Archived: Fairmeadows Home Care Office G05

Fairmeadows Home Care Office GO5 is a domiciliary care agency. It provides personal care to people living in their own houses in Northumberland. It provides a service to older adults and younger adults. There were 60 people using the service at the time of our inspection.

We inspected Fairmeadows Home Care Office GO5 [hereafter referred to as Fairmeadows] in January 2016 when we found two breaches of regulations related to safe care and treatment and good governance. In July 2017, we inspected and found improvements had been made in each of these areas and rated the service good.

There was a registered manager in place. He was also the registered provider and director of the company. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found serious shortfalls in many areas of the service. The overall rating for this service has deteriorated from 'good' to 'inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any of key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or varying the terms of their 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.

At the time of our inspection, the provider had agreed with the local authority not to accept any new care packages.

There were shortfalls and omissions with the management of risk. Documented risk assessments were not always in place for identified risks such as bed rails and choking.

Procedures for the safe storage and administration of medicines were not always followed, and some medicines records were unclear which posed a risk to people.

Safe recruitment procedures had not been followed including appropriate checks by the Disclosure and Barring Service [DBS] and identity checks. Suitable numbers of staff were not employed to ensure calls could be completed in a timely manner.

People told us they felt safe with regular staff, but less so at the weekend when a high number of unfamiliar or less experienced staff supported them. Procedures for supporting people with finances were not sufficiently robust. Receipts for transactions carried out by staff on people’s behalf were not always available.

Office staff felt unsupported and were taking responsibility for the operation of the service. They were dedicated to supporting staff and people, who were, in the main, complimentary of the support provided by them. Office staff had not received formal supervision.

People were not always supported to have choice and control of their lives. Records did not demonstrate that staff supported them in the least restrictive way possible and policies and systems in the service did not always support this practice.

People were supported with eating and drinking but specific risks relating to eating and drinking and special dietary advice was not always recorded in people’s care records.

We observed a number of caring interactions between staff and people, and we saw that the privacy and dignity of people was maintained. Records however, did not demonstrate that people were always included and involved in their care.

Care plans were in place, but these were basic in design and lacking in individual detail. People’s relatives often left information around the home including instructions for staff about people’s needs and preferences. This information had not been formally incorporated into care records to ensure consistent and safe care was provided.

The complaints procedure was not always followed by the provider. We spoke with some people and relatives who told us they had had cause to complain and said that their complaints had been resolved. There was no evidence, however, of any response to the complaints of another relative.

The service was not well led. The registered manager and provider did not have an overview of the service and no audits had been carried out to monitor the quality and safety of the service. They had been spending time driving staff to visits and ensuring calls were covered which meant they had limited time in the office. The other director for the service was absent during the inspection. Staff told us the amount of time the other director had spent in the office in recent months had decreased.

There were gaps in records related to people, staff and the management of the service. There was confusion about the roles and responsibilities of staff working in the office which meant it was difficult to ascertain who was responsible for specific tasks.

There was no evidence that feedback had been obtained from people, relatives, staff or visiting professionals about the quality of the service.

Staff expressed concerns about the financial management of the service including concerns about their pay. Concerns were raised by staff about the financial management of the service. We used our regulatory powers to request information about the provider’s finances. The registered manager was unable to provide us financial information during the inspection because they did not have access to the necessary systems.

Following the inspection the provider wrote to tell us they planned to close the service and transfer the business to another care provider.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, the need for consent, receiving and acting upon complaints, fit and proper persons employed, staffing and good governance.

You can see the action we have told the provider to take at the back of this report.

At the time of the inspection, the service was actively providing care to 85 people in Northumberland.

At our last inspection of this service in April 2015, we gave the service a rating of 'requires improvement' and asked the provider to take action to make improvements. This was because we found the provider had breached Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider sent us an action plan outlining the action they would take to meet this regulation. At this inspection, we found these regulations had been met and the rating had improved from 'requires improvement' to 'good.'

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.

We checked the management of medicines and found that improvements had been made and these were being managed safely. New paperwork had been introduced to ensure instructions were clear to staff.

Staff were seen to follow correct infection control procedures and used personal protective equipment correctly. There were ample supplies of gloves and aprons. This had improved since the last inspection.

Risks to people were identified and plans were in place to mitigate these. Risk assessments were carried out to identify potential risks to staff in people’s homes including whether there were any obvious hazards or pets present.

Staff recruitment procedures included checks on the suitability of staff to work with vulnerable people. Staff did not work unsupervised with people until full recruitment checks had been completed. Some staff records did not contain full dates of previous employment history and we have made a recommendation about this.

