FHS24 Nursing+Care Agency

Updated 5 December 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing. One person was receiving live in care in their own home in a specialist housing scheme with warden support.

Three people were receiving care and support whilst living in their own homes under a ‘supported living’ style approach. This is so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. They were supported by the managing director to run the service.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 30 October 2019 and ended on 31 October 2019. We visited the office location on 30 October 2019.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We met with four people who used the service, and this included carrying out observations when they had limited verbal communication. We spoke with the registered manager and the managing director. We also spoke with 10 members of staff which included care staff and members of office staff.

We looked at four people’s care records and five staff files. We also looked at information received in relation to the general running of the service including medication records, auditing systems, policies and procedures, compliments and complaints, and training records.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 5 December 2019

About the service

FHS24 Nursing+Care Agency is a care at home service that provides personal care including supported living and live in care for people with learning difficulties, mental health, autism and older people. At the time of the inspection four people were receiving support with personal care. People had limited verbal communication, so we captured some of their experience through observations.

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.

The service for people with learning disabilities and/or autism has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Improvements had been made with recruitment practices, the provider was now notifying the Care Quality Commission in line with legislation and the provider’s auditing systems had identified concerns. However, it is not clear whether these improvements were sustainable yet. Additionally, small concerns found on the inspection had not always been identified by the management. Although they were proactive at responding to them.

People told us they were happy and appeared comfortable in the presence of staff. Medicines were administered safely. Most risks had been identified with ways to mitigate them in place. However, concerns were found with one person who had a specialist eating and drinking plan. Following the inspection, the registered manager had taken action to rectify them. Records and processes around the management of behaviours which could challenge themselves or others were in place.

The management strove to be open and constantly develop and improve the support people were received. When systems had identified issues, actions were being taken.

People were supported by enough staff to meet their needs. Staff had received a range of training including specialist courses in health and social care. Care plans were personalised and provided a range of information for staff to use to support people’s needs and wishes. There were good links with other health and social care professionals.

Staff were kind and caring and knew the people they were supporting well. Staff respected privacy and dignity. Links had been developed with the community which had a positive impact for people. Independence was promoted, as were the values of treating each person as an individual.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service who had learning disabilities and/or autism can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service with learning disabilities and/or autism reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 January 2019) and there were multiple breaches in regulation. The provider completed an action plan and met with us to tell us how they would improve. We also completed an inspection to follow up the warning notice (published 13 June 2019) where the rating was not change. At this inspection we found improvements had been made and the provider was no longer in breach of any regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Since the last inspection we recognised that the provider had failed to display their ratings on their website. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

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.