Background to this inspection
Updated
20 August 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 Health and Social Care Act 2008.
Inspection team
The inspection was completed by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
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 or registered manager would be in the office to support the inspection. Inspection activity started on 5 May 2022 and ended on 14 June 2022. We visited the location’s office on 5 May 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included feedback from the public and notifications from the provider. We sought feedback from the local authority. We used all this information to plan our inspection.
During the inspection
We visited the office on 5 May 2022. During the visit to the office and following the inspection, we spoke and received feedback from eight staff including the provider, care co-ordinators and nominated individual/registered manager to gather their views about the quality of care provided. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with two people and three relatives to seek their feedback about the quality of care they received. We also received feedback from four health care professionals who work with the service in providing care to the people who used the service. We requested and reviewed various records in relation to three people’s care, recruitment records, staff training, supervision and how the provider monitored the quality of care people received.
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.
Updated
20 August 2022
About the service
Fisher Healthcare East Anglia Ltd is a small home care service providing personal care to people living in their own homes. 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. At the time of the inspection the service was providing care to 10 people who were receiving the regulated activity of personal care.
People’s experience of using this service and what we found
Whilst most people spoke positively of the level of care and support they received from Fisher Healthcare, we found weaknesses in risk assessments, care planning and governance arrangements. Risks in relation to people receiving personal care were not always assessed, and when they were the service did not always provide clear plans and guidance in how to manage such risks. Care plans were in place, however, there was a lack of consistency, detail, and they were not always up to date which could put people at risk of inappropriate care. The service quality assurance system was not fully effective and did not identify the shortfalls we found during our inspection. There was limited provider oversight of the service.
People who used the service were safe from harm and abuse and care workers demonstrated an understanding of their role when reporting and responding to abuse. There had been improvements made in the service and people were now receiving their medication safely. People also felt staff had a good knowledge of their needs and any risks they had. One said, “They will keep an eye on me. I get confused with the tablets particularly and they will check and make me safe.”
Overall staff were recruited safely, and sufficient staff were deployed to meet people's needs. Staff received a comprehensive induction and regular competency checks, supervision and appraisals.
There had been good relationships developed with health care professionals. Professionals spoken to said, the communication was very good, and the service kept them up to date with any relevant changes in a timely manner.
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 supported this practice.
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 (published 31 March 2021) and there were five 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 we found some improvements had been made. However, the provider remained in breach of regulations.
This service had been in Special Measures since 29 December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service was no longer in Special Measures.
Why we inspected
We carried out an announced focussed inspection of this service in November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve risk management, management of people’s medicines, recruitment processes, governance and failure to notify CQC of incidents the provider is required to do so by law.
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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fisher Healthcare East Anglia Ltd on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to risk management, governance systems at this inspection. Following the inspection a warning notice was issues to the provider in respect of these breaches.
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.