Fen Homecare

Updated 6 September 2022

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 Health and Social Care Act 2008.

Inspection team

This 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.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was not a registered manager in post. There was a manager currently in post who was in the process of applying to the CQC to become registered.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 23 June 2022 and ended on 25 July 2022. We visited the location’s office on 23 June 2022.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority, Healthwatch England and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people and five of the relatives to seek their views about the care. We spoke with five professionals who are involved with the service. We spoke to seven staff members including the manager, office staff and support staff. We reviewed four people’s care records and six staff files. We also reviewed various quality assurance documents and policies.

After the inspection

We continued to clarify information and request further documentation from the manager. We worked with other agencies and professionals to assess the risks to people in relation to recruitment and rota management. CQC continue to work with other agencies in regard to these concerns to ensure people are safe.

Updated 6 September 2022

About the service

Fen Homecare is a domiciliary care agency providing personal care to people in their own homes. The service provides support to people living with dementia as well as other physical and mental health needs.

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 our inspection there were 70 people using the service who received the regulated activity of personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not support anyone with a learning disability or an autistic person. The manager was still reviewing with the provider if they intended to continue or to remove the group ‘learning disabilities’ and ‘autism’ from their registration. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is currently registered as a specialist service for this population group.

Right Support:

People’s rights to choose were not always upheld and people were supported by staff who had not received training about consent or understood how to promote choice and 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.

One person’s right to choose to self-administer medicines was not supported. People’s mental capacity had been assumed instead of exploring if the issue was a language barrier rather than comprehension.

People were supported by staff who were working unsafe shift patterns and long hours. Rotas were not managed in ways that meant sufficient numbers of staff to ensure breaks and safe ways of working.

People were supported with their medicines but the records for medicines did not always reflect safe medicines management and administration.

Right Care:

People told us language barriers between themselves and staff sometimes meant they struggled to make their wishes known as staff could not always understand them verbally or through written instruction.

Information was not always in formats people could understand which meant they were reliant on relatives to translate information about their care.

People told us staff were kind and caring and treated them nicely. Staff understood how to promote people’s dignity and privacy.

Right Culture:

People were supported by staff who had not had the appropriate checks on their suitability for the role. Staff did not all understand how to recognise or report abuse and safeguard people they were supporting.

Person centred approaches were not promoted by the manager and staff team. People’s care was not monitored for the quality and standards of care provided. Checks on staff knowledge and skills were not made, to ensure they could meet people’s needs.

People were not supported to lead empowered lives and identify clear goals to promote their independence and ensure care was personalised. Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate.

The provider did not ensure a complaints system was in place to enable people to voice concerns that were then investigated with outcomes clearly recorded. The provider did not have systems in place to ensure they acted openly and notified all concerned when something went wrong.

We have made recommendations about improving monitoring of safeguarding concerns and openly managing significant events ensuring a duty of candour is upheld.

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

Rating at last inspection

This service was registered with us on 6 May 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about staffing, governance and recruitment practices. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to recruitment practices, staff training and support, consent, complaints, person-centred care and quality assurance systems and management of the service at this inspection.

We issued warning notices to the provider in response to a breach of regulation 17 (good governance) and regulation 19 (fit and proper persons employed). We have imposed a timescale for the required improvements to be completed.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 of 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