Felicity Care

Felicity Care is a domiciliary care agency providing the regulated activity of personal care to people living in their own homes. At the time of our inspection there was one person using the service.

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

One relative told us that the care staff that supported their family member were kind and caring. However, despite this feedback we identified areas of concern similar to those from the previous inspection which had not been addressed.

Specific management policies and procedures in place were not reflective of best practice and current guidelines and lacked guidance on the processes to be adhered to ensure regulations were being met. The lack of management audits and checks meant that the issues we identified during this inspection had not been identified by the registered manager.

Staff recruitment processes had not been robustly completed and verified to ensure that staff employed were safe to work with vulnerable adults.

People received their medicines safely and as prescribed. Risks associated with people’s health and care needs had been assessed and guidance was available to staff on how to manage risk to keep people safe.

Staff were aware of their responsibilities to raise concerns if they felt a person was being abused. The service understood the importance of infection prevention and control and had measures in place to keep people safe.

Staff felt supported in their roles. The service worked in partnership with other organisations to support people and their relatives

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 8 April 2021). The service remains rated requires improvement. We identified issues relating to unsafe recruitment practices of staff and the governance of the service. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an announced focused inspection of this service on 16 December 2020. At the inspection we recommended that the provider consider current guidance on the management of medicines and that they consider training and guidance around maintaining appropriate and accurate care records.

We undertook this focused inspection as the provider had told us that they had made the required improvements and requested a review of their ratings as the current rating was impacting their ability to take on more work. During this inspection we found that whilst some improvements related to the recommendations made had been implemented, we identified further issues relating to recruitment of staff and good governance. This report only covers our findings in relation to the key questions of Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the previous comprehensive inspection to calculate the overall rating. The overall rating for the service has remained as requires improvement. 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 Felicity Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to regulations 19; fit and proper persons employed and 17; good governance. Please see the action we have told the provider to take at the end of this report.

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 also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Felicity Care is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection there were three people receiving support from the service.

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

Relatives were very happy with the quality of care given to their family members. The registered manager was described as being ‘very responsive’ to people’s needs. Care staff knew people well and people received a continuity of care. Relatives felt people were safe with staff that visited them. Staff had received training in safeguarding. Staff had received training around COVID-19 and the safe use of Personal Protective Equipment (PPE). People and relatives were able to give feedback on the service and care provided.

Despite positive feedback, we also found some areas of concern. We were assured people received their medicines and staff were trained to provide medicines support. However, we identified some concerns around the management of medicines. Some aspects of care and management oversight were not well documented.

We have made a recommendation around medicines.

We have made a recommendation around maintaining accurate and appropriate records.

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

Rating at last inspection

The last rating for this service was good (published 01 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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.

At the last inspection in February 2016, the service was rated ‘Good’. At this inspection we found that the service remained ‘Good’.

We carried out this inspection due to high number of safeguarding concerns that we had received about the service and how it was being managed.

Felicity Care provides home care services to people living in their own homes. At the time of the inspection the service provided personal care and support to 56 people.

People and relatives told us that they felt safe and happy with the care and support that they received from care staff from Felicity Care.

Care staff understood the term ‘safeguarding’ and were able to list the different types of abuse that people could experience. Care staff clearly demonstrated the actions they would take if they suspected that people they supported were being abused.

The provider had a variety of systems in place to ensure people were kept safe and free from harm. This included individualised risk assessments, robust recruitment procedures and safe processes to ensure the safe administration of medicines.

Sufficient staff were available to meet people’s needs. People and relatives confirmed they received care from regular and consistent staff with whom they had established positive and caring relationships.

Staff received induction and regular training to enable them to carry out their role effectively. In addition to this, staff confirmed that they also received regular supervision and an annual appraisal which supported them in their role.

Care plans contained consent forms that had been signed by people and relatives consenting to the care and support that they received from Felicity Care. Where possible, people were encouraged and supported to make choices and express their preferences in the least restrictive way possible. Policies and systems in place supported this practise.

People were supported with their nutritional, hydration and health care needs where this had been identified as an assessed need.

Care plans were detailed and person centred and clearly outlined the person’s needs and requirements as per their choice and preference. However, we did note that the provider did not always follow a consistent approach with all care plans that we saw. Care plans did not always include records of people’s likes and dislikes as well as some background information..

People and relatives knew the registered manager and felt able to raise any concerns or complaints and were confident that these would be dealt with and resolved appropriately. However, some people and social care professionals had raised concerns about the registered managers approach when issues or concerns were raised.

The registered manager had a number of systems in place which enabled the service to assess, monitor and improve the quality of care provision. This included spot checks of staff whilst at work and customer satisfaction surveys. However, some feedback from social care professionals that had been received and feedback from one person suggested that the registered manager was not always positive in their approach.

Further information about our findings is detailed in the sections below.

Felicity Care is a domiciliary care service specialising in providing rehabilitation support to people in their own home. At the time of our inspection there were six people who received personal care from the agency.

