Figtree Care Services Ltd

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.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Figtree Care Services Limited may receive regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of inspection, the service only supported people who required regulated activities. Approximately 25 people were receiving personal care in their own homes. The majority of 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 were receiving care to support them at the end of their life.

A registered manager was employed at the service. 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.

At our last inspection, on 24 and 25 August 2017, the service was rated ‘Requires improvement’. We found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to, the provider had not provided care that met people’s needs and preferences; systems had not been established to assess, monitor and improve quality effectively and accurate and contemporaneous records had not been kept. The registered manager sent an action plan dated 3 November 2017 stating they would meet the regulations by June 2018.

At this inspection, on 16 and 18 October 2018, the service continues to be rated ‘Requires improvement’. This is the third consecutive time the service has been rated Requires improvement. The provider and registered manager had made improvements in some areas. People’s care plans had improved, setting out their needs and preferences, the breach of regulation 9 was now met. However, we found that accurate recording continued to be an issue. Although some small improvements had been made to quality monitoring, these were not robust enough to identify and sustain improvements. Records had not been maintained to ensure people always received the care and support they needed; Records showed some people had received shortened and late care visits by staff.

We found further areas of concern that needed to be improved. Safe recruitment practices were not followed; the policy for medicines administration was not clear to ensure people’s safety; staff did not always receive the training required to meet people’s needs.

People and their relatives were asked their views through a questionnaire survey. The results were not analysed to provide an opportunity for the provider and registered manager to make improvements following the feedback. We have made a recommendation about this.

The provider had commenced management meetings where they met with the registered manager every three months to keep up to date. The meetings did not show a clear oversight and direction of the provider in order to provide continuous improvement. This is an area identified as needing improvement by the provider.

Individual risks were identified to ensure measures were put in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to keep people and staff safe from identified hazards.

A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew who they would talk to if they did not. Not all staff had received safeguarding vulnerable adults training.

Accidents and incidents were reported and recorded appropriately. The registered manager monitored incidents. Staff followed safe practice to control the risk of infection and had enough equipment such as disposable gloves and aprons available to wear.

The registered manager responded to formal complaints made as directed by the provider's policy. Informal and verbal complaints were recorded on a complaints log with the action taken.

Staff were supervised by the registered manager or a coordinator to check their competency and offer support.

People told us they made their own decisions and choices. The registered manager understood the basic principles of the Mental Capacity Act 2005 and made sure their processes upheld people’s rights.

Although many people did not require the assistance of staff with their nutrition and hydration needs, some people did require this support. People and their relatives told us they were happy with the support given by staff and it worked well.

Many people did not require the assistance of staff to look after their health care needs as they either managed this themselves or had a relative or friend to help. Where support was required, people and their relatives told us staff were observant and offered advice or to make appointments with healthcare professionals.

The positive and caring approach of staff was clear from the responses of people and their relatives, telling us how happy they were with the staff who supported them. People were given a service user guide at the commencement of their care and support with the information they would need about the service they should expect.

An initial assessment was undertaken of people’s personal care needs so the registered manager could be sure they had the staff resources with the appropriate skills available to support people. People had a care plan to detail the individual support they required as guidance for staff.

We received good feedback from people and their relatives about the caring attitude of the registered manager and staff.

During this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report. Full information about the Care Quality Commission's regulatory response will be added to the report after any representations and appeals have been concluded.

There was not a registered manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 registered manager had left the service since our last inspection and a new manager had been appointed. The acting manager was going through the processes to become registered with the CQC.

We previously inspected this service on 7 and 8 July 2016 when we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. The breaches of the regulations related to safe recruitments practices, assessing risk, care plans did not set out the needs of people, records were poorly written and no effective auditing systems were in place. We found on this inspection that improvements had been made but there were still areas where the service was in breach of regulations.

The provider had systems in place to identify individual risks to people. However, formal environmental risk assessments had not been completed. We have made a recommendation about this in our report.

People were protected from abuse by trained staff who understood how to recognise the signs of abuse and how they should report it. Staff received training that gave them the confidence and knowledge to provide effective care.

