FHS24 Nursing+Care Agency

FHS24 Nursing+Care Agency is a care at home service that provides personal care including supported living and live in care for people with learning difficulties, mental health, autism and older people. At the time of the inspection four people were receiving support with personal care. People had limited verbal communication, so we captured some of their experience through observations.

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.

The service for people with learning disabilities and/or autism has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

Improvements had been made with recruitment practices, the provider was now notifying the Care Quality Commission in line with legislation and the provider’s auditing systems had identified concerns. However, it is not clear whether these improvements were sustainable yet. Additionally, small concerns found on the inspection had not always been identified by the management. Although they were proactive at responding to them.

People told us they were happy and appeared comfortable in the presence of staff. Medicines were administered safely. Most risks had been identified with ways to mitigate them in place. However, concerns were found with one person who had a specialist eating and drinking plan. Following the inspection, the registered manager had taken action to rectify them. Records and processes around the management of behaviours which could challenge themselves or others were in place.

The management strove to be open and constantly develop and improve the support people were received. When systems had identified issues, actions were being taken.

People were supported by enough staff to meet their needs. Staff had received a range of training including specialist courses in health and social care. Care plans were personalised and provided a range of information for staff to use to support people’s needs and wishes. There were good links with other health and social care professionals.

Staff were kind and caring and knew the people they were supporting well. Staff respected privacy and dignity. Links had been developed with the community which had a positive impact for people. Independence was promoted, as were the values of treating each person as an individual.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service who had learning disabilities and/or autism can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service with learning disabilities and/or autism reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 4 January 2019) and there were multiple breaches in regulation. The provider completed an action plan and met with us to tell us how they would improve. We also completed an inspection to follow up the warning notice (published 13 June 2019) where the rating was not change. At this inspection we found improvements had been made and the provider was no longer in breach of any regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Since the last inspection we recognised that the provider had failed to display their ratings on their website. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

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

FHS24 Nursing + Care Agency is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to, older and younger disabled adults including people on the autistic spectrum. The agency also provides unregulated services such as care staff to nursing and care homes and support in the community for people who do not require personal care.

At the time of the inspection, the service was providing care and support to four people living in their own homes and three of them were under supported living arrangements. This was so that they could live in their own home as independently as possible. People using the service required up to 24-hour support from staff due to their disabilities or needs.

People’s experience of using this service:

People were still not being supported by staff who had been safely recruited in line with current legislation and the provider’s policies. Staff recruitment records continued to not have complete employment histories with gaps in employment that had not been checked by the provider. There continued to be inconsistencies between references checked and declared employment histories. Systems were still not fully in place to monitor the recruitment of staff with positive criminal checks.

There had been improvements. Most staff had police checks prior to starting work. Systems were in place to prevent staff who did not have permission to work in this country from working illegally.

Rating at last inspection:

We carried out a comprehensive inspection of FHS24 Nursing + Care Agency on 2 and 4 October 2018.

At the October 2018 inspection, the service was rated requires improvement overall. ‘Safe’ was rated requires improvement. This rating will not change because it was only a warning notice follow up inspection. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘FHS24 Nursing + Care Agency’ on our website at www.cqc.org.uk

Why we inspected:

Following the October 2019 inspection, we served a Warning Notice for a breach of Regulation 19 of the Health and Social Care Act 2008, Fit and Proper Persons Employed.

We undertook a focused inspection on 10 April 2019 to check the provider was meeting the legal requirements for the regulation they had breached that resulted in them being served a Warning Notice. This focused inspection was to ensure the provider had taken sufficient action to ensure people were protected from unsuitable staff working with them. This report only covers our findings in relation to these areas.

Enforcement:

The service continued to be in breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Fit and Proper Persons Employed. The provider has not met the requirements of the Warning Notice and a further check on this will be made.

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 continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

At the last inspection, we found concerns with medicine management, people with specific health needs had not had risks considered and recruitment processes were not in line with legislation. This led to two breaches of Regulation in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection, the provider sent us an action plan to show us how they were going to resolve the concerns and in what timescale.

During this inspection we found there had been improvements with most medicine management and assessing people’s health needs. However, we found continuing issues with the recruitment process. We also found several new concerns including how well led the service was.

