Fosse Healthcare - Lincoln

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. We found the service did keep people safe but risks to safety were increased due to inconsistent care visit times. The provider had good staff recruitment and induction processes in place, which meant staff were checked to ensure they were suitable for the role and trained to meet people’s needs. Staff would benefit from additional learning in relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in addition to a clearer understanding of some people’s diagnosed conditions. Risks to people and their medicines and reducing the risks of infection and promoting safe environments were well managed and staff understood how to reduce the risk of avoidable harm and kept people safe.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt that management and office staff failed to learn from their complaints regarding inconsistent care visit times and what they felt was poor communication. For example, people told us they did not get rotas or they were incorrect, times varied and they felt they were not listened to. One person told us,” [Staff in the office] answer my calls and appear to listen but then not much gets done.” Another person said, “I have given up trying to get things done the way I want.”

Staff and leaders told us about the positive culture for learning from events and promoting development of staff skills. Leaders told us how they had learnt from complaints about food preparation, the registered manager arranged for a training room that included learning about food people liked, what it tasted like and how to prepare it. This had resulted in a reduction of complaints about food and staff feeling more confident. A staff member told us, “One person I used to go to couldn't communicate verbally and wasn't eating their microwave meals. I spoke to their relative and gained an understanding of home cooked meals the person liked to eat. For lunch I would their favourite dishes and they absolutely loved eating them. They knew they would get a proper home cooked meal instead of a microwave meal. This made them much happier. I was glad they were eating better.”

The provider had processes in place for recording and monitoring incidents, complaints and compliments to learn and look at how they could improve their systems and practice. They acted upon feedback and created an improvement plan with clear actions and recorded outcomes. The provider and registered manager understood the requirements of the Duty of Candour and ensured they were open and apologised to the relevant people when things went wrong.

We saw written feedback from people which showed they were supported to safely transition between services and relevant referrals were made. One person wrote about how impressed they were with the staff member who supported them saying how they had clearly read their care plan as they didn’t need to ask questions. The person was impressed with the staff members knowledge of the care role.

Staff understood the importance of good care and being aware of any concerns that might arise. They knew to make referrals to the correct professionals where required. One staff member told us, “I have a good relationship with the people so I always notice any differences in their care or deterioration. If I notice this I ring the office and let them know and talk through what the next steps are. They say they will pass on to the person’s occupational therapist and social worker.”

Professionals spoke positively of the way staff worked with them to meet people’s needs. One professional told us, “In approximately the last 2 months, I have noticed a significant improvement in several elements within Fosse. Communication, attitude, integrity, responsiveness, frequency, speed and capacity is being announced with minimal need for chasing. In last 12 months, office staff are vastly improved with a much-improved attitude to resolving issues and answering queries.”

The provider had policies and processes in place to support collaborative working when assessing people’s needs and ensuring safe care. They assessed risks and preferences and incorporated these into care plans to guide staff on how best to safely support people.

Feedback from people about safeguarding was mixed. Some people told us they felt safe. A relative said, “I don’t feel [my family member’s] safety is at risk in any way.” However, while we found no evidence to suggest people were unsafe, due to how care was planned, most people told us they often did not feel safe. For example, one person said, “I don't feel safe because I never know when they're coming or who's coming." Another person told us, “Sometimes [office staff] send a man out at night, and it's frightening." A relative told us, “[My family member] is really not comfortable with male carers, but they still come." People told us this caused them a great deal of distress and worry.

Staff understood what abuse looked like and how to report it, how to reduce the risk of avoidable harm and keep people safe. One staff member said, “I would look out for changes of behaviour in [the person], so if I know them very well I will notice if they go quiet or have physical markings I haven't seen before, I would raise it with the office. I would contact the office again for updates, if no change and then if not I could go to senior management. I can go to CQC or the safeguarding team. [Managers] have shown me the whistleblowing policy and I did raise a concern previously and they acted really quickly.” Some staff were less confident about their understanding of applying the principles of The Mental Capacity Act 2005 (MCA) and would benefit from refresher scenarios to better understand how it applies to them in practice.

The provider had policies and procedures in place to safeguard people and reduce the risk of avoidable harm. Staff received mandatory training on safeguarding and the (MCA) and Deprivation of Liberty Safeguards (DoLS). Safeguarding concerns and best practice was shared in staff supervisions and staff meetings.

People were supported to manage and understand risks. They were involved in assessments and reviews of their care and treatment and had access to updates in their care plans.

