Farecare Gloucestershire Limited

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

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

This meant people’s needs were not always met.

This service scored 50 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.Since taking over, the new manager showed they understood how person-centred care was best delivered by staff who had built a bond with and had knowledge of a person. The manager told us “We have tried to keep the same carers people had before and who know them well.” Feedback from people was positive. One person said, “[Staff] call 4 times a day and I never feel rushed; they spend time doing things properly.” One relative said, “They often come back and check on us even though it is not part of their working day.” Staff told us the manager updates them using their electronic app. One staff member told us, “The app tells us everything we need to know, and I always read up on [people’s] needs before I visit. I like to ask questions, and I would phone the office if I needed more information.” However, care plans we reviewed did not always include details on how staff could safely support and empower people to be involved in making decisions about their care. Care plans stated there may be a specific risk or need, but did not contain person-centred information on how to uniquely support each person. For example, 1 person’s care plan stated they may experience distressing symptoms of deteriorating mental health and required reassurance. However, there were no details on what the reassurance should consist of or reasons why the person may be feeling distressed, or when and how to escalate concerns to health care providers. Care was not always personalised to people’s individual needs and updated regularly. The manager did not regularly review people’s care to ensure people were able to explore the best options for them.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.People did not always receive care consistently as commissioned. There was a high number of care calls which were significantly earlier or later than expected. Records showed people did not always receive the right number of care staff to support them. For example, we saw 2 people who required 2 staff to attend their care calls but only 1 staff member attended for almost half of all of their care calls in a month. We were not assured people always received the commissioned care they required which increased the risk of harm occurring to people. People did not have health passports in place to support continuity of care. Staff were not aware of how they should hand over people’s care needs if they needed to go into hospital, and did not have any emergency grab sheets they could provide to paramedics. Staff told us they could access information from the care app used, but there was not a system or process the staff knew to initiate. This meant there was a risk people transitioning between health and care services may not always receive consistent and joined up care. One staff member told us, “One day a person I was supporting was unwell. I called the office. They said to call the DN's, but the DN’s said it was a GP issue, so I had to ring the office again and they said to call 111.” Systems were not in place to monitor people’s care and ensure effective consistent care was provided as and when people needed to move between health and social care services. This meant people’s experiences and outcomes may have been impacted.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.People had a service user guide which clearly described the expectations of the service and key contacts. People we spoke with told us they could get through to the office for out of hours support. Staff told us they had a system in place for out of hours support. Staff told us they were able to access the management team to raise concerns and request advice when they needed it. Staff told us advice given was appropriate and responsive to people’s changing needs.

The provider did not always make it easy for people to raise complaints about their care. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

People told us they felt listened to. One relative told us, “I never feel that I cannot pick up the phone and contact them in any way. Everyone in the office are all amazing. I don’t know what we would do without them.” A system was in place to record complaints, but at the time of the inspection the manager told us there had been no complaints. There was no system in place to review complaints for themes, actions taken and lessons learned. This meant if complaints were made opportunities to learn and improve outcomes for people could be missed. We were not able to establish how effective the complaints process and system was at this inspection.

The service did not always make sure people could access the care, support and treatment they needed when they needed it.Once someone was referred to the service or requested a package of care, the management team ensured a timely assessment was arranged. The package of care was reviewed, and staff were updated to the person’s needs using the electronic care app. However, we found inconsistencies in staff accessing specialist health and social care support when required. We also found instances where staff were not able to access the correct support for people in a timely manner due to misunderstandings around who the appropriate decision-making health professional was. We also found records were consistently missing regarding support received from external agencies. For example, records from district nurses for people self-administering insulin, and details on why a person was prescribed medical oxygen therapy and when this would be reviewed. This meant we could not be assured people received equitable access to other health partner agencies.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.The experience and outcomes people experienced differed as not all people always received their commissioned care calls. There were inconsistencies in the data we reviewed about care calls. Evidence showed staff did not always have enough travel time between care calls and therefore some care calls were either late or shortened. There was also evidence some calls were missed. However, we could find no direct impact on people.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.Some people did have outcomes recorded for end of life should it be required. Information was not person centred and did not detail what people’s wishes were if end of life care was required. The manager and NI did not have full oversight of their responsibilities and did not have systems in place to monitor this. However, we could find no impact on people due to this shortfall.