Fosse Healthcare - Nottinghamshire

Fosse Healthcare - Nottinghamshire is a domiciliary home care service providing personal care to adults with personal care needs. Fosse Healthcare - Nottinghamshire were providing a service to 196 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 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. Some did raise concerns about punctuality of calls and consistency of staff teams. The provider had acted to address this, and records showed most calls were completed on time; however, this was not translated into positive feedback from all people.

Efforts had been made to have a more robust and effective approach to investigation of safeguarding incidents. The provider was currently working with the Local Authority in relation to current safeguarding cases. The outcome of these is not yet known. We will continue to monitor this.

Improvements had been made to the overall assessment of risk; including the risks associated with people’s health and safety. Staff were recruited safely. People’s medicines were well managed. Accidents and incidents were appropriately investigated. 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. Staff were well trained, and their practice was regularly assessed to aid development and improve the quality of support people received. People were supported to lead a healthy and balanced lifestyle with risks to people’s dietary needs assessed and acted on. 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 support this practice.

Improvements had been made to the overall governance of this service. Stable management was now in place; the registered manager was supported by the nominated individual to continually improve the quality of the care people received. The registered manager had a good understanding of the regulatory requirements of their role. People’s experiences had improved since the last inspection, although some did still raise some concerns which have been referred to in other parts of this report.

The provider had acted to try to provide a more person-centred and inclusive approach to care. A ‘family provider portal’ enabled relatives to view their family member’s care records and to raise concerns if needed. People felt especially 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 20 August 2019). There was a breach 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 26-28 June 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance of the service.

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 Fosse Healthcare Nottinghamshire 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People told us they felt safe with staff; however, many raised concerns about staff punctuality and the consistency of staff. Records showed calls were overall made on time and people normally received a consistent team of staff; however, people told us their experiences did not always reflect this.

Risks were assessed in key areas; although, this was not consistently applied across all aspects of care, such as repositioning of people who were at risk of developing pressure sores. Environmental risk assessments were in place, but these did not include reference as to how to make people safe in an emergency.

The provider ensured safeguarding processes were followed. People’s medicines were managed safely. The risk of the spread of infection was safely managed.

The provider had systems in place to help staff to learn from mistakes. We did note that a staff member did not follow care plan and risk assessment guidance when providing care for a person which placed the person’s safety at risk.

Most people received care in line with their assessed needs. There were gaps in some staff training, although there were plans in place to address this.

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 support this practice.

People received the support they needed to maintain a healthy diet, although guidance was not in place to support people with appropriate foods for a diabetic diet. People had access to other health and social care agencies where needed.

People and relatives found the staff to be caring and respectful. People were treated with dignity when personal care was provided. Independence was encouraged.

People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

People’s care records were person-centred and focused on what was important to them. People told us when they received their expected member(s) of staff they always received care in their preferred way.

Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care was to be discussed with people during reviews of their care.

Quality assurance processes were in place; however, these were not always effective in highlighting and addressing the concerns we have raised during this inspection.

Some members of staff had not completed refresher training when needed, this could place people at risk of receiving inappropriate or unsafe care.

People were asked for their views during telephone interviews; however, no analysis was conducted to identify any trends. No annual survey was completed to enable the provider to assess the quality of the service provided for all. This could hinder the opportunity for continued learning and development.

Some people felt office-based staff did not always communicate effectively with them. When people had met the registered manager, they found her to be supportive and approachable. The registered manager had a good understanding of the regulatory requirements of their role

Rating at last inspection and update: The last rating for this service was Good (published 7 March 2017). The service’s rating has now changed to requires improvement.

We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. More information about this is in the full report and can also be found at www.cqc.org.uk

Why we inspected

This was a planned inspection based on the previous rating

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out this inspection on 30 January 2017. It was an announced inspection, which meant the provider knew we would be visiting. This was because we wanted to make sure the registered manager, or someone who could act on their behalf, would be available to talk with us.

This was the first inspection of the service since it was registered in August 2015.

A registered manager was in post. 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.

Some concerns were raised regarding the potential impact of inconsistent timekeeping, late calls and inadequate communication and the associated risk to people’s safety and welfare.

Staff were appropriately recruited, trained and supported. They had undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. Communication was effective and regular meetings were held to discuss issues and share best practice. Staff understood their roles and responsibilities and spoke enthusiastically about the work they did and the people they cared for.

The provider had detailed policies and procedures relating to medicines management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicines training was updated appropriately.

Staff knew the people they were supporting and provided a personalised service and used effective systems for gaining consent. Individual care plans, based on a full assessment of need, were in place detailing how people wished to be supported. This helped ensure that personal care was provided in a structured and consistent manner. Risk assessments were also in place to effectively identify and manage potential risks.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Systems were in place to effectively monitor the safety and quality of the service and to gather the views and experiences of people and their relatives. The service was flexible and responded positively to people’s changing needs and any issues or concerns raised. People and their relatives told us they were confident that any concerns they might have would be listened to, taken seriously and acted upon.

We have made a recommendation regarding the scope and thoroughness of current quality monitoring arrangements