Farecare Gloucestershire Limited

Farecare Gloucestershire Limited is a domiciliary care service providing personal care for people in their own home. At the time of the inspection, 29 people were receiving support from the service with personal care.

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

We found improvements were still needed to ensure safe recruitment practices were followed.

We found improvements were still needed to ensure people's risks were assessed and mitigated in areas, for example, epilepsy, catheter care and nurse delegated tasks. Records relating to people's risks required improvement to ensure staff had access to complete and up-to-date information to keep people healthy and safe.

We found that improvements were still needed to the provider's quality monitoring systems and processes.

Improvements were needed in areas such as records related to people’s “as required” medicines and prescribed medicine patches. People were supported by trained staff to receive their medicines.

We did not find that these shortfalls had impacted people's care. The provider had identified areas that required improvement through their own quality monitoring and developed an improvement plan. However, further time was needed for the registered manager to fully embed and complete their improvement plan before we could judge it to be effective in bringing about the required improvements.

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.

The majority of people and relatives we spoke with told us they felt safe and well cared for by the service.

Staff understood their responsibility to report concerns and poor practices. Staff knew how to report any incidents or accidents.

Staff understood their role to wear Personal Protective Equipment (PPE) in line with government guidance.

Systems were in place to engage with staff and people who use the service.

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 requires improvement (published 02 December 2022), 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 that not enough improvements had been made, and the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to verify if the provider made enough improvement in relation to previous breaches of regulations.

The inspection was also prompted in part by concerns we have received in relation to the quality of care 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.

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 remained requires improvement 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 Farecare Gloucestershire Limited 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 from 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 of regulations in relation to people's risk management, safe recruitment, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Farecare Gloucestershire Limited is a domiciliary care service providing personal care for people in their own home. At the time of the inspection, 34 people were receiving support from the service with personal care.

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

People and their relatives told us they felt safe and that staff supported them with their needs.

We found some improvements were needed to ensure safe recruitment practices were followed and to ensure audits were fully effective in identifying and addressing quality and safety concerns in the area of staff recruitment.

We found some improvements were needed to ensure people's risks were assessed and mitigated in areas such as eating safely and supporting people with diabetes. We found records relating to people’s risks required improvement to ensure staff had access to complete and up -to- date information about the care that had been agreed to keep people healthy and safe.

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. However, records did not always clearly evidence people’s mental capacity particularly in relation to decision specific areas such as support with medicines administration. We recommended that the provider reviews their systems of assessing and documenting people’s capacity.

We did not find that the shortfalls identified on inspection had impacted on people's care. At the time of the inspection, the registered manager had identified that some improvements were needed to the service and was in the process of appointing a designated person to implement these improvements and appraise the service. They shared with us their initial findings in areas such as record keeping in relation to people’s care documentation and quality monitoring systems as well as the monitoring of accidents and incident. However, auditing process had not been effective in identifying improvements required to people’s risk management, recruitment processes, medicines and assessments of mental capacity we found.

Staff had received training in recognising safeguarding concerns and knew the actions to take to protect people from harm. Staff had awareness of recognising and reporting signs of abuse or any incidents or accidents.

Systems were in place to engage with staff and people who use the service.

Staff understood their role to wear PPE in line with government guidance.

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 good (published 14 February 2020)

Why we inspected

We received concerns in relation to safe recruitment practices. 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 good to requires improvement 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 Farecare Gloucestershire Limited 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 safe recruitment practices, management of people’s risk and quality monitoring processes at this inspection.

We made a recommendation to support the provider's systems of assessing and recording people’s mental capacity.

Please see the action we have told the provider to take at the end of this report.

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.

Farecare Gloucestershire Limited is a is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 15 people at the time of our 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

People were protected from harm and abuse through the knowledge of staff and management. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. People's medicines were safely managed.

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.

People were treated with respect and kindness and their privacy and dignity was upheld. People and their representatives were involved in the planning and review of their care.

People's individual needs and wishes were known to staff. Electronic systems enabled staff to have easy access to people’s care records which could be promptly updated when the need arose. There were effective arrangements in place for people and their representatives to raise concerns about the service.

Effective quality assurance systems were in operation with the aim of improving the service in response to people's needs.

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 Good (report published 11 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was safe. There were sufficient staffing levels to ensure safe care and treatment. Where calls were late or missed the registered manager had software to deal with this and plans in place to deal with emergency situations. Risk assessments were implemented and reflected the current level of risk to people.

People were receiving effective care and support. Staff received training which was relevant to their role. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA).Staff supervisions and appraisals were being completed so staff were able to learn and develop. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in place supported this practice.

The service was caring. We observed staff supporting people in a caring and patient way. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence.

The service was responsive. Care plans were person centred and provided sufficient detail to provide safe, high quality care to people. There was a robust complaints procedure in place and where complaints had been made, there was evidence they had been dealt with appropriately.

The service was well-led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Regular meetings for staff and people who used the service were being completed.