Care Outlook (Forest Hill)

Updated 9 March 2023

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

The inspection team comprised of one inspector and two Experts 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 homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of Inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the registered person would be in the office to support the inspection. Inspection activity started with calls to people on the 19 and 20 December 2022. We visited the office on 6 February 2023.

What we did before the inspection

We reviewed information we had received about the service including complaints and notifications we received from the service. We spoke with the local authority who commission the care and support people receive.

During the inspection

We spoke with 35 people who used the service and 8 relatives, so they could tell us their experience of the care provided. We spoke with the registered manager, the regional manager, the deputy manager, a quality monitoring officer and five care workers. We sent feedback questionnaires to 100 care workers and we received 12 responses.

We reviewed a range of records including care and support plans and medicine records for 20 people. We looked at records of recruitment, training, and supervision records for ten care workers. We reviewed records relating to the management of the service, including quality assurance audits and accident and incidents and complaints. We also analysed electronic call monitoring (ECM) data for all people who used the service.

Updated 9 March 2023

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 care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Care Outlook (Forest Hill) is a domiciliary care service which provides personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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 the inspection there were 270 people receiving care and support for personal care.

Right Support: The provider was not following the principles of the Mental Capacity Act as they had not carried out mental capacity assessments when they had reason to believe people lacked capacity to consent to their care and support. The provider was unable to provide any evidence where decisions were made in people's best interest.

Right Care: There were ongoing issues with the provider’s electronic call monitoring system which meant there was a continued risk people would not get their care visits as planned. The information in care plans and risk assessments was inconsistent which meant there was a risk staff would not be given the most up to date information about how to mitigate risks. Medicines support was not always in line with current guidelines. People’s nutritional needs were recorded however there was a lack of information regarding people’s preferences around food.

Right Culture: The quality assurance and governance processes were not always effective as they had not identified the issues we found with care plans and risk assessments. The provider was following up on some of the issues with staff attendance, but they had not identified all the issues we found. Despite these issues people were mainly positive about the care and support they received. People told us, “I have found them to be brilliant and I have no problems and “I would recommend this company to others if they were going to have the carers I have.” There were processes in place to gather feedback. The provider worked with a range of health and social care professionals when planning care and support.

Rating at last inspection and update

The last rating for this service was good (published 21 January 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the scheduling and monitoring of people’s care visits and the way the provider responded to concerns raised. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care Outlook (Forest Hill) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of risks, staffing, consent to care and good governance. We have made recommendations in relation to training for staff and making care plans more person-centred. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.