Archived: Fairhaven Healthcare Ltd

Fairhaven Healthcare Limited is a domiciliary care agency. It provides personal care to people living in the community. At the time of inspection Fairhaven Healthcare Limited was providing personal care to 31 to people in their own homes. 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 did not always receive a service that ensured their safety.

Medicines were not managed safely. There was a lack of oversight of medicine administration. There was a lack of information about some people's medicines such as what they took and what the medicines were for. Medicine administration records were not always complete.

Risks to people's health and wellbeing had not always been assessed, monitored or mitigated effectively. People were at risk of harm because staff did not always have the information they needed to support people safely. The provider had not established an effective system to ensure people were protected from the risk of abuse.

Staff were not recruited safely. This meant people were potentially at risk of staff being employed

to work with them who were not suitable. There were not enough staff to ensure people received support in a timely way that met their needs and preferences.

The service was not well led.

The registered person did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified concerns or driven sufficient improvement relating to service quality. Records were not always complete. People were not always given the opportunity to feedback about their care. The lack of robust quality assurance meant people were at risk of receiving poor quality care.

Following the inspection, the registered person acknowledged the concerns that we identified during the inspection and told us of their plans to make improvements regarding care records, medicine records, staffing, recruitment, training and quality assurance systems.

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 (report published 9 October 2019). There were multiple breaches of regulation. We issued a warning notice requiring the provider to make improvements regarding the safe care and treatment of people.

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

At this inspection, we identified five breaches of regulation in relation to safe care and treatment, safeguarding people from abuse, the employment of fit and proper persons, staffing and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Why we inspected

We undertook this focused inspection to confirm the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

Follow up

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.

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

People’s experience of using this service:

Risks to people were not always effectively identified and managed to ensure people were appropriately protected.

Medicines were not always safety managed in line with best practice guidance. The provider had failed to make adequate improvements since the service’s last inspection.

The provider had limited quality assurance processes in place to monitor the delivery of people’s care. We found these were not always effective or robust to identify and drive improvements.

We received mixed feedback from people that their care was delivered at the preferred time to meet their needs. We have recommended the provider review their care call schedules.

The provider’s recruitment practice did not always ensure new applicants provided a full employment history.

We received mixed feedback from people and their relatives about being involved in the planning and reviewing of their care.

People’s rights and freedoms were not always protected. Where people were considered to lack capacity, systems and processes did not always reflect compliance with the principles of The Mental Capacity Act 2005.

People told us staff were caring and supported people to maintain their privacy and dignity.

Morale amongst staff was positive and staff told us they felt supported in their role by the general manager.

Rating at last inspection:

This service was previously rated as requires improvement at the last comprehensive inspection and found to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. That report was published on 22 May 2018.

Why we inspected:

All services rated requires improvement are re-inspected within one year of our prior inspection. This was a planned inspection based on the previous inspection rating.

Enforcement:

We found breaches of four regulations at this inspection. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

Until the provider can show they are compliant with the fundamental standards in the regulations, we will continue to monitor the provider's progress in line with our published protocol for services rated requires improvement. These procedures will include meeting with the provider and requesting an agreed improvement plan with timescales.

Not everyone using Fairhaven Healthcare Limited received a regulated activity; CQC only inspects the service being received by people provided with 'personal care' help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

This inspection was undertaken on 13 and 17 April 2018. At the time of the inspection approximately 70 people were receiving a regulated activity from Fairhaven Healthcare Limited.

A registered manager was 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.

People were not always support to take their medicines safely and relevant national guidelines were not always followed in relation to the safe administration and management of medicines.

Where accidents, incidents, and near misses had occurred there was a process in place which recorded the incident. However, this process was not robust. This meant that any themes or trends would not always be identified which could result in effective and appropriate action not being taking in a timely way that would mitigate future risks.

There was a lack of effective systems and processes in place to monitor the quality and safety of the care provided; which would allow timely investigations and highlight potential learning and continual improvement.

We received positive feedback from people about the service. They expressed satisfaction and spoke highly of the staff and management team. All the people and family members who were asked if they would recommend the service to others said they would.

People and their families told us they felt safe. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. Risks relating to the health and support needs of the people and the environment in which they lived were assessed and managed effectively.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people in their own homes. There were sufficient numbers of care staff to maintain the schedule of visits. People were satisfied with the consistency of the staff; however some people reported that call times were not consistent.

Staff completed an induction programme and were appropriately supported in their work by the management team. People and their families described the staff as being well trained and they were confident in the staff's abilities.

Staff and the management team knew how legislation designed to protect people's rights affected their work. They always asked for consent from people before providing care.

Where people required support with eating, drinking or meal preparation this was provided appropriately. Care plans were detailed, informative and supported staff to provide effective care and support to people. Staff understood people's healthcare needs and people were supported to access healthcare professionals when needed.

People who used the service felt they were treated with kindness and said their privacy and dignity was respected. Staff knew the people they provided care to well and understood their physical and social needs.

At the time of the inspection no one using the service was receiving end of life care. However the care manager assured us that people would be supported to receive a comfortable, dignified and pain-free death.

People and, when appropriate, their families were involved in discussions about their care planning and given the opportunity to provide feedback on the service. They were also supported to raise complaints should they wish to.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.