Staff had received training in the safeguarding of vulnerable adults, and a safeguarding and whistle-blowing policy was in place.

We received mixed reports about staffing. The provider was in the process of recruiting additional staff, and some staff told us they were very busy. Other staff and people using the service told us they thought there were sufficient staff available. Steps had been taken by the provider to review workloads and new work patterns had been introduced to help relieve pressure on staff.

Accidents and incidents were recorded and reviewed on a regular basis.

An in-house trainer was employed by the service who was qualified to deliver training to staff. There was a mixture of e-learning (computer based training) and face to face. Staff received an induction and shadowed experienced staff until they were confident and deemed competent to work alone. Staff received regular support and supervision from office based staff.

The service was operating within the principles of the Mental Capacity Act 2005. People had maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people with meals, and food hygiene training was provided. Where people required specialist support with eating for medical reasons, bespoke training was provided to staff by the district nurse.

We observed that staff were caring and courteous when visiting people. They displayed warmth and a good knowledge of the individuals, with whom we saw they had a good rapport. We received positive feedback about the staff from people and their relatives.

The privacy and dignity of people was maintained, and staff were sensitive and discreet when discussing their care needs. They involved people during their visits and supported them to maintain their independence where possible.

Person centred care plans were in place and we received positive feedback from people and relatives about the responsiveness of the service. Other people and relatives were critical of how responsive the service was due to fluctuating visit times and high numbers of staff involved in some people’s care. Staff told us the only complaint they had about working for the provider was lack of travel time between visits. The provider had picked this up through their own quality monitoring and plans were in place to address these concerns. We have made a recommendation about this.

A number of office based staff had been recruited since the last inspection to support the provider in the running of the service. These included coordinators and human resources staff. Office staff had additional responsibilities such as training and quality improvement, and there had been investment in computer systems to support the effective operation of the service.

We received feedback that office staff including the provider were supportive, approachable and helpful. They listened to staff and supported them to work flexibly where required. Morale appeared good amongst staff who told us they enjoyed working for the provider.

Fairmeadows Home Care is based in Ashington, Northumberland. It provides domiciliary care to people across the south east of Northumberland. At the time of the inspection the service was supporting 40 people.

At the time of our inspection there was a registered manager in place. Our records showed he had been formally registered with the Commission since November 2011. 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 was also a director of the company.

People told us they felt safe when receiving care. They told us they trusted the care workers who supported them and looked forward to them visiting. Staff told us they had received training in relation to safeguarding adults and would report any concerns to a senior member of staff. The provider had dealt with three safeguarding issues in the last 12 months and had involved adult safeguarding services appropriately, although they had failed to notify the CQC of the incidents.

Processes were in place to recruit staff and to carry out checks to ensure they were suitably experienced to support people with their personal care needs. Some staff had joined the service with existing Disclosure and Baring Service (DBS) checks. The manager told us risk assessments, to ensure that it was appropriate to accept previously issues DBS certificates, were undertaken. However, these assessments were not formally recorded. People told us that staff generally attended appointments on time, although there were occasional late calls. People told us there had been missed calls in the past but these were not regular events.

Staff told us there was always a senior care worker on call to provide information and advice. Senior care workers could also call on managers or directors for advice and support, if necessary. Senior care workers on call had access to care plans and information on line to deal with any questions or queries.

There were no clear records of the medicines that care staff were administering or supporting people to take. There were no care plans for “as required” medicines, meaning there were no instructions for care staff about how and when these medicines should be given. There were no body maps or visual indications of where creams or topical medicines should be applied. Medicine records were in the form of a daily log making it difficult to see how often medicines had been given or omitted.

People told us they felt that staff had the right skills to support their care. Staff told us they had received sufficient training to carry out their roles. The provider was moving to an on line training system which would support the regular review and updating of staff training. Staff told us they received regular supervision and we saw documents that supported this. The manager told us that only a small number of staff had been with the service more than a year and he had not yet arranged annual appraisals.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. The manager was not aware of anyone supported by the service who was subject to an order under the Court of Protection (CoP). Questions about CoP orders and Power of Attorney were not routinely included in the assessment process. We have made a recommendation about this.

People told us that they found staff caring and supportive. We observed there to be good relationships between people and the care workers who supported them. They said their privacy and dignity was respected during the delivery of personal care and support. People were also supported to maintain their well-being, as staff worked with district nurses or would support people to contact their general practitioner, when necessary.

