Fisher Healthcare East Anglia - Norwich

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.

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 30 people who were receiving the regulated activity of personal care.

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

The provider did not have effective oversight of the quality and safety of care being provided to people. The provider’s representative whom the provider had told CQC was responsible for this task, had not conducted any monitoring or assessment of the standards of care on their behalf.

Both the provider’s representative and manager demonstrated some shortfalls in their practice. This had resulted in appropriate actions not always being taken to reduce risks to people’s safety.

Current systems in place to monitor the quality of care provided were not consistently effective at identifying or rectifying errors. Incidents had not always been reported for investigation and where they had been, not investigated. This is important so that lessons can be learnt to prevent incidents to people’s safety from re-occurring.

Risks to people’s safety had not always been adequately assessed or managed. Some people had not received their medicines correctly. Appropriate actions had not always been taken to reduce the risk of people experiencing alleged abuse or to reduce the risk of the spread of infection.

The provider had not conducted all the required checks to enable them to reasonably assess whether staff were of good character before they were employed or during their employment.

The service had experienced some difficulties recently due to several of their staff not being able to work for various reasons including having to self-isolate due to the COVID-19 pandemic. People told us they received their care visits but not always at their preferred time and on occasion, only one staff member attended a care visit when there should have been two. The provider was aware of the situation and was actively trying to recruit more staff and had sought assistance from the local authority as is appropriate.

Rating at last inspection (and update):

The last rating for this service was Requires Improvement (published 9 June 2019) and there were two 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

We received concerns in relation to the management of medicines, infection control, safeguarding people from the risk of abuse, staffing levels and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

During the inspection, we identified breaches in relation to risk management, infection control, safeguarding people from the risk of abuse, management of people’s medicines, recruitment processes, governance and failure to notify CQC of incidents the provider is required to do so by law.

Some of our concerns required the provider’s urgent attention. Therefore, we issued them with a letter giving them the opportunity to act to avoid us taking urgent action. This assurance was received and therefore, urgent action was not taken. Full information about CQC’s regulatory response to the more serious concerns found during this inspection will be added to this report after any representations and appeals have been concluded.

Follow up

We will meet 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 act 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 of 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.

Fisher Healthcare East Anglia Ltd is a domiciliary care service based in Norwich, providing care in Norwich and the surrounding areas, primarily to older people.

At the time of the inspection, the service was providing personal care to 38 people living in their own homes and there were 28 staff.

Fisher Healthcare East Anglia Ltd is a new franchise of Fisher Healthcare Ltd and took over the service provision from Fisher Healthcare Ltd in January 2018.

Fisher Healthcare East Anglia Ltd had also established a second branch in Suffolk to provide a similar service which had yet to be registered with the Care Quality Commission. They agreed to also apply to register this location and its manager by the end of March 2019. This separate location was not inspected as part of this inspection; but will be inspected once appropriately registered.

People’s experience of using this service:

Fisher Healthcare East Anglia Ltd had recently experienced a period of instability related to difficulties with poor performance of its management team. The provider had resolved this through major changes to the management team which occurred three months prior this inspection. The new management team has since been working to make improvements.

All the stakeholders involved, including people using the service, staff and commissioner had faith in the new management’s open approach and their ability to return to providing high quality care.

The new management initially needed to prioritise ensuring delivery of care and stabilising the staff team; alongside this work they then reduced its service provision through appropriately serving notice to unsustainable packages of care. Whilst they had ensured they met all their commitments to provide care in this period, the management team acknowledged prioritising provision of care meant they had neglected other aspects of governance.

People usually received their medicines when they needed them. However, medicines administration records were not always completed fully and the management were significantly behind with auditing the medicines administrations records, so could not be sure safe practice was being maintained.

Care reviews were not always being completed with appropriate frequency to identify potential changes in needs and desired outcomes.

Risks to people’s individual safety had usually, but not consistently, been assessed. However, staff acted to reduce risk wherever possible and were knowledgeable about how to support people to remain safe from abuse or harm.

People received support to maintain their health when needed and the care they received enhanced their wellbeing.

Care plans were appropriately person-centred and care practice reflected good knowledge and understanding of people’s needs.

Feedback from people using the service was positive, both about the quality of the care provided and the new management team.

The provider operated safe recruitment practices and now had sufficient staff to ensure people received the care they needed. Staff were suitably trained and skilled to provide safe and effective care that met people’s needs and preferences.

Rating at last inspection:

Fisher Healthcare East Anglia Ltd was a new legal entity and as such had not previously been inspected or given a rating.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people received safe, compassionate, high quality care.

Future inspections will be carried out to enable us to have an overview of the service; we will use this inspection and information we receive to inform future inspection timescales.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk