Farecare Gloucestershire Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Inadequate.

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.We received positive feedback from people’s relatives. One relative told us, “[Staff] made sure everything was in place … how to take photographs and updates of the [medicine] dosages and this was all kept in internal systems so that new staff know what to give [person] when. We put a log in place and [staff] liaise regularly with us if they have any concerns.” However, we did not find evidence which showed people, and their relatives were always offered and included in opportunities to review their care. We found people’s care and treatment plans were not up to date and not always reflective of people’s current care needs and associated risks. We found a lack of evidence to suggest appropriate partner agencies had been contacted where support was needed. The manager told us, “People’s needs are assessed when they start with the service. We include them, their family members and social workers. We document this on their customer file. We are trying to improve how we document things, so it is clearer who was involved and when.”

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.People were not always informed about current good practice which was relevant to their care, and they were not always involved in how this was reflected in their care plan. There was a lack of evidence to show the manager had completed relevant assessments to identify risks associated with nutrition and hydration and they did not have body maps in place for application of creams. For example, we found some people who required topical creams did not have body maps in place to guide staff on which areas to apply the creams. We found via a discussion with staff, 1 person had a diagnosis of a specific condition, but this information was not recorded anywhere within their care records. We were not assured staff had guidance available to them to ensure they delivered person-centred care which was in line with best practice and standards.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.Some people had information recorded in their care records regarding accessing advice from partner agencies such as Occupational Therapists, but contacts were historic. Care plans were not regularly reviewed so we were not assured what updates were sought based on people’s changing needs. There was a lack of information in people’s care plans on how they were supported with their health care including how they accessed the dentist, optician and GP. We saw from 1 person’s care records any concerns or changes were to be reported to the person’s relative. There was no information recorded about raising concerns with the GP when people's health deteriorated. This meant there was a risk medical intervention would be delayed. We did not see evidence which supported good communication with people's GP's which left them at risk, especially for people without next of kin. We found in 1 person's care records their GP had last been contacted in 2023, despite them having significant health concerns. In another person’s care records advice from the local authority regarding an occupational therapy assessment had last been sought in 2024, but there was no evidence found to suggest recent contacts with health and social care professionals had taken place. We were not assured people received appropriate health care support which left people at significant risk of harm to their health and wellbeing.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.Some people had information recorded in their care records regarding accessing advice from partner agencies such as Occupational Therapists, but contacts were historic. Care plans were not regularly reviewed so we were not assured what updates were sought based on people’s changing needs. There was a lack of information in people’s care plans on how they were supported with their health care including how they accessed the dentist, optician and GP. We saw from 1 person’s care records any concerns or changes were to be reported to the person’s relative. There was no information recorded about raising concerns with the GP when people's health deteriorated. This meant there was a risk medical intervention would be delayed. We did not see evidence which supported good communication with people's GP's which left them at risk, especially for people without next of kin. In one person’s care records advice from the local authority regarding an occupational therapy assessment had last been sought in 2024, but there was no evidence found to suggest recent contacts with health and social care professionals had taken place. We were not assured people received appropriate health care support which left people at significant risk of harm to their health and wellbeing.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.For example, there was no reliable monitoring of what people ate, drank or events that led to incidents. Although there were clinical monitoring tools to assess people’s risks, the actions required to mitigate the assessed risks were not fully recorded or embedded. Staff did not have all the information they required to know how to mitigate the known risks. This meant people were at risk of dehydration, falls and weight loss.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.Staff were aware of offering people choice and not forcing people to receive care, but we were not assured staff fully understood The Mental Capacity Act (MCA). One staff member told us “We have 1 client with dementia, but it's not normally too bad, I try to offer 2 choices. It's about communicating with [them] in the right way and giving [them] visual options. We get on very well.” People’s care plans did document some detail around the support they required, but information was not recorded regarding people’s capacity, ability to consent and the support they required to enable them to make decisions. Therefore, people were not always supported in accordance with the Mental Capacity Act. We reviewed care records for 8 people who were living with dementia or who had memory difficulties and found no mental capacity assessments had been completed, nor did records show the provider had conducted mental capacity assessments to determine people’s capacity to consent to making specific decisions. This meant people were not informed of their fundamental human rights to refuse care and support. Therefore, we were not assured staff would always recognise when a person may be lacking capacity to consent to care and treatment.