Figtree Care Services Ltd

Updated 18 January 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We reviewed the information we held about the service including previous inspection reports. We also looked at notifications about important events that had taken place in the service, which the provider is required to tell us about by law.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with five people who used the service and five relatives about their experience of the care provided. We spoke with three members of staff including the registered manager.

We reviewed a range of records. This included four people’s care records and three medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, staff rotas and staff supervision and observational checks.

Updated 18 January 2020

About the service

Figtree Care services Ltd is a domiciliary care agency providing personal 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. Approximately 21 people were receiving personal care in their own homes at the time of inspection. Most people receiving care and support needed two staff to provide their care at each visit. People had varying needs, some had physical difficulties with their mobility, some had received treatment in hospital for serious health conditions and others had long term health conditions.

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

The service people received was not always safe. The administration of people’s medicines was safer, however, staff did not always keep accurate records, for those who needed staff assistance to take their medicines. Individual risk assessments were in place but plans to manage the risk and prevent harm were not always recorded. Staff recruitment continued to need further improvement to make sure only suitable staff were employed to provide people’s care.

Staff now had opportunities to increase their skills and confidence through better training, improving the care people received, however, some induction and refresher training was not carried out in a timely way.

Although the provider had made improvements to their monitoring processes, these required more development to make sure people received a service that was safe, of good quality and could be continued. The provider had carried out a satisfaction survey with people and had analysed the results. However, they had not shared this with people and their relatives.

Other elements of care had improved. People told us they felt safe with staff and were confident in their care. People said they felt there were enough staff as their care was rarely cancelled and staff stayed the full length of time when visiting. However, staff sometimes recorded shorter visits than had been agreed. We have made a recommendation about this.

Accidents and incidents were recorded by staff, but a mechanism was not in place to learn lessons from incidents, so improvements could be made to people’s care. People said they felt safe in the with staff and they were clear who they could go to if they had any concerns.

Assessments were carried out with people before they started to use the service to make sure their needs could be met. People were supported to access healthcare advice and given assistance with their nutrition and hydration when this was needed. People and their relatives told us they were involved in and directed their care, making their own choices and decisions.

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 and their relatives were positive about the staff supporting them, saying staff respected them and describing them as caring and kind.

Care plans provided better information and were updated when people’s needs changed. People had the information they needed to make a complaint if they needed to, However, the provider and registered manager did not always follow their procedures by keeping complainants fully informed of the progress and outcome of their complaint. We have made a recommendation about this. People’s end of life care plans needed to be developed further to make sure people’s wishes were recorded for staff to follow.

We received only positive comments about the staff, the registered manager and the office staff from people and their relatives, which was an improvement on the feedback received at the last inspection. People thought the service was well managed.

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 19 December 2018) and there were four breaches of regulation. The service remains rated requires improvement. Although improved, this service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified two breaches in relation to medicines administration records, quality and safety monitoring processes and safe staff recruitment, at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.