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Figtree Care Services Ltd Requires improvement

We are carrying out checks at Figtree Care Services Ltd. We will publish a report when our check is complete.

Reports


Inspection carried out on 24 August 2017

During a routine inspection

We inspected Figtree Care Services on the 24 and 25 August 2017. The inspection was announced. Figtree Care Services provides support for older people living in their own homes. There were 35 people using the service at the time of our inspection.

There was not a registered manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. The registered manager had left the service since our last inspection and a new manager had been appointed. The acting manager was going through the processes to become registered with the CQC.

We previously inspected this service on 7 and 8 July 2016 when we found breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. The breaches of the regulations related to safe recruitments practices, assessing risk, care plans did not set out the needs of people, records were poorly written and no effective auditing systems were in place. We found on this inspection that improvements had been made but there were still areas where the service was in breach of regulations.

The provider had systems in place to identify individual risks to people. However, formal environmental risk assessments had not been completed. We have made a recommendation about this in our report.

People were protected from abuse by trained staff who understood how to recognise the signs of abuse and how they should report it. Staff received training that gave them the confidence and knowledge to provide effective care.

The provider had safe recruitment practices in place. All staff had a safety check to ensure they were safe to work with vulnerable adults. All staff received regular supervisions and yearly appraisals. The acting manager was carrying out spot checks of staff performance to ensure they were working in line with the provider's policy and procedures. There were enough staff to provide care and support for the people. However, we found that there were some occasions when staff were late to calls and people had not been informed. We have made a recommendation about this in our report.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Mental capacity assessments were being carried out and these were decision specific. Staff and the manager demonstrated good knowledge of the Mental Capacity Act 2005.

People were supported to have a healthy and nutritious diet. Staff would support people when needed. People and relatives told us they were given choice over what meals they would have.

People and relatives we spoke to spoke positively about the staff and the care they received. Staff were seen to be communicating to people in a kind and caring way. Staff protected people’s dignity and encouraged independence. Staff demonstrated good knowledge of people and the care they required.

Care plans were detailed and identified each person’s needs. However, reviews were inconsistent and were not being reviewed in a timely manner following changes of people’s needs. Care plans identified people’s preferred likes and dislikes when receiving personal care and staff were aware of these. Staff ensured that people were given choice over their care.

People, relatives and staff told us that the acting manager was having a positive impact on the service. The acting manager had identified that the current auditing systems required improvements but new methods had not been embedded within the service. People’s records were not being consistently updated when required.

We found breaches in the regulations and you can see what action we took at the end of this report.

Inspection carried out on 7 July 2016

During a routine inspection

The inspection was carried out on 7 and 11 July 2016. We gave short notice before the first day of the inspection because the manager was often out of the office supporting staff. We needed to be sure that they would be available to speak with us.

Figtree Care Services Limited provides personal care and support to people who are living in their own home. At the time of the inspection the service was providing support to 15 people, in the Dartford area. The service is able to provide a range of visits to people, from one visit a day, up to several visits per day. Support is primarily given to older people who are receiving continuing health care. The support provided aims to enable people to live as comfortably as possible.

The registered manager had recently left in June 2016. 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 and associated Regulations about how the service is run. A new manager had been employed, but had worked at the agency for less than two weeks when we inspected. The manager said she was in the process of completing an application to become the registered manager.

The service had recruitment practices in place. However, improvement was needed for example, checking validity of references, checking any gaps in employment history, ensuring return of DBS check and providing all staff with a contract of employment.

The manager had started to implement individual risk assessments for each person and the environment in which they lived on the second day of our visit, but further improvement was needed. Care was planned and agreed between the staff and the individual person concerned. Some people were supported by their family members to discuss their care needs, if this was their choice to do so.

Management involved people in planning their care by assessing their needs on their first visit to the person, and then by asking people if they were happy with the care they received. There was an emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. However, no care plan records were seen on the first day of the inspection visit and the manager on the second day of the inspection had started to address this issue. The service was flexible and responded positively to changes in people’s needs. People were able to express their opinions and views and they were encouraged and supported to have their voices heard.

The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in relation to the whistleblowing policy. Staff were confident that they could raise any matters of concern with the provider, the manager, or the local authority safeguarding team. Staff were trained in how to respond in an emergency (such as a fire, or if the person collapsed) to protect people from harm.

Staff were trained in the Mental Capacity Act 2005. Staff understood the processes to follow and knew who to contact, if they felt a person’s normal freedoms and rights were being significantly restricted.

All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding people and infection control. They worked alongside experienced staff and had their competency assessed by the manager. Refresher training was provided at regular intervals. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

People were supported with meal planning, preparation and eating and drinking. People had positive relationships with staff who knew them well. There were enough staff available to meet people’s needs Staff supported people, by contacting the office to alert management, to any identified health needs so that their doctor or nurse could be informed.

The manager told us that currently staff did not assist people with the taking of medicines.

People said that they knew they could contact the management at any time, and they felt confident about raising any concerns or other issues. The manager carried out spot checks to assess care staff’s work and procedures, with people’s prior agreement. This enabled people to get to know the manager and an opportunity to share any concerns.

The service had processes in place to monitor the delivery of the service. As well as talking to the manager at spot checks, people could phone the office at any time, or speak to the person on duty for out of hours calls. People’s views were obtained through meetings with the person and meetings with families of people who used the service. The provider checked how well people felt the service was meeting their needs, by carrying out a yearly survey.

Incidents and accidents were recorded and checked by the provider or manager to see what steps could be taken to prevent these happening again. Risks were assessed and the steps taken to minimise them were understood by staff. However, the records in place to manage risks needed improvement, both for the person and the environment in which they lived.

The manager ensured that they had planned for foreseeable emergencies, so that should they happen, people’s care needs would continue to be met.

Quality assurance systems were not effective in recognising shortfalls in the service. Action had not been taken and recorded to make sure people received a quality service. The manager had however, on starting at the service had a quality assurance and service review undertaken, and was addressing firstly issues that required urgent action.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.