FOREST HOMECARE MID & WEST ESSEX

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last comprehensive inspection completed in October 2021 we rated this key question requires improvement. This assessment looked at the following 6 quality statements: learning culture, safeguarding, involving people to manage risks, safe and effective staffing, infection prevention and control and medicines optimisation. At this assessment we found a positive culture of safety based on openness and transparency. Accidents and incidents were reviewed to establish any themes or trends whereby action could be taken to prevent the risk of reoccurrence. Concerns about safety were listened to, investigated and reported where required and the service used a lesson learned approach to share information to improve the quality of the service to people and staff. Staff had been recruited safely and there were enough suitably trained staff to meet people’s needs. People’s medicines were being managed and administered by trained staff whose competencies were regularly undertaken.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had systems and processes in place to support continued learning. These included group supervisions, additional training where required, supervision, spot checks on staff practice, investigations of concerns and the completion of logs for incidents, accidents, potential safeguarding events and complaints.

Staff told us when incidents had occurred, these were used a discussion point in either staff 1:1's, telephone calls, messages and/or group supervisions. The management team described actions they had taken to support continued learning and to help identify themes and trends to improve the service. The management team were able to demonstrate they understood their responsibilities under the duty of candour which requires services to act in an open and transparent way when accidents or incidents occur.

People and relatives spoke highly of the service and the care they received. Comments included, “It is a well-run operation, in fact I do not know how they can do it for what they charge. I cannot fault them. The carers all cooperate with each other, and it works well,” “All the ladies are lovely and helpful, and go beyond their duty. I buy them fudge and give them biscuits and sweets. It is a nice thing to do. I would recommend them to anybody,” and “Although we do not get a rota, we have a consistent small team supporting us, and we know who is coming.” People and relatives told us they knew how to complain should they need to and said they were confident immediate action would be taken. A relative told us, “If I mention anything to the carers, I know that it’s passed back to the office, they are a proactive agency, and their communication is very good."

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider had systems in place to ensure all safety concerns were investigated and action taken to ensure people’s safety. Records showed the service had made appropriate safeguarding alerts to the local authority when necessary.

Staff confirmed they had received safeguarding training and demonstrated they knew how to prevent, identify and report allegations of abuse. They were confident the management and office staff would take appropriate action if concerns were raised. A staff member told us, “If I saw anything of concern, I would go to head office. I am confident if I did report anything it would be taken seriously, however if of a serious nature I would report to the police, however thankfully I have never witnessed anything like that.” The management team were aware of their role and responsibilities to safeguard people from harm and abuse.

All people spoken with told us they felt safe and had no concerns about their safety when staff visited them. Comments included, “They are all fantastic, they are my angels. They will do anything for you, and they always ask if I need anything done,” “They are absolutely excellent top marks. They even make sure that the dog does not go out the front door when they come in." Relatives we spoke to also reported people were safe. A relative told us, “We get a small group of carers, and they [staff] all know [person] very well. They know [person] has a bad shoulder and they always take care when helping them to get dressed. They also spot when something is not right, and they let me know. They are incredibly careful with [person]. We have a laugh and a joke; it is a very good service.”

People told us they were being cared for safely and how staff understood their specific needs and how best to support them. A relative told us, “[Person] is at risk of falls and has fallen at home before. They [staff] have found [person] called the ambulance service and me. They are careful to make sure [person] is supported correctly.”

Staff understood how to manage risk to people’s wellbeing. Staff told us they read people’s risk assessments and were kept updated of changes to people’s care requirements. Staff told us they had received specific training in moving and handling to support people to move around their homes safely. One member of staff told us, "Every person's risk assessments can be found on our electronic app for our guidance. The persons risks will come up as an alert. The app is easy to use, it was a really good investment."

