC regulates the personal care and support. Not everyone who used the service received personal care. There were 104 people using this service at the time of our inspection, 82 of those people received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were not fully protected from the risks of abuse as the provider had not always recognised when incidents should have been referred to the local authority safeguarding team for assessment. Improvements had been made to some aspects of medicines management however, some risks remained. Some people had experienced improvements to the timeliness of their care calls; other people still experienced variations.

The provider had made progress on the action plan they had put in place to address the issues identified at our last inspection. However, some issues remained, and governance arrangements were still not fully effective at identifying shortfalls.

The provider completed recruitment checks on potential staff members before they were employed so as to help reduce risks to people from staff who were not suitable for the job role. Staff had sufficient information and training for them to understand and meet people’s care needs. The provider had taken action to protect people against the risk of infection. Staff had sufficient PPE and had been trained in what actions to take to reduce the risk of spreading infection.

Assessment processes were in place for people’s care needs. Staff received training and checks on their competency and understanding to provide the care people required. People were offered choices and supported with their meals and drinks when this was part of their care. Other health and social care professionals were involved in people’s care when needed, and records reflected their involvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider investigated and responded to concerns people raised and used these to help inform how to improve the service. People and their relatives were involved in reviewing their care and their views on the quality and safety of the service had been sought. The management team were viewed as approachable and supportive by care staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was Inadequate (published 25 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, some but not enough improvements had been made and the provider was still in breach of regulations.

Special Measures:

This service has been in Special Measures since our last inspection which was published 25 August 2021. During this inspection the provider demonstrated that improvements have been made so that the service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service on 21,22,23,24 and 28 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and Notification of other incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements. In addition, it contains our findings in relation to the Key Question of Effective which was rated as inadequate.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fosse Healthcare Derby on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fosse Healthcare - Derby is a domiciliary care service. It provides personal care support to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection, Fosse Healthcare – Derby was supporting 130 people with personal care.

People’s experience of using this service and what we found

People were not kept safe from harm and potential abuse. This was because incidents were not responded to appropriately. People had complex health conditions, and care plans did not provide enough guidance to staff on how to support people. Staff reported that their knowledge and skills came from learning through work, rather than having high quality training and induction.

Medicines were not safely managed, which put people at risk of harm. We were informed that staff were not completing regular COVID-19 tests, one staff member was unaware that these tests were available. Not testing staff routinely put people at risk of COVID-19 transmission. Care visits were late or not completed, which meant people did not have their needs met as agreed.

The care provided did not meet current national standards. Staff supported people to eat, but did not always record the amount that people ate to ensure they were not at risk of malnutrition. External professional advice was not always sought and recorded to ensure that care was given effectively.

People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests; and systems in the service did not support this practice.

People reported that staff were kind. However, the impact of late and missed calls did not create a caring ethos at the service. People felt that calls were often rushed. Professionals had reported that sometimes people did not receive thorough personal care. This poor quality personal care can be undignified.

People felt that complaints were not always responded to. Records showed that complaints were not always fully investigated to ensure improvements were made. At the time of the inspection no one was receiving end of life care. However, the poor practices we observed would mean that end of life care would not have been high quality.

The leadership at the service was not effective. Audits had not recognised that improvements were needed, and safeguarding allegations had not resulted in effective change. The service is expected to notify the Care Quality Commission of events that occur at the service, however we had not received these notifications as expected.

People were able to engage in social activities that were important to them. The service had alternative communication formats (like large written font), in case people needed this to understand information given to them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was Good (published 4 September 2018).

Why we inspected

The inspection was prompted due to concerns received. The local authority safeguarding team had informed us of allegations including neglect and poor quality care; including’ medicines, diabetes, skin and catheter care. The provider is legally required to notify us of allegations of abuse, but we had not been made notified of these allegations by the registered persons. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needed to make improvements and that people were at risk. Please see the full report for details of our concerns. We forwarded our concerns to the provider and they sent us an action plan, describing how they intend to make the required improvements. We will assess the effectiveness of this action plan at our next inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were breaches of regulation 12 (safe care and treatment), regulation 13 (safeguarding from abuse and improper treatment) and regulation 17 (governance.)

