FARJ Services Ltd

FARJ services Ltd is a domiciliary care agency that provides personal care to people in their own homes. At the time of the inspection they were supporting 26 people.

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

People were not consistently protected from the risk of infection because not all staff were tested for COVID-19 as per government guidance. Staff had access to personal protective equipment (PPE) which was used appropriately.

Systems and processes in place were not always effective in ensuring the service had the most up to date guidance and best practice information.

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. Improvement was required in the recording of mental capacity assessments and best interest decisions.

People were supported by staff who knew them well, had adequate training and were recruited safely.

Care plans and risk assessments were detailed and included the person’s holistic needs. People’s likes/dislikes, routines and history was documented. People and significant others were involved in the care planning process.

Staff were supported by managers who were open and transparent. Staff felt supported and told us they could give feedback or suggestions to the registered manager and their views would be listened to.

People were supported with dignity and respect and were encouraged to be as independent as possible.

Medicines were managed and administered safely. Staff supported people to make and attend health appointments. The staff team worked closely with external professionals to ensure people’s health needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 1 April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about late calls and moving and handling. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Farj services Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Farj Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in Northamptonshire and the London Borough of Ealing.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of inspection 39 people were being supported with personal care.

People’s experience of using this service and what we found

The systems in place to monitor the quality and safety of the service were not effective. Reviews and monitoring of care plans failed to identify when significant information was missing. The provider had not ensured the systems they had in place were enough to enable them to have full oversight of the service.

Risks to people’s care were not always identified or assessed and plans to support staff to deliver safe care were not always in place. Although no one had been harmed by this failure, this put people at unnecessary risk of harm.

Staff understood their responsibilities to keep people safe from abuse or harm. People received their medicines safely and there were effective practices in place to protect people from infection.

People were cared for by staff who were caring and kind and passionate about their work. They arrived on time and stayed with people for the time agreed. People’s dignity and privacy was maintained, and people felt in control of their lives.

People had individualised care plans which ensured they received person-centred care. Plans considered people’s preferences likes and dislikes and their cultural and religious backgrounds.

Staff received the training they required and were supported through regular supervision. They liaised with other health and social care professionals to look at ways to improve people's life experiences.

The registered manager was open and honest and was receptive to suggestions as to how to improve the service. There was a complaints procedure in place and people knew who they could speak to if they had any concerns.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 September 2019). The service remains requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

At our last inspection we found three breaches of the regulations in relation to safe care and treatment, fit and proper persons employed and governance of the service. The provider was issued with a warning notice after the last inspection to make the improvements required to comply with the regulations.

Not enough improvement had been made at this inspection and the provider was still in breach of two regulations.

There was not always risk assessments and plans in place to minimise the risk to people’s care which put people at risk of harm.

This was a continued breach of regulation12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Systems and processes were not effective enough to monitor the quality and safety of the service. This placed people at risk of harm.

This was a continued breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

Enforcement

We have found continued breaches in relation to safe care and treatment and governance at this inspection.

Please see the action we have told the provider to take at the end of the full version of this report.

What happens next?

We will meet with the provider to discuss how they will make improvements. We will work with the local authority and continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

FARJ Services Ltd is a domiciliary care agency providing personal care to people with a variety of support needs. At the time of inspection 56 people were receiving care and support in Northamptonshire and the London Borough of Ealing.

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

The leadership and the management of the service was ineffective. There was no registered manager in post and the provider had not maintained sufficient oversight.

The was a continued lack of oversight and governance systems to monitor the service. Systems that were in place were not always followed by staff, audits were completed inconsistently, and the findings of audits were not acted upon. People were asked for their feedback on the service but there was no record of action taken in response.

Records relating to people’s risks were incomplete, contained misleading information and were not always available to the staff providing people’s care. Medicine records were not accurate, and the administration of people’s medicines was not consistently recorded. People had not been consistently safeguarded from abuse.

Safe recruitment practices were not followed, and staff were deployed to work unsupervised before criminal records checks had been completed. There was insufficient planning and oversight of staff scheduling and staff were working excessive hours.

People provided positive feedback about the individual staff who provided their care. Measures to prevent and control the spread of infection were followed by staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 19 April 2019) and there was one breach 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, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 26 February 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance of the service. This inspection was prompted in part due to concerns received about the quality, safety and governance of the service. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No new areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for FARJ Services Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to recruitment, safety and governance of the service at this inspection.

Please see some of the actions we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

• Governance systems and audits were not always effective in identifying where improvements were needed.

• Timely action was not always taken to respond to known areas of required improvement.

• Improvements were required to the planning and timing of people’s care visits.

• People had not been consistently safeguarded from abuse; this had been investigated by the local authority. Action had been taken to ensure that people’s support was provided in a safe appropriate way.

• Improvements were required to medicines record keeping.

•Staff recruitment procedures needed to be strengthened to ensure that all necessary recruitment checks had been completed as part of the staff selection process.

• Improvements were required to the measures in place to assess people’s mental capacity. People's consent was gained before any care was provided.

• People’s care plans and risk assessments did not always fully reflect their needs.

• People felt that staff did not always respect their preferences.

• Staff were supervised and felt supported by the management team.

• People’s healthcare needs were met, and people had access to health professionals as required.

• People had good relationships with their regular staff and felt that they treated them with kindness, dignity and respect.

• People and their family were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The management team were open and honest, and worked in partnership with outside agencies to improve people’s support where required.

• We recommend that the provider finds out more about training for staff, based on current best practice.

Rating at last inspection:

Good (report published 23 September 2017)

Why we inspected:

This inspection was carried out in response to concerns that people were at risk of receiving unsafe, poor quality care. There had been an increase in safeguarding concerns which had been investigated by the local authority and substantiated. The provider also had an action plan in place from the local authority quality improvement team and was receiving regular support visits from the quality improvement officer.

Enforcement:

At this inspection we found the provider to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Action we told provider to take is recorded at the end of the report.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This announced inspection took place on 1 September 2017.

There was a registered manager in post at the time of our inspection. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although the provider, registered manager and staff had received training in relation to the Mental Capacity Act 2005, the service had not applied the principles of the Act when delivering care to people who used the service, who may have lacked the capacity to make decisions about their care and treatment. Mental capacity assessments had not been completed where they may have been needed. We raised this with the provider who assured us that this would be looked at following our inspection.

People received safe care and support. Staff understood their role in safeguarding people and they knew how to report concerns. The service had enough staff to deliver the kind of care people needed. People's medication was managed safely and staff were recruited and checked to ensure they were safe to work with people who used the service.

Staff had a good understanding of people’s support needs and had the skills and knowledge to meet them. Staff received a full induction into the service, had updates to their training and regular supervisions. Staff were clear about their roles and responsibilities in caring for people and described being well supported by the management.

Care records contained risk assessments and management plans to protect people from identified risks. They gave information for staff informed staff on the measures required to minimise any risks. Staff were vigilant regarding people’s changing health needs and sought guidance from relevant healthcare professionals.

Staff and people's relatives were confident that if they had any concerns they would be listened and that they would be addressed.

The provider monitored the quality and safety of the service and staff performance was regularly monitored. There were systems in place to ensure that incidents and accidents were recorded and action taken as a result.

The provider’s values and vision was clear and focussed on providing care that was person centred and that would enable people to remain as independent as possible.

Staff demonstrated a kind and caring approach to supporting people. People using the service had a consistency of care staff which meant that staff knew the people they cared for and understood their needs, likes and preferences.