Staff were aware of risks and where to find further information about how to manage them. One staff member explained how they had found a person’s catheter was not in place and immediately contacted the emergency nurse and the person’s next of kin to gain support and ensure they were fully informed. The emergency nurse attended and made sure the person was safe and everything was working well.

Risks to people were well managed, assessed and regularly reviewed. Where appropriate other health and social care professionals and people’s relatives were involved to ensure the measures to reduce the risk were appropriate, safe and in the person’s best interest.

People told us staff mostly kept their homes tidy and clean. Some people were concerned about staffs’ lack of knowledge to operate a microwave safely but were aware the provider had taken action to improve this.

Staff understood how to check equipment and keep the house tidy and clean to reduce the likelihood of people coming to harm. One staff member told us, “I make sure equipment is in working order, has been checked and has all relevant safety stickers on. I make sure equipment is clean and hygienic and that people cannot trip over anything by ensuring mats and rugs are secure. For [people] who smoke, I empty and dampen the ashtrays where necessary. Pick up items such as clothing, rubbish off the floor to avoid falls. Keep the house tidy. Clean the kitchen and empty the bins regularly and change soiled bedding.”

Risks to people and their safe environments were well managed. Each person had an environmental risk assessment to identify any person and location specific risks and how to reduce them. Servicing was monitored and planned for equipment to ensure it was safe to use.

People did not always feel staff were recruited who had the language and other skills to meet their needs. People also spoke about concerns of staff inductions and staffing levels as a reason in their view for a lack of consistent staff teams, being unable to have gender preferences of care and care time visits. In relation to care visit times, a person told us, “We can't get on with our day if we don’t know when [staff] will be here. [Staff] can be up to 2 hours late." Another person said, “[Staff] came at 10am and then came back at 11.15am for my dinner. My call should be about 10, then my lunch at about 1pm.” In relation to other concerns a person told us, “I don’t think there is any training, just shadowing and that’s not enough if they are shadowing someone who is not good at the job."

Staff told us they had a thorough recruitment and induction process including training, shadowing more experienced staff and assessments of their skills and knowledge. A staff member told us, “[The induction] was useful, the information was there, they covered everything from moving and handling to the correct way to support somebody up off the chair or use the sara steady. They taught us how to read medicines instructions from the notes, the medicine administration record (MAR) and the label. I did shadowing of shifts and the [staff member] I did the shifts with was amazing and gave me more information about person centred care.”

The provider had good staff recruitment and induction processes in place, which meant staff were checked to ensure they were suitable for the role and trained to meet people’s needs. Numbers of staff meant people were not always able to have their preferred gender of staff and the timing of care visits were inconsistent. The registered manager was making changes with a view to improving this and they continued to recruit more staff, however, this had a significant impact on people’s experience of their care and impacted people’s ability to plan their day.

People had no concerns about infection prevention and control. They felt staff had good personal and food hygiene and used personal protective equipment (PPE) when required.

Staff understood how to prevention the risk of infection and knew what to do in the event of an outbreak. They used PPE when required and told us they had plenty of supplies.

Risks to people and their environment in relation to infection were reduced due to risk assessments and the use of the correct PPE. Staff received training on this and information about best practice was regularly shared. Managers made observations of how staff ensured good IPC practices in people’s homes.

People told us they were involved in managing and discussing their medicines and any changes. Not all people being supported required support with medicines as they were able to administer and order these themselves or with the support of their relatives. Where staff did support people, this was done safely and with people’s consent.

Staff understood how to safely manage medicines and what to do in the event of an error. One staff member told us the registered manager had supported them when they made an error, the staff member spoke with the pharmacy immediately for advice on the persons safety and then informed the office who offered additional training and assessing to reflect on what happened. Staff were also knowledgeable about STOMP, an NHS England initiative to stop the over prescribing of medicines to people with a learning disability. The staff member told us they had learnt about this during their Oliver McGowan training. Training of this type is a mandatory requirement and gives staff an awareness and insight to the issues faced by autistic people and people with a learning disability. A staff member told us, “When considering medicating someone with a learning disability and autism the benefit must outweigh the risk. It should be the correct medication, the correct dose and for as little time as possible.”

Risks to people and their medicines were well managed. Each person had a risk assessment and a self-administration risk assessment. There was detailed guidance in people’s care plans about the medicines people were prescribed, the reasons and symptoms of potential side effects to be aware of. People were fully involved in reviews of their medicines and encouraged to work with their GP or other health professional to review any changes. This helped to ensure people were prescribed the correct medicine and were safe.