Fosse Healthcare - Lincoln

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people’s needs. We found people’s needs were not always met. People’s preferences were assessed and included in their care plans. However, these were not always upheld in practice, which caused some people to feel distressed. We received mixed feedback about the responsiveness of complaints and how they were managed and people felt ignored and unheard. However, we found no evidence to support this in records of how complaints were received or responded to. Information was shared with people in ways they understood. Where required, staff supported people to attend or access appointments with health professionals and worked with other professionals to help people work through barriers or inequalities to accessing healthcare.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s preferences were assessed and included in their care plans. However, people felt they were not always upheld in practice, which caused some people to feel distressed as they told us they had “given up trying to get things done the way they wanted.” Subsequently, people had mixed feedback about the quality of their care. One person told us, “The care is thoughtful I think and we talk about it as we go along.” Another person said, “[Staff] will ask me what I like and if they understand my answer they will help me that way, if not they carry on as they please.”

Staff and leaders told us how they ensured care is planned in a person centred way in line with people’s assessed needs and care plans. They said people were empowered to make their own decisions and agree how care was delivered. They held regular reviews and informal meetings to gather feedback from people to use to improve the service.

People did not feel their care was well co-ordinated, with a lack of continuity, which they told us made them feel unvalued and rushed. One person told us, “We can't get on with our day if we don’t know when [staff] will be here. They can be up to 2 hours late." A relative said, “[My family member] does feel rushed on occasion. They don’t always get the care the way that makes them feel comfortable.”

Staff followed care plans and raised any concerns about capacity and ability to continue with the care.

Professionals felt the staff and management team worked well to ensure care provision. One professional said, “A strengthened approach to joint working has positively impacted service delivery and outcomes for [people]. We have observed a significant reduction in concerns related to safeguarding and poor practice, which reflects an improvement in care standards.”

The registered manager had systems in place to ensure joined up care when working with external professionals and other services to meet people’s needs. They had worked hard to support people with protected characteristics to change the way care was delivered in order for support to be more responsive where people had more complex health needs.

The registered manager had systems in place to ensure joined up care when working with external professionals and other services to meet people’s needs. They had worked hard to support people with protected characteristics to change the way care was delivered in order for support to be more responsive where people had more complex health needs.

Staff listened and understood how people communicated. People’s communication preferences had been assessed and staff understood the importance of respecting this as well as maintaining confidentiality.

There were systems in place to assess people’s preferred language and Information was shared with people in ways they understood. The registered manager and provider was aware of the accessible information standard and GDPR rules around the confidential storing of information. The provider shared newsletters and emails with updates. Rotas were available for people but these were only accessed digitally, which some people struggled to access. People were sent a paper copy of the rota but only where they had specifically requested it.

We received mixed feedback about the responsiveness of complaints and how they were managed. However, we found no evidence to support this. Some people told us they were happy to make a complaint but often felt there was little point as they did not feel heard and nothing changed, one person told us this made them feel as if they did not matter. For example, one person said, “I can complain and don’t worry about it because otherwise how do they know what I want. [Staff] answer my calls and appear to listen but then not much gets done.” Another person said, “Not very helpful in the office and I get shoved from pillar to post. On the whole, I find they don't listen to me." However, other people told us staff listened to them and they felt cared for because of it. They told us staff tried to help them and they had confidence if they raised a complaint it would be “received gracefully.” One person said, “I would say they listen to me and do try to help the way I like.” Another person told us, “I do believe they listen to me and care.”

Staff recognised when a person had a complaint and were happy to escalate this to management or senior staff to be addressed. They recorded the complaint appropriately and aimed to make changes to improve the situation.

The registered manager had a complaints policy and procedure in place that was shared with people. They clearly recorded all details about the complaint, action taken and outcomes. Where required, they ensured the complaint was also reported to other agencies such as the local authority or the CQC. They responded to the person involved with the outcome and apologised when things had gone wrong, with an understanding of their duty of candour. The registered manager also had other processes in place for seeking people’s feedback such as questionnaires, reviews and informal chats. They used this information to learn lessons about how to improve the quality of care in the future and included actions in the service improvement plan.

People were supported by staff to arrange or access appointments or call emergency services when required.

Staff knew how to access contact details for various health and social care professionals and told us how they worked with them or raised concerns about people’s health or environment. Where it was required, they called the emergency services and waited with people to ensure they were safe.

A professional told us, “Fosse has become increasingly responsive, ensuring care requests are addressed promptly and appropriately.”

The provider had systems in place to assess people’s health needs and made appropriate referrals to health care providers where required to ensure people’s health needs were met. Where required they were flexible about care visit times and how care was delivered to better meet people’s needs in the event of changes to their health to enable access to treatment. A professional told us, “Fosse has become increasingly responsive, ensuring care requests are addressed promptly and appropriately.”

People were supported to review their care and how it was delivered so that barriers to good care and accessing relevant professionals could be resolved, which reduced the risk of inequalities to accessing healthcare.

Leaders told us of how they had worked with various external professionals to support people with complex health needs to enable them to accept care and treatment. They made reasonable adjustments so that the care was provided in ways they understood and felt comfortable with. This has resulted in an improved quality of life and clearer communication between the person and various services supporting them.

The registered manager and staff team worked hard to ensure clear guidance was in place to empower people to take control of their care and work flexibly where required. They made referrals and held meetings with external professionals to ensure they promoted people’s rights by making reasonable adjustments and working with people to agree the best approaches that worked for them.

People were supported to discuss their wishes in the event of illness or end of life, where they wanted to. These wishes were added to their care plans to ensure they were supported accordingly. Not all people had wanted to discuss or disclose these wishes and where this was the case, it was recorded and respected but revisited periodically.

Staff understood the extra sensitivities needed when supporting people who were at the end of their life as well as their relatives during this difficult time. One staff member told us, “I used to go and listen [to the person] for maybe an hour at a time. I believe in active listening. [Their relative] rang me and told me it made their day having me to talk to so it must have been very comforting to them.”

The provider and registered manager ensured all wishes and actions were recorded in the persons care plans and where required they liaised with other health professionals such as the GP and/or the palliative care team. This ensured people were supported in the way they wished and provided the dignity of pain management and good care at the end of life.