Archived: Forever Homecare

Updated 1 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector and two Experts by Experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service did not have a manager registered with the Care Quality Commission. When a manager is registered with the Care Quality Commission, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 12 August 2021 and ended on 24 August 2021. We visited the office location on 12 August 2021, 13 August 2021 and 16 August 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and sought feedback from local authority professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with six people using the service, 17 family members and one friend of a person receiving support. We also spoke with nine members of staff, including six care and support workers, the care coordinator, manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also sought feedback from three further care and support workers by phone but received no replies.

We reviewed a range of records. This included 12 people's care and support plans, and eight people’s medication records. We looked at 13 staff files in relation to recruitment, training and supervision, and records in relation to five agency staff. We reviewed a variety of records relating to management of the service including policies and procedures, a staff handbook, training and supervision matrixes and quality assurance surveys.

After the inspection

We continued to review records shared electronically and continued to seek clarification from the provider to validate evidence found. We sought feedback from five professionals and received written feedback from one professional during the inspection process.

Updated 1 December 2021

About the service

Forever Homecare is a service providing care and support to people in their own home. At the time of the inspection the service was supporting 36 people, and we were told everyone received support with personal care. The service provided both regular daily visits to people receiving personal care and live-in staff members providing a 24-hour support service. The service supported people in Buckinghamshire and Berkshire.

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 supported by a service that was not well managed or monitored. Audits were either not in place, or not effective to assess, monitor and drive improvement in the quality and safety of people's support. The provider had failed to ensure everyone using the service had received an assessment of their needs and we found some people did not have a care plan in place. We also found the service had failed to display their CQC rating at their office base and website. Effective systems were not in place to meet the requirements of the duty of candour and the service had failed to inform the Commission of some information they are required to.

A manager had been appointed following our last inspection. The manager had engaged with people and families, who indicated their experience of service management had improved. Comments from family members included, “Much better since January”, “It’s now on an even footing, things running smoothly” and “I haven’t seen a difference in things good or bad. However [manager’s name] is very nice, very nice.” During the inspection the manager frequently visited people’s homes to discuss concerns, however we found written records were often absent and the office space was disorganised.

We found risks to people using the service were not clearly identified and managed. People’s care plans often contained outdated information or lacked sufficient detail to provide staff with enough information about how to safely manage risks. We also identified significant concerns in relation to the safe management of medicines, concerns regarding staff testing for COVID-19 and a lack of recording and oversight in relation to accidents and incidents.

The service identified required learning for staff and had sourced a new training provider, however training records showed significant gaps in training across the staff team. We identified several concerns in relation to the recruitment and deployment of staff. Since our last inspection staff rotas had been adjusted to consider travel time, and people and families indicated timekeeping had improved. People’s comments included, “Pretty much on time. Let me know if they are going to be late”, “95% of the time they are on time” and “They don’t come on time, they are late.”

Care plans did not always provide staff with details of people’s likes, preferences or protected characteristics. Since our last inspection we found people were more likely to receive support from regular staff and this also considered people’s cultural and language needs. People told us staff treated them with respect and communicated effectively. Feedback from families included, “They all speak Punjabi”, “They know how to communicate with Dad” and “They know how to make a cup of tea the way she likes and when she wants.” People described positive interactions with staff, with comments such as, “Very kind and respectful” and “The staff are all nice to me.”

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 and update

The last rating for this service was inadequate (published 4 March 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 25 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective 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 remains 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 Forever Homecare 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care and treatment, safeguarding from abuse, recruitment and staffing practices, good governance, duty of candour, assessing people's mental capacity to consent to care, display of CQC ratings, and in informing the Commission of information they are required to.

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

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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains 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.