Background to this inspection
Updated
3 February 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We carried out the inspection visit on 8 and 15 December 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.
The inspection team consisted of two inspectors 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.
Before the inspection we reviewed information that we held about the service to inform and plan our inspection. This included information that we had received about the service as well as statutory notifications that the provider had sent to us. A statutory notification contains important information about certain events that they must notify us of. We contacted Healthwatch Leicestershire who are the local consumer champion for people using adult social care services to see if they had feedback about the service. We contacted the local health commissioners who had funding responsibility for some of the people who were using the service.
We spoke with six people who used the service and eight relatives of people who used the service over the telephone. We spoke with the registered manager, the regional manager, the area manager, the operations director and eight care workers. We looked at the care records of 13 people who used the service and other documentation about how the service was managed. This included policies and procedures, staff records, training records and records associated with quality assurance processes.
Updated
3 February 2017
We carried out the inspection on 8 and 15 December 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.
The service is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of our inspection 119 people used the service.
The month prior to our inspection Fosse Healthcare had secured a large contract to provide care packages to people who had previously received their care from other providers. This meant that they were providing over double the care calls in the second week of November than they had the previous week. As part of this process Fosse Healthcare had transferred a number of staff from other providers to be employed by them. We had received feedback from people using the service, their relatives and the local authority that there were concerns about the quality of the care provided and significant disruption to people’s care packages. While the provider had clearly made some progress, at the time of the inspection a number of concerns remained.
The service had a registered manager. 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 did not feel safe because they could not be sure that staff would arrive to provide their care. People could not be sure that they would receive their medicines as required. Staff were not given clear guidance and support in order to ensure that people were supported to take their medicines.
Staff had received training to keep people safe and understood how to raise concerns. Where issues relating to people’s safety had been identified they had not always been recognised and reported as safeguarding concerns.
Safe recruitment checks had taken place prior to staff employment. Staff understood their role in keeping people safe. Assessments regarding risks to people were not always completed, as a result people were not protected from the risk of avoidable harm.
Staff had received training and supervision to meet the needs of the people who used the service. Staff told us that they felt supported.
People were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA)
People were supported to maintain their health. Staff provided people with food and drink to meet their nutritional and hydration needs.
People’s independence was promoted and people were encouraged to make choices. Staff treated people with kindness and compassion. Dignity and respect for people was promoted.
People’s needs for care had not always been assessed. Staff were not provided with a sufficiently clear understanding of how to support people who used the service. People did not always receive their care at the times that they needed or preferred.
People did not feel that they were listened to or that they could make contact with the service in order to request changes. Complaints were not managed in line with the provider’s complaints procedure.
Systems where not effective to review the care that people received and to check that these were in line with their assessed needs. Checks on the quality of the service that people received were in place but these were not robust.
The provider did not have an effective system for monitoring call times and ensuring that people received the care that they needed to remain safe. Audits had not been effective in identifying concerns and it was not clear what action had been taken to prevent re-occurrence.