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We have received an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This is the second comprehensive inspection of the service. This inspection took place on 10 July, 17 July and 8 August 2018 and was announced. This was the first inspection of the service under its current registration. At the time of our inspection visit 100 people were using the service.

At our last inspection in May 2017 we rated the service overall as ‘Requires Improvement’. At this inspection the service had improved, we found evidence to support the rating of Good.

A registered manager is now 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 2008 and associated Regulations about how the service is run.

People were protected from the risk of harm. Staff had been trained in safeguarding people and understood how to assess, monitor and manage their safety. A range of risk assessments were completed and preventative action was taken to reduce the risk of harm to people.

People were supported with their medicines in a safe way. People’s nutritional needs were met and they were supported with their health care needs when required. The service worked with other organisations to ensure that people received coordinated care and support.

People were protected by safe recruitment procedures to help ensure staff were suitable to work in care services. There were enough staff to meet people's needs. Staff received training for their role and ongoing support and supervision to work effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider followed the principles of the Mental Capacity Act, 2005 (MCA) in planning and delivering people's support. People's consent was obtained before they were supported.

People were involved in their care as far as possible and care plans were regularly reviewed and updated as people’s needs changed. Staff were provided with clear guidance to follow in the care plan which included information about people’s preferences, daily routines and diverse cultural needs. Staff had a good understanding of people's needs and preferences and worked flexibly to ensure they were responsive.

People and their relatives were happy with staff who provided their personal care and had developed positive trusting relationships.

People, relatives and staff were encouraged to provide feedback about the service which was used to assess the quality of the service and to make any required improvements. The provider had a process in place which ensured people could raise any complaints or concerns and people felt comfortable to do this should they need to.

The registered manager and provider were aware of their legal responsibilities and provided leadership and supported staff and people who used the service. The registered manager and staff team were committed to the provider’s vision and values of providing good quality, person centred care.

The provider’s quality assurance system to monitor and assess the quality of the service was used effectively to improve the service. Lessons were learnt when things went wrong and improvements made to prevent it happening again. The provider worked in partnership with other agencies to meet people’s needs and people's health and well-being was continuously monitored at the service.

Fosse Healthcare - Derby provides personal care and treatment for adults living in their own homes. At the time of our inspection the service supported 50 people who lived within the city of Derby.

This was our first inspection of the service since they registered with us on 21 April 2016.

There is no registered manager in post. The manager is currently awaiting a disclosure and barring check, (DBS) check which will allow an application to register with CQC. At the point of publication this application had not been received.

The service does not have registered manager. The current manager is awaiting documentation before she can forward an application to be registered. This 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.

We received mixed comments about the quality and consistency of service people received. Some people told us they were pleased with the service and the manager and staff listened to them, wanted to hear their views, and kept them informed about the service. Others however told us about missed calls, changes of staff at short and sometimes no notice and changes of call times that impacted on the person receiving the service.

Medicines were now well managed following intervention by the new manager. There had been a number of occasions where people had not been given their medicine, or medicine was given but this had not been recorded on the appropriate charts.

Staff ensured most people had enough to eat and drink, with a small number that told us about early meals and lack of fluids between visits. Most staff took a flexible approach to the people they supported regularly by assisting them with additional household tasks. However there were a number of incidents reported to the staff at the office where people were unhappy with staff where they had left tasks incomplete. People and their relatives were aware how to make complaints about the quality of service they received. The service had received complaints and most had been addressed? Information about the complaint procedure was included in the information they received when the service began along with office and out of hours contact telephone numbers.

People and their relatives said the manager and staff were approachable and they were kept up-to-date with their family member’s progress and any changes or developments at the service.

The service provided safe care. Staff were trained in safeguarding (protecting people from abuse) and knew how to keep people safe. Information about safeguarding and whistleblowing was included in the staff handbook.

Staff provided people with the care and support they wanted and encouraged them and their relatives to be an active part of the care planning process. Staff had been trained to assist people to take their medicines safely and in the way they wanted them. People were treated with dignity and respect.

The area manager and manager carried out audits of all aspects of the service to drive improvement and to provide a well-led service. People’s and their relative’s views, were encouraged to add value to this process.