Focus Learning

Updated 1 December 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 Care Act 2014.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service did not have a registered manager, they had a manager who was also the provider. This means they are legally responsible for how the service is run and for the quality and safety of the care provided with the Care Quality Commission.

Notice of inspection

We gave the service 48 hours' notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with the provider and assistant director. We reviewed one care record, including care plan and records of daily care. We looked at training records for the provider and assistant director. We also viewed a variety of records relating to the management of the service, including policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We reviewed further documentation related to care provided by the service. We spoke to one person who used the service and the local authority commissioning team.

Updated 1 December 2022

About the service

Focus Learning is a domiciliary care service providing personal care to one person at the time of the inspection.

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

We identified concerns in relation to risk assessments, understanding of the Mental Capacity Act 2005 (MCA), person centred care, duty of candour and good governance. Risks related to people’s health condition were not fully assessed to help reduce risk of pain when providing personal care. Care plans lacked detail and were not written in a person-centred manner. The initial assessment of need did not provide information on how and what care should be provided. Records of care were not accurate or up to date and did not clearly identify how and when care should be provided. The provider did not understand their duties in relation to duty of candour and did not show an understanding of when to notify CQC. The provider was not transparent about when they began providing care.

The provider had introduced systems for monitoring and auditing the service, however, these were not effective in identifying the concerns found during our inspection.

The provider had completed training relevant to their role, such as, moving and handling, health and safety and infection control. The provider had not attended MCA training and required prompting when we checked their understanding. They understood the importance of offering people choices and asking permission before providing care, however they were not clear about what happens when people cannot consent to care. People told us the provider asked their consent before providing care. We made a recommendation in relation to MCA and refresher training.

The provider did not always follow good practice guidance in relation to visitors to the office preventing and spreading infection. We have made a recommendation in relation to good practice in infection prevention and control (IPC).

The disclosure and barring service (DBS) checks for the provider had been updated. No new care staff had been recruited since our last inspection.

Systems were in place for recording incidents and accidents. Further improvements were required to ensure learning from incidents and CQC notifications were included in the process. There had been no incidents since our last inspection in July 2020.

People felt safe with the provider who provided care. Medicine policies and procedures were in place to support the management of medicine administration. Staff had completed training in medicine administration.

The provider understood their safeguarding responsibilities and had worked with the local authority in relation to a safeguarding concern.

The risk of infection was reduced as there was sufficient personal protective equipment which was being used appropriately.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not always support this practice. We have recommended the provider considers current guidance in relation to the principles of the MCA where people lack capacity.

Feedback about the care provided by the provider was positive.

The provider told us they did not discriminate against people and people's privacy and dignity was respected.

People's care plans were personalised but lacked detail about preferences and likes and dislikes.

The provider told us they had not received any complaints.

People were asked for their feedback about the service, however, this was not was not formalised. We have made a recommendation in relation to obtaining formal feedback.

The provider told us they attended manager forums to gain further knowledge.

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 inadequate (24 June 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the service was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 discharge our regulatory enforcement functions required to keep people safe and to hold managers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, need for consent, assessing people's needs, person-centred care and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.