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Figtree Care Services Ltd Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 18 December 2018

The inspection took place on 16 and 18 October 2018. The inspection was announced.

This service is a domiciliary care agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. Not everyone using Figtree Care Services Limited may receive regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of inspection, the service only supported people who required regulated activities. Approximately 25 people were receiving personal care in their own homes. The majority of people receiving care and support needed two staff to provide their care at each visit. People had varying needs, some had physical difficulties with their mobility, some had received treatment in hospital for serious health conditions and others were receiving care to support them at the end of their life.

A registered manager was employed at the service. 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.

At our last inspection, on 24 and 25 August 2017, the service was rated ‘Requires improvement’. We found breaches of Regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to, the provider had not provided care that met people’s needs and preferences; systems had not been established to assess, monitor and improve quality effectively and accurate and contemporaneous records had not been kept. The registered manager sent an action plan dated 3 November 2017 stating they would meet the regulations by June 2018.

At this inspection, on 16 and 18 October 2018, the service continues to be rated ‘Requires improvement’. This is the third consecutive time the service has been rated Requires improvement. The provider and registered manager had made improvements in some areas. People’s care plans had improved, setting out their needs and preferences, the breach of regulation 9 was now met. However, we found that accurate recording continued to be an issue. Although some small improvements had been made to quality monitoring, these were not robust enough to identify and sustain improvements. Records had not been maintained to ensure people always received the care and support they needed; Records showed some people had received shortened and late care visits by staff.

We found further areas of concern that needed to be improved. Safe recruitment practices were not followed; the policy for medicines administration was not clear to ensure people’s safety; staff did not always receive the training required to meet people’s needs.

People and their relatives were asked their views through a questionnaire survey. The results were not analysed to provide an opportunity for the provider and registered manager to make improvements following the feedback. We have made a recommendation about this.

The provider had commenced management meetings where they met with the registered manager every three months to keep up to date. The meetings did not show a clear oversight and direction of the provider in order to provide continuous improvement. This is an area identified as needing improvement by the provider.

Individual risks were identified to ensure measures were put in place to help keep people safe and prevent harm. Environmental risks inside and outside people’s homes were documented to keep people and staff safe from identified hazards.

A safeguarding procedure for staff to follow should they have concerns about people was available to staff. People told us they felt safe and knew

Inspection areas

Safe

Requires improvement

Updated 18 December 2018

The service was not always safe.

Robust recruitment practices were not in place to safeguard people from unsuitable staff. Records were not accurately maintained to make sure safe practices were followed; People’s care visits were often cut short and were not always at the times people expected.

The responsibilities for administration of people’s prescribed medicines within their home was not always clear to ensure safe practice.

Individual risks were identified to help protect people’s safety. Risks in relation to people’s home environment were checked to keep people and staff safe. Accidents and incidents were reported and checked by the registered manager.

Staff knew how to keep people safe by following the safeguarding procedure and reporting any concerns they had.

Effective

Requires improvement

Updated 18 December 2018

The service was not always effective.

Suitable induction and training was not always provided to develop staffs’ skills appropriately to meet people’s care needs. Staff were supported through a supervision and observation process.

People had an initial assessment to determine the care and support they required from staff.

People had control over the choices and decisions they wished to make.

Staff provided the support people required with their health needs and the preparation of meals and fluids.

Caring

Good

Updated 18 December 2018

The service was caring.

People made positive comments about the staff who supported them, finding them kind and caring.

People and their relatives were involved in their initial assessment. Staff knew people and their relatives well.

People were given a guide about the support they received and the standards they could expect from the staff.

People experienced care from staff who respected their privacy, dignity and independence.

Responsive

Requires improvement

Updated 18 December 2018

The service was not always responsive.

Individual care plans that were in place recorded the personal detail needed to provide people’s care. However, these had not always been updated to respond to changes or following a review.

The complaints logged had been responded to appropriately. Changes had been made as a result of complaints.

People did not always have the opportunity to share their end of life wishes.

Well-led

Requires improvement

Updated 18 December 2018

The service was not always well led.

Some monitoring processes were in place to check the safety and quality of the service. These had not been effective in identifying areas that required improvement. The provider did not maintain a clear oversight of the service to ensure improvements were made and sustained.

Records were not maintained to provide a clear picture of the delivery of people’s care.

Staff meetings were held to keep staff up to date with the information they needed.

Feedback was sought from people about the service they received. Analysis was needed to ensure the opportunity was taken to make improvements.

The registered manager was aware when CQC should be notified of significant event. The provider displayed the rating of their last inspection within the registered office.