Fortress Care Services

Updated 11 May 2022

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 and flats.

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.

Notice of inspection

We gave the service 48 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 14 June 2021 and ended on 7 July 2021. We visited the office location on 16 June 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We reviewed information we requested from the provider to show the improvements they had made where a breach of regulation had been identified at the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with the relative of the person who used the service about their experience of the care provided to their family member. We also spoke with four staff: a care worker, a care co-ordinator, the registered manager, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. We looked at the person’s care records, staff training records, and a variety of records relating to the management of the service. These included staffing schedules, risk assessments, procedures and audits.

Updated 11 May 2022

About the service

Fortress Care Services is a domiciliary care agency which provides personal care and support to adults in their own homes. At the time of our inspection the service provided personal care to one person. One live-in care worker provided most of the person’s care. Their breaks were covered by the care co-ordinator.

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

The provider and registered manager did not demonstrate they had learned from previous inspections or had applied learning across the service. They had still not taken enough action to make, or sustain, required improvements identified at previous inspections. They had not always taken the action they said they would take regarding safe administration of medicines, guidance for staff on how to meet all of the person’s needs, and governance.

Staff were trained to administer medicines and their competency was assessed. This helped to ensure the person received their medicines as prescribed. Staff knew the person well. However, the guidance did not provide any guidance for staff on how to recognise if the person may be in pain. This meant any new staff may not know when to offer pain relief. Shortfalls in staff guidance for medicines prescribed “when required” had been highlighted at our previous inspection.

Records did not always provide consistent or complete guidance in how to meet the person’s needs. A live-in care worker provided the person’s care most of the time and knew the person extremely well. Their breaks were covered by a relief member of staff who also knew the person well. However, there was not sufficient guidance to ensure all the person’s needs would be met should new staff provide their care.

Risks had been assessed in relation to the person’s care. However, risks for staff, which could impact on the care the person received, had not always been formally assessed. These included the main care worker working for long periods of time without a break.

The provider and registered manager did not demonstrate they could implement new government guidance. For example, they had not implemented a system for staff to be tested for COVID-19 in line with current good practice guidance.

The provider had not employed any new staff since the last inspection. This meant we were unable to test their recruitment and induction processes.

Staff members had received training relevant to their roles. Staff felt well supported by the management team and received regular supervision and appraisal.

The person was supported to have maximum choice and control of their life 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.

Staff supported the person to maintain a healthy diet and to access healthcare services when needed. They liaised with health and social care professionals and followed their instructions.

Care staff were very caring and the relative was happy with the care their family member received. Care staff supported the person to maintain contact with people important to them.

The relative knew how to complain and was confident any concerns they raised would be addressed within the service. No complaints had been made since the last inspection.

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 31 December 2019). There were two breaches of regulations. 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 or sustained and the provider was still in breach of regulation 17.

The service was rated requires improvement overall at the last two inspections and inadequate overall at the two inspections before that.

Why we inspected

We carried out an announced comprehensive inspection of this service from 30 September to 2 October 2019. We found two breaches of legal requirements. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety and good governance of the service.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation of the governance and management of the service at this inspection.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.