FHS24 Nursing and Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and live in carers when it is required. It provides a service to, older and younger disabled adults including people on the autistic spectrum. The agency also provides unregulated services such as care staff to nursing and care homes and support in the community for people who do not require personal care.

This service provides care and support to four people living in their own homes and three of them were under supported living arrangements. This was so that they can live in their own home as independently as possible. People using the service required up to 24-hour support from staff due to their disabilities or needs. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living or care in people’s own homes; this inspection looked at people’s personal care and support.

Not everyone using FHS24 Nursing and Care Agency receives 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.

The care service for people with learning disabilities has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. “These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service had a registered manager in post who is also one of the directors. 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. The registered manager is supported by the managing director to run the service.

The service was not being well led. Although the management had developed positive relationships with people. People and their relatives were happy with the support they received. We found systems were not identifying concerns found during the inspection. There was not a demonstration by the management of learning from previous inspections. Notifications to other bodies were not always being completed in line with current legislation.

People using the service thought they were kept safe. Most medicines were managed safely. Some improvements were made during the inspection with records around ‘as required’ medicines and temperature checks for medicine storage. Risk assessments were now carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. Recruitment systems continued to fail to follow current legislation.

People were protected from potential abuse because staff understood how to recognise signs of abuse and knew who to report it to. However, systems were not always in place to manage potential safeguarding incidents. Staff had been trained in areas to have skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to see other health professionals

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. Staff understood the processes when people lacked capacity to make decisions. People were supported, when required, to eat a healthy, balanced diet. Success had been found when people wanted to lose weight to become healthier.

Care and support was personalised to each person which ensured they could make choices about their day to day lives. Care plans reflected people’s needs and wishes and they had been involved where possible. People knew how to complain and there was a system in place to manage them. Although, none had been received since the last inspection.

People told us, and we observed, that staff were kind and patient. People’s privacy and dignity was respected by staff. Improvements could be made with some language used when recording care that was provided. People’s cultural or religious needs were valued and they were involved in decisions about the care and support they received.

We found two breaches of regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of regulations in the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.

We made two recommendations. One was about safeguarding processes and the other was about how information is shared with people who use the service.

FHS24 Nursing and Care Agency is registered to provide personal care to people in their own homes. Most people receiving support from the service had complex needs including learning disabilities and autism. As a result they had limited verbal communication skills so were unable to speak with us. At the time of our inspection there were four people using the service. The service worked alongside other care agencies to provide larger packages of support for nine other people.

The service had a registered manager. 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 and relatives told us they felt safe. We found improvements could be made with some of the medicines administration procedures. Staff knew people’s preferences of how they liked to take them. However, one medicine was not being administered as prescribed and there were gaps in records which meant it was difficult to monitor stock and evidence that people has received their prescribed medicines.

Most people's health care needs were monitored and met. Staff and the registered manager made sure people saw the health and social care professionals they required and implemented any recommendations made which people agreed to. However, there were occasions when risks associated with health needs had not been considered and staff had not been provided with guidance.

Quality assurance systems did not identify all concerns found on the inspection. There were limited records to demonstrate learning from issues found by the management. Complaints were being managed. However, there were not always records in place to demonstrate actions had been taken and the lessons learnt.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and knew the procedures to follow if they had concerns. Staff told us concerns raised would be appropriately managed. However, a safe recruitment procedure was not always being followed because potential employees had not always received complete checks before starting to work with people and when concerns had been highlighted risks had not been considered.

People were supported by sufficient numbers of staff to meet their needs. There was a system in place to ensure staff who did not drive were on time. No person or relative reported concerns about missed calls. Staff were supervised informally and had annual appraisals. They told us they received enough training to meet most people’s needs. However, we found there had been gaps in identifying some training staff required to keep people safe.

Staff supported and respected the choices made by people. People’s cultural and religious diversity was respected. People who required special diets received them and staff understood their needs.

People and their relatives thought the staff were kind and caring and we observed positive interactions. People’s privacy and dignity was respected by staff. Staff had good knowledge about people’s needs. The needs of the people were reflected in their care plans.

We found two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.