FCNA Homecare

Updated 15 June 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 was carried out by one inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses.

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 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 26 April and ended on 17 May 2023. We visited the location’s office on 26 April 2023.

What we did before the inspection

We reviewed information we had received about the service since our 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 (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 23 March 2023 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We were unable to speak with people during this inspection due to the limited number of people receiving a regulated activity from the provider. However, we spoke to relatives to understand their experiences of care provided. We spoke with 5 staff including support staff, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records including people's care plans, risk assessments and records relating to the provision of care. We looked at staff files in detail and reviewed additional recruitment checks, training records, supervisions and appraisals. We looked at records relating to the management of the service including audits and policies and procedures. We also used technology such as video calls to enable us to engage further with the provider and electronic file sharing to enable us to receive and review additional documentation securely.

Updated 15 June 2023

About the service

FCNA Homecare is a domiciliary care agency providing personal care to 2 people. The service provided support to older and younger adults. At the time of our inspection there were 16 people using the service in total.

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 and relatives felt care was provided safely. However, people’s risk assessments required development to ensure staff were provided with detailed guidance on how to manage risks associated with the provision of people’s care. Recruitment checks had not always been carried out; at the time of inspection the registered manager had begun to address this however, people’s references had not been obtained and recruitment records were not always present in staffs files. The administration of people’s medication was carried out safely; however, we identified in some instances people’s medication records had not been completed correctly. The registered manager provided evidence staff had completed refresher training relating to the management and administration of people’s medicines. We have made a recommendation the provider reviews people’s risk assessments.

Staff’s training and induction programme had been reviewed by the registered manager however, there were gaps in staffs training. People’s dietary needs and preferences were recorded in their care plans; however, where some people required a ‘soft’ diet the consistencies of their food and fluids had not been recorded. The registered manager was following this up at this time of inspection and had requested a referral with the appropriate professionals. Initial assessments carried out for people required further development to capture people’s needs in detail. The provider used an electronic care planning system which required additional detail in some cases to provide staff who did not know people well with clear guidance on how they wished to be supported. We have made a recommendation the provider ensures communication with external professionals is documented.

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; the policies and systems in the service did not always support this practice.

Relatives praised staff for the care provided to people and stated people were supported by staff who understand their needs well. Staff feedback demonstrated they knew how to support people while protecting their dignity and privacy and promoting their independence. Staff understood how to provide person centred care.

Some relatives raised concerns regarding the timings of calls, stating calls were often late. Relatives reported this didn’t impact areas of care such as the administration of medicines; they stated they felt better consistency in the times could be achieved with better organisation from the management team. Relative feedback around the response to complaints was mixed; for example, one relative told us they felt the registered manager was responsive to concerns raised, while another relative told us the opposite. People’s communication needs were not always clearly recorded in their care plans. We have made recommendations the provider reviews complaints management and their oversight of care planning.

The providers governance systems required significant development. We were unable to evidence any provider oversight of the registered managers operational management of the service. This meant any gaps in auditing, oversight and governance at registered manager level had not been identified or supported by the provider. We found the providers electronic care planning system produced compliance percentages; in several areas compliance was low. We discussed this with the provider who shared an audit template they intended to complete to improve oversight of the service. By the end of our inspection there was no evidence to show this had been completed and additional governance systems at provider level were needed to identify, assess and improve areas of the service. We have made a recommendation the provider reviews their governance systems to ensure the registered manager solely focuses on the management of the service.

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 good (published 9 October 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service. Additionally, the inspection was prompted in part due to concerns received about the management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of the full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this 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.