At the last inspection we recommended the provider completes individualised risk assessments for all aspects of people’s care. At this assessment we found the provider had made those improvements in relation to risk management. Risks to people’s health and wellbeing had been identified, assessed, reviewed regularly and updated when required. For example, a person with a specific medical condition, their risk assessment contained detailed information the condition, what potential signs/symptoms staff should look out for and what to do in the event of an emergency situation occurring. The manager and office staff provided us with evidence on how staff practice was monitored to ensure the delivery of safe care. These included, spot checks, competency checks, supervisions and gathering regular feedback from people using the service.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff feedback in relation to staffing levels and travel time in between scheduled call visits was variable. Most staff reported they had sufficient travel time between visits. A small number of staff felt depending on the number of visits, sometimes there was enough travel time and at other times there were not enough. Staff reported that the service had enough staff to provide all planned care visits, however a small number of staff felt staffing levels were up and down and could be better. Their comments included, “There are not so many carers now, getting people to stay in the job is the problem”, “The staffing levels are low at the moment, we could do with more staff, however all the calls are covered, and staff help out where they can” and “I think there are plenty of staff. The company has ongoing recruitment. I can only speak for myself; I do not have enough clients at the moment. I would like more.”

We received positive feedback from people and relatives about the timing of the care calls. People told us they were not rushed by staff and were happy with the care they received. Comments included, “They are normally on time, and they are never rushed. If they are late due to something, they will call me and let me know.”, “We have a small group of carers, so we see the same faces. I always get a phone call if they are going to be a little late. They are all diligent, normally turn up when they should and stay the full time” and “You can set your watch by them, excellent timings and always arrive on time.”

Systems were in place to ensure there were enough suitably qualified, skilled and experienced staff. Safe recruitment practices were followed. We checked the recruitment records for 4 members of staff and all the required pre-employment checks had been completed. This included disclosure and barring service (DBS) checks and obtaining up to date references. Managers and office staff monitored the call monitoring data in real time to ensure all planned care visits were provided. A monthly overview was kept of any late/missed calls. We reviewed those for January and February 2024, there were no missed calls, for the few recorded late calls [45 minutes or later] it was clear what action had been taken by the service to ensure people still received their care calls and how the staff team kept in contact with people until they arrived. From the feedback we received from people and relatives regarding the timings of their calls it did not identify that this had impacted on the delivery of the service people were receiving.

Staff were able to tell us how they use personal protective equipment (PPE) in accordance with best practice guidance. Comments included, “I wash my hands regularly, change my PPE after personal care to handling food. Incontinence aids are disposed of in the appropriate bins,” and “I wear gloves and apron, we have enough PPE available to us.” Staff had undertaken infection prevention and control training and were provided with personal protective equipment (PPE) which could be collected from the office. The provider had an up to date policy in place to support effective infection prevention and control and was following current guidance.

People and relatives, we spoke to did not share any concerns in relation to the infection prevention and control practices of staff. Comments included, “They [staff] have always got their gloves and take them off and put them in the bin before they leave, they are very good at that”, “Really happy with their standard of hygiene” and “Staff always wear gloves and apron and take it off when they leave and put it in our bin.”

Relatives we spoke to told us their loved ones received their medicines where required and on time. One relative we spoke to said, “Yes, [Name] is prescribed medicines 4 times a day, and it’s handled well.” Another relative told us, “They [staff] handle the blister packs and help administer [persons] eye drops.”

Staff told us they completed training to manage and administer people’s medication and confirmed that their competency was assessed at regular intervals. One member of staff told us, “They check our competency before we are signed off to work. If an error occurred, I would check the person is ok and call 111/ 999 if necessary. I would then inform my manager and the persons relative.” The service had appointed a dedicated compliance officer who had oversight of the medicines monitoring. They told us, “I carry out visits to people’s homes to ensure staff are providing the correct care and support to people, including their medicines administration. I check people’s daily notes, their medicines and run a monthly medicines audit to identify any themes or trends.”

There were appropriate systems in place to help make sure medicines were managed in a safe way. We saw that audits were completed monthly, and any issues were dealt with promptly. We were assured that lessons were learned and shared with the staff team following any medication error or incident. We saw the electronic care planning system and e-mar system helped minimise the risk of medication omissions. For example, if a care worker left a visit without administering a person’s medicines, as required, the system would alert the office staff. Office staff would then call the care worker to ensure they returned to the person’s home to complete the task. We saw that people’s care plans contained clear details about the medicines they took, as well as when and how they required them.