FCNA Homecare

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to the need for consent and decision making.
 

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We did not see information showing how assessment findings informed care plans or how changes in people’s needs were reviewed with them or those important to them. Assessments used to manage the risk of pressure damage, including the Waterlow assessment, were not consistently completed or reviewed. This meant we could not be confident that risks were identified promptly or that assessments reflected people’s needs over time.

There was limited evidence to show how risks of deterioration were identified or monitored where appropriate. As a result, we could not be assured that people’s changing needs were consistently recognised and responded to.

We could not see how staff evaluated whether identified risks, such as weight loss or reduced mobility, had improved or deteriorated over time, limiting assurance about ongoing assessment of people’s needs.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Structured clinical tools that form part of recognised evidence based practice, such as MUST, Waterlow and falls risk assessments, were not used consistently, and some were completed only after our assessment started. This limited the assurance needed to demonstrate care was planned using up to date clinical information.

We could not confirm how staff measured the impact of care interventions, such as hydration support or skin care plans, to ensure they were aligned with evidence based practice.

We did not see information showing how staff applied clinical guidance or used professional input when care needs became more complex, including managing deterioration or repeated refusals of medicines.

Care plans and assessment documents submitted did not demonstrate how best practice frameworks informed decisions or how people’s preferences were incorporated into treatment planning.
 

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We did not see evidence to demonstrate how information about people’s medicines was shared or coordinated with external professionals where appropriate, such as when changes to medicines occurred or risks were identified.

While there was evidence of some communication with external healthcare professionals, we did not see clear or consistent evidence within the information available to demonstrate how staff were receiving, recording or following directions from these professionals in a structured way. There were limited examples showing how external clinical input was formally incorporated into care planning or delivery. This meant we could not be assured that information from other professionals was consistently understood, acted upon or communicated to support safe and joined up care.

We did not see evidence of structured reviews, outcome monitoring or risk trend analysis, which meant staff did not have consistent information to support coordinated care or communicate changes effectively to healthcare partners.

Safeguarding relevant events, such as falls and environmental hazards, were not recorded as threshold decisions or learning events, limiting assurance that concerns were escalated or discussed across teams.
 

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

There was limited evidence to demonstrate how staff recognised early signs of deterioration or changes in people’s health, or how these were monitored where appropriate. This meant we could not be assured that health risks were consistently identified and acted upon in a timely way.

We did not see evidence to demonstrate how staff used structured approaches, where appropriate, to assess or review risks such as falls or changes in condition. This limited assurance that people’s health risks were consistently identified or reviewed over time.

Repeated refusals of medicines were not escalated or clinically reviewed, meaning the provider could not demonstrate how they supported the person to understand risks, maintain health or access professional advice.
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was limited evidence to demonstrate how the provider reviewed information over time to identify trends or changes in people’s outcomes. This meant we could not be assured that monitoring activities were used effectively to understand whether care was improving, remaining stable or declining.

Some information about people’s care was recorded, but the use of structured assessment tools to support outcome monitoring was inconsistent. Leaders acknowledged that only basic information was captured within the care planning system, which restricted the service’s ability to track whether people’s outcomes were improving, declining or remaining stable, particularly where risks were emerging.

Although the provider collected operational data, such as visit completion and observations recorded during care, this information focused mainly on activity rather than outcomes. Records did not consistently show how this information, or learning from incidents and risks, was analysed or used to inform adjustments to care. As a result, the provider could not always demonstrate how monitoring arrangements supported improvement in outcomes for people.
 

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

There was insufficient evidence within the information available to demonstrate how people’s mental capacity was assessed, how decisions were made in their best interests where required, or how consent was sought and respected in line with legal requirements, particularly in more complex situations or where restrictions were in place. The provider confirmed there was no established process for best interest decision making or oversight of restrictive practices.

Feedback from people using the service indicated that staff generally asked for consent and involved people in day to day decisions about their care. However, there was no clear evidence to demonstrate how consent was considered in more complex or restrictive situations, or how people’s rights were upheld where capacity may have been in question. This limited assurance that decisions were made lawfully, proportionately, and in line with people’s rights.

We did not see evidence to demonstrate how restrictions on people’s liberty were recognised or considered in line with the Mental Capacity Act. In situations where restrictions were in place, we could not be assured that appropriate legal processes had been followed to ensure these were lawful and proportionate.