Fosse Healthcare - Nottingham

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

People and those important to them knew how to raise concerns when they did not feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. Safety risks to people were managed well. Managers assessed and reviewed safety risks to people and made sure people and those important to them, were involved in making decisions about how they wished to be supported to stay safe. There were enough suitably skilled and experienced staff to support people with their needs. New staff had an experienced staff member as a buddy to support their learning as part of their induction. Staff received relevant training to meet the range of people’s needs at the service. Staff received support through supervision to support their continuous learning and improve their working practice.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were unable to explain how the learning culture effected their experience. However, due to effective processes and good staff knowledge, we assessed that people had a positive experience. People felt able to speak up if they had a concern. They also felt that managers and staff would work with them to make improvements to people’s care if needed. One person said, “‘I can’t criticise them in any way, they’re really good; if you ask them to do anything they’ll do it.”

Staff told us that they had regular reflective supervision sessions and team meeting discussions to review what was working well, and what could be improved at the service. Staff gave examples of how the staff team had learnt from incidents. For example, one staff member said, “Learning was shared for improvement and consistency; staff could also feedback to management.” Learning when things go wrong supports to reduce the chance of the same thing happening again.

There were clear processes to review incidents and then make improvements. Staff were provided with the opportunity to reflect after incidents, to ensure learning and improvement could occur. Staff meetings allowed staff to reflect on what was working well, and what could be improved at the service. There was a clear policy on the duty of candour. This policy guided staff to tell the person (or, where appropriate their advocate) when something had gone wrong. We reviewed complaints that had been made and saw they had been investigated and responded to and their policy had been followed.

People told us that communication between the care team and other health providers was good and that if there were concerns regarding health staff would contact family on the persons behalf or the GP, emergency services or another relevant healthcare professional. One person told us about care staff arriving when they weren’t well. They said, “They [care staff] went into ‘looking after me mode’, they called an ambulance, phoned the office and my son and daughter, and they stayed with me until I went into hospital.”

Staff knew how to monitor people’s health conditions, to ensure timely referrals were made to other services. For example, when concerns had been identified about a person’s catheter care, the district nurse was contacted to follow up. The management team ensured people experienced continuity of care, such as after a person has been into hospital. The registered manager told us, “If a person is coming home the care coordinator one of management will do a visit to make sure everything is ok. If it’s been more than 2 weeks, we will re-assess the persons care needs. We also maintain interaction with hospital staff to check what’s going on.”

Partners told us the provider worked in collaboration with them, so services worked seamlessly for people. One partner working with the service said, “Updates and information passed back and forth between Fosse and myself are clear evidence of a working partnership/collaboration which in turn, allows required adjustments to be made to care packages leading to a joined up, seamless service.”

Staff kept clear summary documentation on people’s holistic needs. If the person required a hospital admission, this information could be shared with medical professionals to provide an up-to-date information about the person. Where people required external health and social care support, documentation showed that suitable referrals had been made. For example, we reviewed emails to social workers which evidenced this.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt the environment was managed safely. People told us that staff kept their environment safe and tidy. One person said, “They clear up after themselves and turn off switches.”

Staff knew how to monitor the safety of the environment, and where to report any concerns to. Staff were able to give examples of how they ensured they supported people to maintain a safe environment which included following risk assessments. One staff member said, “I will check for trip hazards, we have equipment check procedures, I make sure I am scrambling key-safe numbers, locking doors, and using lights for personal safety when it is dark.”

The environment, inside and outside, was assessed by one of the management team when people started care, and staff carried out ongoing observations and reported any concerns regarding the environment to the management team. We saw examples of where the registered manager had engaged the fire service to support people with safety in the home for example, for people who smoked.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people and relatives told us staff gave their medicine at regular times, and as their prescription required. One person who had time-critical medicine told us they had some concerns about medicines, “Staff have to come at specific times, they’re usually on time, although sometimes the last call can be late”. One person spoken with said, “Meds are given by them (staff) only, on every call; it’s all ok, no problems with it.” Another relative told us about support their loved one received with applying creams, “They’re very gentle with it.”

Staff were able to explain how they supported people to take their medicines safely, actions they took and the systems they used for recording when they had given medicines. One staff member said, “We use eMAR (electronic medicines administration record); and I will order medicines if need be and collect them from the pharmacy. We will liaise with GPs and district nurses as needed. Each person’s home has a folder with contact information for the doctor, district nurse and the pharmacy the person uses.” Staff knew who to report medicine concerns too. For example, if they felt a person’s medicine was no longer effective, they understood where to document this, which health professionals to contact and the importance of reporting concerns to the management team.

Staff kept clear records of when they had given prescribed medicines. We saw medicines were given as prescribed and prescribed creams had clear guidance for staff and application was shown on a body-map to ensure people had creams applied appropriately. Some people required ‘as needed’ medicine and staff had clear written guidance on how this should be administered. For example, one person required paracetamol if they were in pain. Staff had clear guidance on what symptoms the person would show, how much dosage should be offered and how often this medicine could be taken. Staff had received training on how to administer medicines safely. The management team had regularly assessed the staff’s competency, to ensure they were following best practice.