People’s care needs were assessed, although a formal record of the assessment undertaken was not always available in people’s records. Care plans detailing the type of support people should receive where contained within care records in people’s homes. Staff told us there was sufficient information for them to carry out care effectively and people told us staff often referred to the plans when they visited. Care plans did not always have a date to indicate a maximum time before they should be reviewed. The provider had a complaints procedure in place. There had been no formal complaints within the last 12 months. People told us they had not raised any recent complaints and any issues or concerns they had raised were dealt with.

Senior care workers undertook regular spots checks on care workers to ensure they were providing appropriate levels of care. Wider audit and checking processes were not always in place, particularly around the safe administration of medicines. Records related to assessments of people’s needs or risk assessments for staff were not routinely recorded. Questionnaires had been sent to people to ascertain their views of the service. Indications from the questionnaires were that people were positive about the service. Staff told us there were regular meetings and information was provided to ensure they were up to date about any changes in systems. Daily records were up to date and contained good details. The provider had failed to notify the CQC of significant events related to the running of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. We also found a breach of the Health and Social Care Act 2008 (Registration) Regulations 2009, in that the provider had failed to notify us of incidents they are legally required to do so. You can see what action we told the provider to take at the back of the full version of the report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found '

Is the service caring?

The person we spoke with told us that he was happy with the service that he received. During our conversation with him he told us, 'He (the manager) has gone out of his way to ensure I have had the help I need'; 'Out of all the care companies I have been with he gives the best service' and 'The carers are sound as a pound.' He also told us, 'He's (the manager) always ready to sort out anything I need.'

We saw people's care plans contained information about their particular needs and covered areas such as an overview of the person's current health or social needs, personal support, mobility, medication and domestic support. We found that records contained specific plans related to each section.

Is the service responsive?

The manager told us that before delivering care he would visit people in their home to ascertain their wishes with regard to the type of care they required and how they wanted support to be delivered.

We saw in people's care plans that after each section of the plan there was a section entitled, 'How I like to be supported'.

We spoke with one person who used the service. He told us, 'You get more of a personal approach; you are not just a number on their books.' He also said, 'They treat me with respect and I treat them with respect. They have always got time for you.'

Is the service safe?

The person who used the service, and staff confirmed that they could contact the manager at any time if there was a problem. One care worker told us, '(the manager) gives us lots of support; you can ring them up anytime.' The person who used the service told us, 'He's always ready to sort out anything I need.' The care workers told us that if they were concerned about the person's health they would contact the local health or emergency services for advice or support. This meant there were suitable arrangements to deal with an emergency.

We saw evidence that prior to people accessing the service the provider carried out risk assessments to ensure that individual's needs could be met safely. We saw that there were risk assessments in relation to the home environment, and whether specialist equipment was to be used such as a wheelchair or a hoist.

Is the service effective?

People's care records indicated that the provider worked closely with other professionals and services to supports people's needs.

We spoke with one health professional about how they worked with the provider. They told us, 'They are excellent. They always react; always get back to you on the 'phone.' The person who used the service told us, 'He's (the manager) always ready to sort out anything I need.'

The provider had a range of experience and training to support them in delivering effective care and support.

Is the service well led?

The provider had a strong ethos on delivering individually tailored, high quality care based on a range of service delivery in the care sector. Services were based around a highly personal service.

Care was provided by a small group of care workers so that people's individual needs were always at the forefront of care delivery. One person who used the service told us, 'For the effort the lad puts in, he deserves every success. He has gone out of his way to ensure I have the help I need.'

The manager told us that because of the brief period of full operation there had been no accidents or incidents, no safeguarding issues and no complaints. He told us he would be considering ways on how to obtain feedback from people using the service to help maintain and improve the standard of care.

Where additional help and advice was required the provider sought professional input and support to ensure the person's welfare and health were maintained.

Care plans were detailed with good information for staff to follow. One person told us, "It's brilliant. It's the best care I've had since I've been ill. I look forward to them coming." One relative told us, "They are very good. They are very observant, if anything is amiss."

The provider had a safeguarding policy available. Staff told us they had undertaken safeguarding training. We saw copies of certificates that confirmed this. Staff were able to describe what was meant by safeguarding and their responsibility in protecting vulnerable people.

People were assisted to take their own medication. One person who used the service told us, "They are very helpful. They help me take my tablets; open the pack for me and make sure I have a drink."

People confirmed the required number of staff always attended visits. One relative told us, "There are always two carers and they are here for the full hour in a morning." All staff had or were about to complete a level three National Vocational Qualification in care.

We saw the provider had a complaints process. One relative told us, "I've not had reason to complain. They are very open to what you have to say."