Background to this inspection
Updated
12 January 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 8 November 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit to be sure that they would be in.
The membership of the inspection team included one inspector, one specialist professional advisor who was a registered nurse and two experts 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.
We did not receive a Provider Information Return (PIR) for 2018. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
As a part of the inspection we spoke with 11 parents who gave us the views of their children and young people who were using the service. We were unable to speak with children directly. We also spoke with the manager, the clinical educator and clinical lead, two nurses, two care workers and a representative from the new registered provider.
We looked at records at the service related to the delivery of care, the administration and management of the service. We looked at 15 care records, five recruitment files, four staff duty rosters, quality audits and medicine administration records for six people.
We asked four health and social care professionals for their views of the service after the visit. We did not receive any responses from them.
Updated
12 January 2019
This inspection took place on 8 November 2018 and was announced. Focused Healthcare Limited provides nursing and personal care for children and young people living in their own homes. This service is a domiciliary care agency. At the time of the inspection there were 80 people using the service.
There was a registered manager in post at the time of the inspection. The registered manager was not present during the inspection because they were on long term sickness leave. An interim manager was managing operational aspects of the service with support from the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements the Health and Social Care Act 2008 and associated Regulations about how the service is run. Since our last inspection the service had changed to a new registered provider.
At our last inspection on 31 March 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.
Risks for people were identified by staff. Risk management plans contained sufficient information for staff to manage and mitigate those risks. However, people’s daily records were not always completed as recommended. Staff followed the provider’s infection control policy to reduce the risk of infection.
Medicines were managed and administered safely. There were established systems in place for the administration, storage and disposal of medicines. We found the quality of the medicine administration records were not robust because staff did not always indicate when medicines were given to people. Staff completed training in medicines management and had their competency assessed.
There were established safeguarding systems and procedures in place. Staff understood how to protect people from harm and abuse. Safeguarding training was completed by all staff which helped them to take appropriate action to manage any allegations of abuse. These concerns were reported to a manager and to the local authority for investigation.
Enough staff were available and deployed to provide safe care to people. Safer recruitment processes were used to ensure suitable office based staff, nurses and care workers were employed at the service. Pre-employment checks were returned before staff were approved as suitable to work with people.
Relatives said staff were caring. Staff delivered care, support and treatment in a compassionate manner to ensure people received dignified care while maintaining their privacy.
Staff continued to receive an induction, training, supervision and appraisal. Staff were encouraged to explore and reflect on their jobs.
People were supported to have maximum choice and control of their lives and staff provided care in the least restrictive way possible for people. The provider’s policies and systems in the service supported this practice.
Staff asked people for their consent before providing care and treatment. People’s choices and wishes were recorded in health and care needs assessments. Care records were completed with and signed by people and their relatives. People were provided with copies of their assessments and care plan so they were aware of the support provided to them.
People had the care and support they needed that valued their levels of independence. This helped people continue their education and to take part in activities they enjoyed. Staff met people’s end of life needs when they required this specialist care and support.
Staff completed shopping for people when this was needed. Staff supported people with maintaining their nutritional needs which supported their health care condition and met their preferences.
The provider had a complaints procedure in place. Complaints were managed well and investigated with a written outcome send to the complainant.
The quality of the service was monitored and reviewed. An action plan was put in place to address any concerns found. The manager had developed working relationships with health and social care organisations.