Forest Homecare Suffolk

About the service

Forest Homecare Suffolk is a domiciliary care agency providing care to people 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 there were 39 people receiving personal care and support from the service.

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

The provider could not demonstrate how the service met the principles of right support, right care, right culture. This meant we could not be assured of the involvement of people who used the service in their care and support. Initially the provider told us they did not support any people who lacked capacity, had a learning disability or who were autistic. However, we identified that there were people being supported by the provider who had a learning disability.

Right Support

We found guidance within people’s care plans for staff members to follow when supporting autistic people or people with a learning disability were not sufficient. Care plans and risk assessments did not provide staff with information on how to promote their independence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff training in record keeping needed to be improved in relation of the use of the Mental Capacity Act 2005 (MCA).

The service did not plan for any staff travel time between care calls and care calls were frequently shortened to enable staff to be on time for the following person’s care.

Right Care

People's care and support plans did not always reflect their range of needs or promote their wellbeing and independence. This meant they did not provide detail on the specific actions staff should take to ensure practices were least restrictive to the person and reflective of a person's best interests.

Right Culture

People were not empowered to influence the care and support they received.

The provider did not have adequate knowledge of the ‘Right Support, Right Care, Right Culture’ guidance. In addition, in July 2022 the Health and Care Act 2022 introduced a requirement that regulated service providers ensure their staff receive training on learning disability and autism which is appropriate to the person’s role. The Oliver McGowan Mandatory Training on Learning Disability and Autism is the standardised training that was developed for this purpose and is the government's preferred and recommended training for health and social care staff to undertake.¿The provider had not heard about this training and staff working for Forest Homecare Suffolk had not undertaken it.

Quality and safety monitoring systems were not robust. There was a lack of governance processes and systems to help ensure the safe running of the service. This meant the provider could not be proactive in identifying issues and concerns in a timely way.

The provider was not able to demonstrate how they would meet the underpinning principles of Right Support, Right Care, Right Culture’. We signposted the provider to relevant information.

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 8 August 2019).

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

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

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We also received concerns in relation to the management of medicines and the leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Forest Homecare Suffolk is a domiciliary care agency providing care to people 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 there were 60 people receiving personal care and support from the service.

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

People told us they felt safe and they were supported by reliable, regular staff who arrived to support them at the agreed time. Staff had an understanding of safeguarding and identified potential abuse, so this could be investigated and acted on by the management of the service.

Each person had a risk assessment which explained the risk to their health in detail and how staff were to assist them to keep safe. When medicines were prescribed the person had a medicines administration record, where staff recorded when the person had taken their medicine.

People were asked for their views about and were involved in the planning of their care. People’s care records were individualised and contained sufficient information about their past history and preferences for staff to provide them with person centred care.

Staff received appropriate support and training for their role. There were opportunities for staff to further develop their skills, knowledge and progress into roles with more responsibility. Each member of staff had a yearly appraisal to discuss their work and plan their career.

Where required, people received appropriate support to maintain good hydration and nutrition.

The service worked well with other agencies such as dieticians, district nurses and doctors to ensure people’s needs were met. People were supported to make and attend appointments with healthcare professionals where this was part of their agreed care plan.

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 told us staff were kind, understanding and caring towards them. They told us staff treated them with respect and dignity and they were cared for with regard to their preferences.

The service had a complaints policy and procedure which was provided to people when they commenced using the service.

There was a robust quality assurance system in place capable of identifying areas for development and improvement. People were given an opportunity to feedback their views on the service and their comments were acted on. The service had a senior staff on-call service system in operation which people using the service and staff could call upon at anytime for assistance.

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

Rating at last inspection:

At our last inspection of 14 November 2016, the service was rated Good. The report was published on 13 December 2016.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will 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.

The service has 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 2008 and associated Regulations about how the service is run.

The provider was given 48 hours’ notice of our visit. This was to ensure documentation and people we needed to talk to were accessible on the day of our inspection.

People were complimentary about the service they received from Forest Homecare. People’s needs were assessed and appropriate information was given to people before the service commenced.

Staff had good knowledge of safeguarding procedures and were clear about the actions they would take to help protect people. Where safeguarding concerns had been identified the service had made the appropriate referrals and was open and transparent. There were processes in place to identify and manage risk so that staff had the information needed to provide safe care and support. Also places where we say ‘people said’ or ‘staff felt’ that is evidence too.

Systems were in place to assist people with the management of their medication and to help ensure people received their medication as prescribed. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. Staff were well supported to carry out their work and had received regular support and training.

There were sufficient numbers of staff, with the right competencies, skills and experience available to help meet the needs of the people who used the service.

Where needed people were supported to eat and drink sufficient amounts to help meet their nutritional needs and staff knew who to speak with if they had any concerns around people’s nutrition. People were supported by staff to maintain good healthcare and were assisted to gain access to healthcare providers where possible.

People had agreed to their care and been asked how they would like this provided. People were treated with dignity and respect and that staff provided their care in a kind and caring manner.

The registered manager had a good understanding of Mental Capacity Act 2005 and who to approach if they had any concerns and the appropriate government body if people were not able to make decisions for themselves.

People knew who to raise complaints or concerns to. The service had a clear complaints procedure in place and people had been provided with this information as part of the assessment process. This included information on the process and also any timespan for response. We saw that complaints had been appropriately investigated and recorded.

The service had an effective quality assurance system and had regular contact with people who used the service. People felt listened to and that their views and opinions had been sought. The quality assurance system was effective and improvements had been made as a result of learning from people’s views and opinions.