Fordingbridge

Fordingbridge, otherwise known as Hearts at Home Care, is a domiciliary care service providing personal care to people in their own homes. This is help with tasks related to personal hygiene and eating. Not everyone who uses the service receives personal care. CQC only inspects where people receive personal care. Where they do, we also consider any wider social care provided.

Seventeen people were receiving personal care from the service at the time of the inspection.

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

There were enough staff for people to have a mostly regular team of staff. People received a weekly rota to say which staff would be visiting when. In the past, staff recruitment checks had not always been rigorous. The service had since remedied most gaps in records, such as missing references. However, we have made a recommendation in relation to recruitment records.

People and relatives told us staff treated them or their family member kindly and respectfully, honouring their preferences and promoting their independence. People’s personal information was kept secure and staff understood the importance of this. We have made a recommendation about the management of confidential images.

Everyone we spoke with said they or their family member felt safe with care staff. Managers and staff understood their role in protecting people from abuse and avoidable harm. Risks to people and staff providing their care were assessed and managed. Although medicines were managed safely, the provider was seeking to improve oversight with a new computerised recording system.

Staff had training in infection prevention and control. People told us staff cleaned their hands. There was a good supply of personal protective equipment (PPE) and staff wore this during visits.

People, relatives and staff talked about the service being family run. Staff and managers talked about people respectfully and compassionately. The registered manager and nominated individual were clear about their responsibilities. They maintained oversight by seeking people’s feedback, spot checks and audits, and regular supervision and informal conversations with staff.

The nominated individual and registered manager recognised the pandemic had adversely affected staff morale. There had been frequent changes in office staff and there were ongoing efforts to recruit suitable replacements. People, relatives and staff voiced that this had been unsettling and sometimes hindered communication. However, staff spoke positively about their work.

Rating at last inspection

The last rating for this service was good (published 8 January 2020).

Why we inspected

We received concerns in relation to staff recruitment. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No 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.

The overall rating for the service has remained good. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. The provider had taken action to reduce the risks and this had been effective. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fordingbridge 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.

Hearts at Home Care, Fordingbridge is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 35 people were receiving care and support from the service.

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

At the last inspection we identified a breach in regulations with regard to the safe recruitment of staff and also issues with record keeping, governance and auditing and policies and procedures. The service implemented an action plan to address these issues and is no longer in breach of regulations.

People and relatives told us the service provided staff who were caring and supportive. People received care that was responsive to their individual needs. Staff had a good understanding of how people preferred to have their care and support provided.

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take medicines safely.

Risks to people were assessed and regularly reviewed. Staff understood the actions needed to minimise the risk of avoidable harm including the prevention of avoidable infection. Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

People felt listened to and consulted when planning and agreeing what care and support they needed. People and relatives told us they could confidently raise any concerns, and these were addressed appropriately.

There were sufficient numbers of trained, experienced staff to meet people’s needs. Safe recruitment practices had been introduced; appropriate checks were completed to ensure only suitable staff were employed. Staff received induction and on-going training and support that enabled them to carry out their roles positively and effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People and where appropriate their relatives were involved in decisions about their care.

Governance systems and oversight of the service had been reviewed and improved. Issues were identified, and actions taken to address any shortfalls.

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 09 December 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

We telephoned staff members and people who received a service from the provider and their relatives on the 17 and 18 October 2018. We only contacted people who had agreed to give us feedback.

The service currently supports 32 people living in the areas surrounding Fordingbridge including Downton and Ringwood.

The service has no registered manager, however the manager in post has recently submitted their application to CQC to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The last inspection of Hearts at Home, Fordingbridge took place on 25 and 26 July 2016 and rated the service as requires improvement. We found concerns in both the safe and well-led domains.

At this inspection we found that the recruitment procedures were not safe and that staff had commenced in post before references and DBS checks had been completed.

The service did not have adequate auditing systems in place to identify missing documents in people’s files or to check that processes such as recruiting staff were being adhered to

At this inspection we found that concerns we had about people’s safety and staff competency in medicines had been addressed and a robust training and competency system was now in place.

A monthly external audit ensured that medicines records were accurate and complete.

Most people told us they received their rotas on time.

The provider had a scheduling system that would ensure staff had sufficient travelling time so that they arrived at people’s homes when expected.

Accidents and incidents were recorded and the provider was introducing a new form including a section to note actions taken to minimise future incidents.

Risks were assessed and all possible actions were taken to mitigate risks and promote the safety of individuals.

A business continuity plan was in place.

Staff received an induction and completed shadowing shifts before commencing caring for people. People told us they believed staff were well trained. Training the provider considered to be essential was updated annually. Staff were encouraged to complete training which would offer them qualifications.

Staff received regular supervisions and had an annual appraisal. Spot checks on staff when completing care tasks were also undertaken by the provider and feedback from these checks aimed to improve staff performance.

Quarterly staff meetings ensured that staff were informed and felt part of the team. Other essential information was shared using a confidential social media application that all staff could access.

People told us that staff were caring and ensured they provided care that enabled them to retain their dignity.

Care plans were holistic and detailed how people wanted their care to be provided.

The provider was seeking information on people’s personal histories to add to their care files to enable staff to have relevant conversations with them.

Staff knew people they supported well and the provider endeavoured to maintain continuity of care by having a team of regular staff supporting people.

The provider had monthly conversations with people to gather feedback on their care package and to ascertain if changes were needed.

Care plans were regularly reviewed and support decreased as well as increased whenever possible as the provider promoted people’s independence whenever possible.

The manager had a plan in place to address concerns and ensure that tasks were completed on schedule.

Fordingbridge domiciliary care agency provides personal care and support to people in their own homes. At the time of this inspection the service was providing care and support to 24 people with a variety of care needs, including people living with physical frailty or memory loss due to the progression of age. The agency was managed from a centrally located office base in Fordingbridge.

The service had a registered manager. 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.

People and their families told us they felt safe and secure when receiving care. People and their families raised concerns over not being provided with a weekly rota to inform them which staff would be visiting their home to provide care.

People’s medicines records were not always completed appropriately and staff had received training in medicines but no checks were completed to assess that staff were competent to administer people’s medicines safely.

Risk assessments were in place which minimised risks to people receiving care. However the service did not have a business continuity plan in place for foreseeable emergencies.

The provider did not have an effective system in place to monitor the quality and safety of the service.

Staff received training in safeguarding adults. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development. There were sufficient numbers of staff to maintain the schedule of care visits to meet people’s needs.

People felt they were treated with kindness and said their privacy and dignity was respected. Staff had an understanding of legislation designed to protect people’s rights and were clear that people had the right to make their own choices.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans provided comprehensive information which helped ensure people received personalised care. People felt listened to and a complaints procedure was in place.

Staff felt supported by the registered manager and could visit the office to discuss any concerns.

We received positive feedback from people about the service. All people who used the service expressed great satisfaction and spoke highly of the care staff.