We last inspected the service on 1 July 2014 and found that the safeguarding policy did not include details to report all allegations or incidents of abuse to the local safeguarding team or the Care Quality Commission. We also found that complaints made by relatives were not recorded by the service. At this inspection we found that the provider had now met these standards.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 protected from abuse and avoidable harm. People told us they were happy with the support received from the service. The staff member we spoke to knew how to report alleged abuse and was able to describe the different types of abuse. Staff knew how to ‘whistleblow’. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service to external organisations such as the CQC.

Risk assessments were recorded and plans were in place to minimise risks for most people.

People were supported by suitably qualified and experienced staff. Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role. Staff members were suitably trained to carry out their duties and knew their responsibilities to keep people safe and meet people’s needs. One staff member had not received training on the Mental Capacity Act 2005 (MCA).

The staff we spoke with was not able to tell us the principles of the Mental Capacity Act 2005 (MCA) and how this was applied. The staff told us permission was always sought when providing support.

Staff received regular one to one supervisions. Staff told us they were supported by the registered manager.

People were supported to plan their support and they received a service that was based on their personal needs and wishes. People were involved in the planning of their care.

People told us they did their own weekly shopping and were able to buy their own ingredients.

There was a formal complaints procedure with response times. People were aware of how to make complaints and staff knew how to respond to complaints in accordance with the service’s complaint policy.

Questionnaires were completed by people and their relatives about the service, which we saw were positive.

Spot checks were carried out to provide feedback to staff on areas that needed improving and this was communicated to staff.

During this inspection we spoke with one person who used the service and six relatives of people who used the service. We also spoke with the registered manager, one member of office staff and three care staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

One person who used the service told us that they felt safe when being cared for by care staff in their own home. They also told us that staff treated them with respect and dignity. Relatives of people who used the service told us that they were confident that people living in the home were safe and had no concerns in respect of this.

The agency had a safeguarding policy. However, we found that it was not sufficiently comprehensive as it did not mention that the agency needed to report all allegations or incidents of abuse to the local safeguarding team or the Care Quality Commission.

We looked at the training records for care staff and noted that the records indicated that staff had received training in various areas which included safeguarding, health and safety and basic life support.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw that the necessary employment checks had been carried out prior to staff starting work.

Is the service effective?

We spoke with one person who used the service and six relatives of people who used the service and they were generally satisfied with the care provided by the agency and felt that people's needs had been met. One person who used the service told us, 'My carer is excellent. She is understanding, polite and respectful'. One relative said, 'The carer is absolutely excellent'.

Three relatives we spoke with commented on the lateness of care staff. Further, one person who used the service and two relatives told us that they experienced difficulties communicating with some carers due to a language barrier because some carers were not fluent in English.

We looked at a sample of four care records and saw that they contained assessments with details of the personal needs of people, routines and the type of care to be provided. Risk assessments were in place.

Care plans had been prepared following consultation with people who used the service and their representatives. Contracts for the provision of care services had also been signed by either people or their representatives.

We found that care plans failed to include information about people's preferred routines, people's interests and their likes and dislikes and we raised this with the registered manager.

Is the service caring?

People we spoke with were positive about care staff. They told us that they had been treated with respect and dignity by care staff. One person who used the service and relatives we spoke with told us that they felt comfortable around care staff.

Staff we spoke with said that they were aware that all people should be treated with respect and dignity and were able to give us examples to demonstrate how they ensured this.

Is the service responsive?

We spoke with one person who used the service and six relatives. The majority of people told us that if they had any concerns or complaints, they would feel comfortable raising them with the agency.

Relatives we spoke with confirmed that the registered manager had contacted them and had visited them to check whether they were satisfied with the quality of care received and to see whether any changes were required to their care package. One relative told us, 'Someone did visit to do a review' and another said, 'We have had reviews'.

The registered manager stated that telephone monitoring calls had been carried out to ensure that people who used the service or their relatives were happy with the care provided. In addition she stated that spot checks had been carried out to assess the competence of care staff and to ensure that they were carrying out tasks detailed in the care plans.

Is the service well-led?

We found that adequate arrangements were in place for monitoring and reviewing the quality of the service provided to people. A satisfaction survey had been carried out recently. Although the analysis of the results had not yet been completed, we noted that the completed forms we saw indicated that people who used the service or their relatives were satisfied with the services provided.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff meetings were held regularly and staff we spoke with confirmed this. All staff we spoke with told us that they felt able to consult the registered manager if they had concerns or queries and said that they felt supported. Staff were positive about working at the agency.

At this inspection we found the provider was still providing care to one person. The person was protected against the risks of receiving care or treatment that was inappropriate or unsafe. The provider was assessing and monitoring the quality of service. However the provider's policies and procedures did not include guidance for staff. The provider did not have a system in place to regularly review the information contained in these records and bring them to the attention of staff.

The person's needs were assessed and care and treatment was delivered in line with their individual care plan. The planning and delivery of care met some of the person's individual needs but did not ensure the welfare and safety of people.

Suitable arrangements were mostly in place to ensure that people were safeguarded against the risk of abuse. Staff were aware of how to recognise abuse but some staff were not aware of how to report abuse.

There was not an effective system to regularly assess and monitor the quality of service that people receive. We found a lack of policies and procedures in relation to obtaining people's consent, their care and welfare and safeguarding. The provider had a system in place to receive complaints and comments to improve the service.