We carried out a review of the data available to us about Forever Independent on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Forever Independent, you can give feedback on this service.
Forever Independent is a domiciliary home care service providing personal care to adults with personal care needs. They were providing a service to 63 people at the time of the inspection.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
People felt safe when staff cared for them in their homes. People told us staff were punctual and they normally received care from a consistent team of staff team. At the last inspection there were concerns with the way the provider managed people’s medicines. The provider had acted to address this, and, apart from one issue in relation to person’s medicine administration records, we saw these improvements had reduced the risks to people’s safety.
There was a process in place to investigate accidents and incidents and to ensure safeguarding concerns were reported to the relevant authorities. The provider had made changes to the way risk to people’s health and safety were assessed and recorded. This resulted in more detailed care planning and risk assessments. Robust infection control procedures were in place. This included how to reduce the risk of the spread of COVID-19.
People’s physical, mental health and social needs were assessed and met in line with current legislation and best practice guidelines. This included guidance in place for staff to identify the first signs of a person having a stroke.
Staff were well trained, and they received regular supervision of their practice to ensure they continued to care for people in a safe and effective way. People were supported to lead a healthy and balanced lifestyle with risks to people’s dietary needs assessed and acted on. This included guidance for staff to support people who had diabetes. The provider had effective relationships with external health and social care organisations and people’s health was regularly monitored. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Improvements had been made to the overall governance of this service. The improvements required from the previous inspection had been implemented and were showing sustained improvement. The registered manager had a good understanding of the regulatory requirements of their role and had now ensured the relevant authorities were always informed of any incident or death that occurred at their service.
People praised the approach of staff and the registered manager. They felt safe, well cared for and they had confidence that risks to their health and safety were well managed. Most of the people we spoke with would recommend this service to others.
People and staff felt well supported during the height of the COVID-19 pandemic. Staff wellbeing was actively supported and monitored.
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 25 July 2019). There were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an announced comprehensive inspection of this service on 22 May 2019 where breaches of legal requirements were found.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires Improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forever Independent on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service:
Staff had not consistently received training or competency assessments with medication.
Staff had very different experiences with regard to support, training, supervision and appraisal. Some staff felt that they were well supported, and others told us that they never really saw any management or had any input with regard to their performance.
Medicines were not always administered safely. Some of the medication given was not accurately recorded on medication administration records. There were also problems with timing of medication when calls were delayed or cancelled. Staff told us that morning calls could be late and bedtime calls could start early and if there was medication support required, it wasn’t always possible to make sure that people were given medication at the time prescribed.
Medicines were not always recorded and audited appropriately.
People’s information was not kept confidential and secure.
The registered manager has improved the care planning and risk assessments since our last inspection, but the information is not reviewed regularly.
Not all notifications had been received by us, this means that the management are not acknowledging the duty of candour by reporting all incidents that they are required to notify us of by law.
Rating at last inspection: The service was last inspected on 30 April 2018 and was rated as Requires Improvement. This is the third time the service has been rated Requires Improvement. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.
Why we inspected: This was as planned inspection based on previous rating.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. If any concerning information is received, we may inspect sooner. We will also meet with the provider to discuss our concerns.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The service had a registered manager who had been in post since September 2015. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Risks to people safety were not always appropriately assessed or kept under review. People were supported to take their medicines by staff if needed but further information was required by staff to ensure medicines were managed safely.
People were supported by a sufficient amount of staff and told us they felt safe. Staff were aware of how to respond if they suspected abuse. People were supported by staff who understood their responsibilities for maintaining cleanliness and hygiene and to report accidents and incidents.
An assessment of people’s needs was carried out when they first started using the service but care plans did not always contain sufficient information about people’s health conditions. People were supported by staff who received an induction and relevant training but who did not always receive regular supervision.
People were supported to eat and drink and staff sought medical attention if people needed it. However, further information was needed for staff about how they should provide support to ensure that risks were reduced.
People told us they were able to make their own decisions about their care. However, some people were not able to consent to aspects of care and mental capacity assessments and best interest decisions had not always been completed in these instances.
Staff were caring and respected people’s privacy and dignity. Staff were provided with a sufficient amount of time on care calls to be able to provide compassionate care. People were supported by staff who knew their likes and dislikes and were involved in planning their care.
People’s care plans lacked detail about the support they required. Care plans had not always been regularly reviewed or updated when aspects of care provision had changed. There was limited information about any needs people had in relation to protected characteristics under the Equality Act and about their preferences about how they wished to be cared for at the end of their life.
Complaints about the service were responded to and people told us they had little cause to complain. They told us that their needs were met in a way and at a time that suited them.
Quality monitoring audits were not fully effective in identifying areas of improvement and sufficient action was not always taken in response to external audits and inspections. Staff felt supported by the management team but spot checks of their performance were not comprehensive. Feedback was sought from people regarding the service they received and people told us they were happy with the service they received.
This is the second time the service has been rated Requires Improvement. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.
The service had a registered manager in place at the time of our inspection. 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.
People were supported by staff who understood some of the risks they faced, however the measures in place to keep people safe were not always clearly identified.
People could not be assured that systems in place to check they received their medicines when required were robust and understood by all staff.
People were kept safe by staff who understood their responsibilities with regard to protecting people they were caring for from harm or abuse.
People were being cared for by sufficient numbers of staff.
People were cared for by staff who received training relevant to their role and further improvements to the support and training staff received were being made.
People were encouraged to make independent decisions. However, improvements were required to ensure that people who were not able to make their own decisions had their rights protected.
People received the support they required to meet their nutritional and healthcare needs.
People had positive relationships with their care workers. People and their relatives felt that their relation was treated with kindness and people’s privacy and dignity were respected.
People who used the service, or their representatives, were encouraged to contribute to the planning of their care and to give their views on the running of the service.
People described a service which was generally responsive to their needs and told us they were supported in line with their preferences and in a way which maintained their independence.
People told us they felt confident that any concerns or complaints raised would be responded to and records showed this to be the case.
The quality monitoring systems in place were not always effective in identifying and addressing issues.
People’s care plans did not always provide sufficient guidance for staff and had not always been regularly reviewed. We had not always been notified of events which had occurred at the service.
People and staff were complimentary of the management of the service and described an open culture which encouraged feedback.