The provider had safe recruitment practices in place. All staff had a safety check to ensure they were safe to work with vulnerable adults. All staff received regular supervisions and yearly appraisals. The acting manager was carrying out spot checks of staff performance to ensure they were working in line with the provider's policy and procedures. There were enough staff to provide care and support for the people. However, we found that there were some occasions when staff were late to calls and people had not been informed. We have made a recommendation about this in our report.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Mental capacity assessments were being carried out and these were decision specific. Staff and the manager demonstrated good knowledge of the Mental Capacity Act 2005.

People were supported to have a healthy and nutritious diet. Staff would support people when needed. People and relatives told us they were given choice over what meals they would have.

People and relatives we spoke to spoke positively about the staff and the care they received. Staff were seen to be communicating to people in a kind and caring way. Staff protected people’s dignity and encouraged independence. Staff demonstrated good knowledge of people and the care they required.

Care plans were detailed and identified each person’s needs. However, reviews were inconsistent and were not being reviewed in a timely manner following changes of people’s needs. Care plans identified people’s preferred likes and dislikes when receiving personal care and staff were aware of these. Staff ensured that people were given choice over their care.

People, relatives and staff told us that the acting manager was having a positive impact on the service. The acting manager had identified that the current auditing systems required improvements but new methods had not been embedded within the service. People’s records were not being consistently updated when required.

We found breaches in the regulations and you can see what action we took at the end of this report.

Figtree Care Services Limited provides personal care and support to people who are living in their own home. At the time of the inspection the service was providing support to 15 people, in the Dartford area. The service is able to provide a range of visits to people, from one visit a day, up to several visits per day. Support is primarily given to older people who are receiving continuing health care. The support provided aims to enable people to live as comfortably as possible.

The registered manager had recently left in June 2016. 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 and associated Regulations about how the service is run. A new manager had been employed, but had worked at the agency for less than two weeks when we inspected. The manager said she was in the process of completing an application to become the registered manager.

The service had recruitment practices in place. However, improvement was needed for example, checking validity of references, checking any gaps in employment history, ensuring return of DBS check and providing all staff with a contract of employment.

The manager had started to implement individual risk assessments for each person and the environment in which they lived on the second day of our visit, but further improvement was needed. Care was planned and agreed between the staff and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

Management involved people in planning their care by assessing their needs on their first visit to the person, and then by asking people if they were happy with the care they received. There was an emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. However, no care plan records were seen on the first day of the inspection visit and the manager on the second day of the inspection had started to address this issue. The service was flexible and responded positively to changes in people’s needs. People were able to express their opinions and views and they were encouraged and supported to have their voices heard.

The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in relation to the whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the manager, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.

Staff were trained in the Mental Capacity Act 2005. Staff understood the processes to follow and knew who to contact, if they felt a person’s normal freedoms and rights were being significantly restricted.

All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding people and infection control. They worked alongside experienced staff and had their competency assessed by the manager. Refresher training was provided at regular intervals. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

People were supported with meal planning, preparation and eating and drinking. People had positive relationships with staff who knew them well. There were enough staff available to meet people’s needs Staff supported people, by contacting the office to alert management, to any identified health needs so that their doctor or nurse could be informed.

The manager told us that currently staff did not assist people with the taking of medicines.

People said that they knew they could contact the management at any time, and they felt confident about raising any concerns or other issues. The manager carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the manager and an opportunity to share any concerns.

The service had processes in place to monitor the delivery of the service. As well as talking to the manager at spot checks, people could phone the office at any time, or speak to the person on duty for out of hours calls. People’s views were obtained through meetings with the person and meetings with families of people who used the service. The provider checked how well people felt the service was meeting their needs, by carrying out a yearly survey.

Incidents and accidents were recorded and checked by the provider or manager to see what steps could be taken to prevent these happening again. Risks were assessed and the steps taken to minimise them were understood by staff. However, the records in place to manage risks needed improvement, both for the person and the environment in which they lived.

The manager ensured that they had planned for foreseeable emergencies, so that should they happen, people’s care needs would continue to be met.

Quality assurance systems were not effective in recognising shortfalls in the service. Action had not been taken and recorded to make sure people received a quality service. The manager had however, on starting at the service had a quality assurance and service review undertaken, and was addressing firstly issues that required urgent action.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.