FCNA Homecare

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate.

This meant people were not safe and were at risk of avoidable harm.

The provider was in breach of legal regulation in relation to the safe care and treatment.
 

This service scored 34 (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 have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

Evidence submitted did not demonstrate a structured approach to learning from incidents, safeguarding concerns or medicines related risks. There was limited evidence to show how information was captured, analysed or used to identify patterns, including where key records, such as medication administration records (MARs), were not available to support oversight. This reduced assurance that leaders could effectively identify or learn from medicines related risks or assure themselves that staff were competent to manage medicines safely.

Incidents that could have contributed to organisational learning, such as falls and home environment hazards, were not logged in a way that allowed leaders to identify trends or embed lessons across the service.

The evidence submitted did not show how leaders oversaw learning from routine environmental checks. This meant we could not confirm whether safety risks identified in people’s homes were addressed and analysed or used to support service wide improvement.
 

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We did not see consistent evidence that concerns arising during people’s care were appropriately triaged. This meant safety related information was not always escalated in a timely way, shared with relevant healthcare partners, or used to guide joint decision making.

As a result, gaps were evident in core care coordination documentation, including PRN guidance and medicines reconciliation records. This limited our ability to confirm how clinical risks were communicated, monitored or followed up when people transitioned between services.
 

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The evidence submitted did not provide assurance that safeguarding processes consistently supported people’s rights to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm or neglect. The provider did not share concerns quickly and appropriately.

Records did not demonstrate how safeguarding considerations were applied to day to day events or emerging concerns. The documentation provided did not include a clear structure to record safeguarding screening decisions, thresholds, outcomes or learning. This meant we could not be assured that potential concerns were routinely identified, considered against safeguarding criteria, or used to inform safer practice.

Incident records and care management information demonstrated events that required assessment against safeguarding criteria, but these were not documented or reviewed, which limited assurance that people were protected from avoidable harm.

Without information about home environment risks, such as equipment compatibility or fire hazards, we could not confirm whether safeguarding responses appropriately accounted for the conditions in people’s homes. This limited assurance that potential safeguarding risks were identified or acted on.
 

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

In the evidence we reviewed, we did not see routine identification or review of risks with people. Tools used to assess risks such as poor nutrition, including the Malnutrition Universal Screening Tool (MUST), were missing or not consistently used.

Records did not show how staff involved people in discussions about emerging risks, which meant individuals may not have had the opportunity to understand or shape decisions about their safety.

We could not confirm how staff supported people to evaluate safety within their homes. For example, whether hazards or equipment issues were explained, explored or jointly problem solved with the person.

The absence of medicines governance such as PRN protocols, reconciliation records and escalation of repeated refusals, meant people were not always fully involved in managing health related risks.
 

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

Evidence submitted did not include routine home environment safety checks such as fire safety, water‑temperature monitoring, or documentation confirming checks on gas safety, portable electrical equipment, or general hazards within the home.

Although the registered manager stated equipment such as hoists and slings were “checked annually”, the provider did not submit any records verifying this. In the evidence summary, one repair record was noted (for example, an arranged repair to profiling bed controls), but no audit trail existed to show how frequently equipment was reviewed, who undertook these checks, or how suitability and compatibility were confirmed across homes.

We did not see information showing how staff identified or escalated environmental issues during visits. For example, there was no evidence to demonstrate how hazards were recorded, monitored or followed up, including concerns such as unsafe flooring, clutter, heating failures or equipment faults. This meant we could not confirm whether environmental risks were consistently recognised and addressed to prevent avoidable harm

While isolated repairs, occurred, this should not replace routine provider checks for fire/water safety, equipment compatibility or hazard review. The absence of structured checks, maintenance schedules, or home‑safety reviews meant leaders could not demonstrate they had effective systems to oversee environmental risks across the service.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Recruitment evidence showed significant gaps across all staff files submitted, including missing identity checks, employment histories, references, and health declarations at the point of deployment.

The registered manager confirmed staff file audits had not previously been carried out, and the new audits submitted during the assessment did not identify or address these mandatory omissions.

We did not see sufficient or reliable evidence of induction or pre-deployment competency checks, including shadowing, observed practice or skill assessments, to demonstrate that staff had the competence required for safe care at the point of deployment.

Training matrices submitted were inconsistent and did not align with certificates or staff lists, limiting assurance that staff had completed essential training to support safe care.
 

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

No evidence of IPC audits or post incident reviews was submitted, so we could not confirm how the provider identified infection risks or ensured learning from events.

The provider did not supply information on routine environmental checks, including cleanliness checks, which limited assurance that infection risks were being monitored.

We could not confirm how equipment related infection risks were identified or mitigated, such as cleaning routines, safe use of slings or checks on damage or contamination.

The absence of documented IPC procedures or staff updates meant we could not confirm staff understood or implemented safe infection prevention measures.
 

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

Records did not show a consistent system for overseeing medicines safety across the service, particularly where people experienced repeated refusals or had more complex needs. For one person, repeated refusals of clinically significant medicines were not reviewed or followed up, and there was no evidence showing how concerns about these refusals were escalated to prescribers or used to adjust treatment safely. As a result, the provider could not demonstrate that potential risks to the person’s health were identified and managed appropriately.

Information needed to manage medicines safely was not consistently available during the assessment. This included up to date medicines lists, procedures for medicines given “when needed,” and records showing medicines were reconciled following changes. In addition, for people with swallowing risks, we could not confirm that medicines were administered in line with specialist clinical guidance. These gaps reduced assurance that medicines were managed safely and that risks were monitored and acted on in a timely and consistent way.