Focus Learning

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.

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

The manager told us they were only providing personal care to one person at the time of the inspection. After the inspection we were contacted about a second person who was receiving care at the time of the inspection by a member of the public. We were concerned that this information had not been forthcoming at the inspection, as it meant we did not receive an accurate overview of the service.

People at risk of falls did not have appropriate risk assessments to help reduce the likelihood of falls.

People requiring two carers were at risk of harm as they did not receive two carers to provide support.

The manager had a criminal records check but it did not include a vulnerable adults check. We have made a recommendation regarding criminal record checks.

The manager did not have systems in place to show how they learned from accidents or incidents and how to prevent them in the future.

One person and their relative told us they felt safe with the service.

The manager understood their safeguarding responsibilities. The risk of infection was reduced as there was sufficient personal protective equipment which was being used appropriately.

The manager had not completed any recent raining relevant to their role to show they had the knowledge to provide safe and effective support to people.

The manager had not attended mental capacity act training and required prompting when we checked their understanding. They understood the importance of offering people choices, however they were not clear about people consenting to care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Feedback was mixed about how caring the service was. One person and their relative thought the manager was caring. Another relative did not have a good experience with the management of the service.

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

People’s care plans were more personalised but lacked specific details about preferences and goals people wanted to achieve.

The manager told us they had not received any complaints. After the inspection we received information about complaints from a member of the public who had used the service. We were not informed about these complaints, whether they had been recorded and what the response was.

The manager did not have any quality assurance systems in place to monitor the service. The manager was not aware of their duty of candour responsibilities and the need to notify the Care Quality Commission of certain events as required by law.

The manager did not regularly seek feedback from people using the service, their relatives or health professionals.

The manager attended provider forums to gain further knowledge but did not have evidence of how they worked in partnership with professionals.

We have made recommendations about recording communication with health professionals and on-going learning and reflective practice .

Records were not always available at the service and when they were, they were not always fully completed.

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 8 March 2019) and there were multiple 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 enough improvement had not been made and the provider 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 providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing, need for consent, assessing people’s needs, complaints, good governance and notification of death of a service user. Please see the action we have told the provider to take at the end of this report.

Follow up

We will speak with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Focus Learning is a domiciliary care agency It provides personal care to adults living in their own houses.

This was Focus Learning’s first inspection. They were providing care to two people at the time of the inspection with one person having received care for eight months, therefore we have gathered enough evidence to rate them.

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.

Risk assessments were not robust as they did not explain how to mitigate risks people may face in or around their home.

Recruitment was not robust at the service, application forms were not fully completed as they had unexplained gaps in staff employment history and dates staff had worked were not completed. Criminal record checks were not robust as they were from the previous employers and this provider had not carried out their own checks to see if staff were safe to work with vulnerable adults.

People’s needs assessment were brief and contained limited information. Care plans were generic and lacked personalisation. Personal details that staff knew about a person such as preferred name and how they liked to receive personal care was not recorded in the care plan.

The registered manager did not show understanding of the Mental Capacity Act 2005.

Care planning documentation contained a number of blank spaces and was not accurate.

The registered manager had systems in place to monitor the quality of the service but these were not implemented as yet. The registered manager told us they completed random spot checks to ensure care staff arrived on time to deliver care but these were not recorded. The registered manager also informed us they had held a team meeting but this had not been recorded.

All staff knew how to report safeguarding and knew how to whistleblow if the registered manager was not acting on their concerns.

The service was not managing medicines but they had policies and procedures in place to support people to receive them safely.

The risk of infection was minimised as staff followed good hygiene practices and disposed of waste appropriately.

Staff had been trained in food hygiene but did not prepare meals for people at the service.

The name of people’s health professional was recorded in the care planning documentation but their contact details were not provided which meant important information could not be shared with them if needed.

Staff supported people to make their own decisions. Relatives thought their family member was safe with the carers and that the carers came on time for calls.

People were cared for by kind and patient staff who spent time with people to get to know them. People’s privacy and dignity were respected as were people’s individuality. Staff also respected people’s confidentiality.

We found breaches of the regulations relating to safe care and treatment, need for consent, fit and proper persons, person centred care and good governance.

We have made two recommendations one for providing GP contact information and another for incorporating equality and diversity in the care planning process.

You can see what action we told the provider to take at the back of the full version of the report.