Background to this inspection
Updated
19 July 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by 2 inspectors and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was announced.
We gave prior notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. Inspection activity started on 15 May 2023 and ended on 23 May 2023. We visited the location's office/service on 15 May 2023 and carried out a remote meeting with the registered manager on 23 May 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke to 5 people who use the service and 7 people's relatives about their experience of the care provided. We spoke to the registered manager, the human resources manager, the quality assurance manager, a team leader and 3 care staff.
We reviewed a range of records. This included 5 people's care records and medication records. We looked at 4 staff files in relation to recruitment, training and support, and a verity of records relating to the management of the service. We sought feedback from health and social care professionals involved with the service.
Updated
19 July 2023
About the service
Farecare Gloucestershire Limited is a domiciliary care service providing personal care for people in their own home. At the time of the inspection, 29 people were receiving support from the service with personal care.
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
We found improvements were still needed to ensure safe recruitment practices were followed.
We found improvements were still needed to ensure people's risks were assessed and mitigated in areas, for example, epilepsy, catheter care and nurse delegated tasks. Records relating to people's risks required improvement to ensure staff had access to complete and up-to-date information to keep people healthy and safe.
We found that improvements were still needed to the provider's quality monitoring systems and processes.
Improvements were needed in areas such as records related to people’s “as required” medicines and prescribed medicine patches. People were supported by trained staff to receive their medicines.
We did not find that these shortfalls had impacted people's care. The provider had identified areas that required improvement through their own quality monitoring and developed an improvement plan. However, further time was needed for the registered manager to fully embed and complete their improvement plan before we could judge it to be effective in bringing about the required improvements.
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 majority of people and relatives we spoke with told us they felt safe and well cared for by the service.
Staff understood their responsibility to report concerns and poor practices. Staff knew how to report any incidents or accidents.
Staff understood their role to wear Personal Protective Equipment (PPE) in line with government guidance.
Systems were in place to engage with staff and people who use the service.
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 02 December 2022), and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found that not enough improvements had been made, and the provider remained in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service and to verify if the provider made enough improvement in relation to previous breaches of regulations.
The inspection was also prompted in part by concerns we have received in relation to the quality of care and the management of the service.
As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has remained requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Farecare Gloucestershire Limited 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 from 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 of regulations in relation to people's risk management, safe recruitment, and good governance at this inspection.
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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.