Archived: Family Care Agency

Family Care Agency is a domiciliary home care service. The service provides personal care and support to people living in their own homes. At the time of our inspection there were 15 people using the service.

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

We found people were at risk of potential harm due to poor quality risk management and there was a lack of guidance and training available for staff in relation to people’s specific care needs. Medicine records were not always maintained. People and their relatives told us they felt safe, however, safeguarding systems were not always effective at protecting people from potential risk of harm. We received mixed feedback from health and social care professionals regarding the safety of the service.

There was a lack of effective systems and processes to ensure quality of care. Staff were not always aware of roles and responsibilities and the registered manager lacked knowledge in relation to safe medicine practices. Procedures were not in place to analyse care visit times to ensure people received care as planned. Feedback from people using the service and their relatives was mostly positive. However, this feedback indicated care was not being delivered as detailed within people’s care plans. The provider sought feedback from people using the service through customer surveys. Staff had opportunity to raise concerns during one to one supervision with the registered manager. The provider understood their legal responsibilities with regards to duty of candour and was open and transparent during the inspection process.

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

The last rating for this service was requires improvement (published 5 October 2019) and there were 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 improvements had been made in relation to previously identified concerns, however, new concerns were identified, and the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines and potential neglect of people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 requires improvement to inadequate based on the findings of 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 see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Family Care Agency on our website at www.cqc.org.uk.

Enforcement

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 safe care and treatment, safeguarding, governance oversight and staffing at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

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 take action 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 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.

Family Care Agency is a domiciliary care service providing personal care to 44 people at the time of the inspection.

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

Recruitment processes were not robust enough to ensure staff were safe to work with vulnerable people. There were enough staff available to meet people's care and support needs.

Systems to monitor the quality of the service were not effective. The registered manager had not identified areas of concern. Systems and processes put in place to improve the service were not yet established or embedded.

Care records did not always contain clear information covering all aspects of people's individualised care and support. People were not always involved in the planning and delivery of their care. Records to ensure this were not always completed.

When there were problems, the registered manager dealt with them appropriately and put measures in place to reduce the likelihood of recurrence, although records did not always reflect this.

People were happy with the care and support they received and spoke positively to us about staff with whom they had good relationships.

We have made a recommendation about ensuring care plans are person centred.

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

Rating at last inspection

The last rating for this service was requires improvement (published 16 April 2019).

Why we inspected

We received concerns in relation to the management of calls and the suitability of staff. As a result, we undertook a focused inspection to review the Key Questions of Safe, Responsive and Well-led only.

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 remained Requires Improvement. This is based on the findings at this inspection.

We have found evidence the provider needs to make improvement although we found no evidence during this inspection that people were at risk of harm from the specific concerns raised. Please see the Safe, Responsive and Well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Family Care Agency on our website at www.cqc.org.uk.

Enforcement

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Family Care Agency is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection 26 people were using the service. Everyone using Family Care Agency received personal care.

People’s experience of using this service:

• People told us they felt safe receiving support from Family Care Agency and that staff were kind, respectful and caring.

• Not all risk assessments had the required details to ensure all staff knew how to keep a person and themselves safe.

• The provider did not always follow effective recruitment procedures.

• There were gaps in the registered manager’s knowledge of regulatory requirements.

• Audits were not always effective.

• People told us they had regular carers who arrived on time, however when carers changed, people or their relatives were not told who would be arriving and they would often be late.

• Staff received training appropriate to their role.

• There were safeguarding and whistleblowing policies and procedures in place.

• People were being supported daily to make choices and decisions about their care and support.

• The manager was proactive in liaising with health and social care professionals in ensuring people had access to the healthcare they needed.

• People were supported to be as independent as possible.

• People’s individual and diverse needs had been identified before moving to the service and plans of care had been developed.

• Staff responded to changes in people's needs.

• People, relatives and staff told us they had regular contact with the manager and that they were approachable and friendly.

• The service works with professionals from other agencies such as district nurses, physiotherapists, GP’s and occupational therapists.

Rating at last inspection:

GOOD (report published 7 September 2016)

Why we inspected:

This was a planned inspection.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for services rated Requires Improvement.

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

Family Care Agency provides personal care to people living in their own homes in the city of Leicester. At the time of our inspection, there were two people using this service who were supported by three staff.

There was a registered manager in post. 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.

The provider had systems in place to identify, assess and manage risks to the health and safety and welfare of people who used the service. We saw risk assessments were carried out but these did not always include the detailed guidance staff needed to keep people safe. Staff demonstrated that they understood how to keep people safe. People we spoke with said they felt safe as a result of the care they received and trusted the staff who looked after them.

People were protected from the risk of abuse. Staff understood the procedures they needed to follow to ensure that people were safe. The provider's safeguarding policy required further development to include contact details for relevant external agencies to support staff to keep people safe.

People were supported by the number of staff identified as necessary in their care plans to keep them safe. There were robust recruitment processes in place to ensure new staff were suitable to support people in their own homes.

People were supported by staff who were skilled and knowledgeable about their needs. The provider made sure that staff were provided with training that matched the needs of people they were supporting. The provider was in the process of updating their training matrix to record the training staff had undertaken.

We found that people were involved in decisions about their care. The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA). People had consented to their care and staff asked for permission before supporting people with their care needs.

Staff supported people to liaise with health care professionals if there were any concerns about their health.

People told us how staff cared and supported them with dignity and respect and encouraged them to be as independent as possible.

People's care plans were person centred, detailed and written in a way that described their individual care needs. This meant staff were clear about how people were to be supported and their personal objectives met. These were regularly evaluated and reviewed and updated. People were enabled to reduce the risk of social isolation through staff supporting them to pursue hobbies and interests and go out into the wider community.

People were actively involved in deciding how they wanted their care to be provided in line with their wishes. People told us they were aware of how to raise concerns and were confident their concerns would be responded to by the provider. The provider's complaints policy and procedure was in need of further development to provide clear information for people on how to make a complaint and how their complaint would be managed.

People were confident in how the service was led and the abilities of the management team. There were systems in place to assess and monitor the quality of the service. People and staff felt they could share their views and opinions and these would be listened to by the management team. The provider and management team used people's feedback and findings of quality assurance to drive the development and improvement of the service.