Archived: Free Spirit Support Service

Free Spirit Support Service is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection there were five people using the service.

Not everyone using the service received the regulated activity of personal care. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

Peoples experiences

Work was still ongoing to ensure medicines administration records were up to date and accurate. Improvements were noted but they still lacked detail.

Risks were monitored and managed more effectively. However, improvement was still required to the detail of information to ensure staff fully mitigated any risk for people.

Enough staff were employed in ratio to the number of people using the service. Infection control was in line with government guidelines. Lessons learned identified shortfalls and improvement was ongoing.

The service followed the principles of the mental capacity act (MCA) to ensure people’s rights were adhered to. The service worked well with other professionals and made referrals as and when required.

The provider gave limited support to ensure the service run well. The deputy manager in place had identified shortfalls and was enthusiastic to succeed.

Improvements were identified but not sustained at this time. Policies and procedures were still being developed. Governance required more detail to ensure it was fit for purpose.

Rating at last inspection

The last rating for this service was requires improvement (published 02 August 2021) and there were multiple breaches 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/sustained and the provider was still in breach of regulations.

Why we inspected

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

This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led

We have made a recommendation about the management of some medicines.

Follow up

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

At our last inspection, we found concerns with audits and good governance and the registered manager provided us with an action plan setting out how they would make improvements and by when. At this inspection we found action had not been taken and the registered manager had not implemented monitoring or auditing processes to manage the quality of the service.

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

People were not always protected adequately against risk of harm. Risk management had not improved since our last inspection. Risks were not always assessed or reviewed. There were no systems in place to record and report incidents. Staff were not always provided with the information to support people with their medicines in a safe way. There were no systems in place to review these records, or to monitor if people had received the support they required with their prescribed medicines.

Risks associated with people's care needs had not been fully assessed and planned for. People's care plans did not contain detailed guidance for staff or reflected people's current needs. Staff had not consistently received training. New staff had not received any training or full induction other than shadowing opportunities with experienced staff. Staff had not received formal opportunities to review their work and development needs.

Informal support through text or email was received, however was described as not supportive when issues or concerns were identified.

People who had capacity consented to care and treatment. However, for those that lacked capacity there were no policies or systems in place to support this practice. The principles of the Mental Capacity Act 2005 were not fully understood. The registered manager was not aware of the action required should a person be restricted of their freedom and liberty.

There was very little leadership and oversight of the service was poor. There was insufficient risk management and quality monitoring. Auditing was not robust and there were missed opportunities for learning and improving the quality of care.

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 07 March 2019) and there was a 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 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 15 February 2019 and found concerns with how the provider monitored the quality of the service. The provider completed an action plan after the last inspection, detailing what action they would take to improve and by what date.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care services inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Free Sprit support service on our website at www.cqc.org.uk.

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 breaches in relation to keeping people safe, care delivery, staff supervision, staff induction, mental capacity, leadership and oversight of the service at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Free Spirit Support Service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older people, including people living with dementia, people with sensory needs, physical disabilities, learning disabilities and mental health needs. Not everyone using the service received the regulated activity of personal care. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection six people were receiving personal care as part of their care package.

People’s experience of using this service:

The registered manager had not kept up to date with their audits and checks that monitored quality and safety. Whilst they told us they were aware of some improvements which were required, they had not identified all the shortfalls in the fundamental care standards that our inspection found. At the time of our inspection, the registered manager did not have an improvement plan, but following our inspection they forwarded one to us that detailed the action they planned to make.

Staff had not received training and competency assessments in the safe administration of medicines. Records completed by staff to confirm they had supported people with their medicines, did not reflect nationally best practice guidance. There were no systems in place to review these records, to monitor if people had received the support they required with their prescribed medicines.

Risks associated with people’s care needs had not been fully assessed and planned for. People’s care plans did not contain detailed guidance for staff or reflected people’s current needs. However, staff were found to be knowledgeable about people’s needs and routines. The Accessible Information Standard was not fully complied with, because people’s sensory and communication needs had not consistently been assessed and planned for.

Staff had not consistently received training, with three staff not having received any training other than an induction and shadowing opportunities with experienced staff. Staff had not received formal opportunities to review their work and development needs. However, staff had received informal support and had regular contact with the registered manager and care coordinator, who were described as supportive.

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 support this practice. However, the principles of the Mental Capacity Act 2005 were not fully understood. The registered manager was not aware of the action required should a person be restricted of their freedom and liberty. We made a recommendation about the application process to the court of protection.

People were cared for by staff who had completed safe recruitment checks on their suitability to work with people.

The registered manager had not sent quality assurance surveys to people, to seek feedback about the service. However, people told us they were confident to report any concerns and that they were happy with the service they received.

People who used the service and their relatives were positive about the service provided by Free Spirit Support Services. They told us they received care from regular care staff who they had developed positive relationships with and who knew how to care for them. Staff in the main were reported to arrive on time and if they were running late, people were informed. Staff also stayed for the duration of the call and were unrushed, kind and compassionate in their approach.

People told us they had not received formal opportunities to meet with the registered manager to review the care they received. However, they had regular contact with the registered manager who responded to requests for changes with people’s care.

The service met the characteristics of requires improvement in most areas we inspected with good for Caring. More information is in the detailed findings below.

Rating at last inspection:

The service was last inspected on 28 January 2016 and was rated ‘Good’ in all key questions.

Why we inspected:

This is a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit at the next scheduled inspection. If any concerning information is received we may inspect sooner.

The service had a registered manager in place 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.

People were supported by staff who understood the risks people could face and knew how to make people feel safe. People were encouraged to be independent with as little restriction as possible.

People knew the staff who supported them and they worked well together as a team. People received a flexible service that suited their individual circumstances. People who were supported to take their medicines received support to do so when this was needed.

People were provided with the care and support they wanted by staff who were trained and supported to do so. People’s human right to make decisions for themselves was respected and they provided consent to their care when needed.

People were supported by care workers who understood their health conditions and ensured they had sufficient to eat and drink to maintain their wellbeing.

People were treated with respect by staff who demonstrated compassion and understanding. People were involved in determining their care and support and were treated in the way they wished to be.

People were able to influence the way their care and support was delivered and they could rely on this being provided as they wished. People felt they would be able to express any issues of concerns and that these would be acted upon.

People who used the service and staff were able to express their views about the service. There was a motivated staff team who felt supported by the management of the service.

A person who used the service told us, "They (the care workers) are all good at something.' A relative told us, "We are getting a first class service.' Another person said, 'Communication is very good. The staff seem to be well trained as they always know what they're doing.'

Staff we spoke with told us that everyone had a care plan and they were always up to date.

A person who used the service told us, 'I am very happy with the service, they do anything I ask them to.' In a survey questionnaire completed by six people who used the service they all said they felt staff respected their right to make choices and to make decisions about their life.

A relative told us, 'The care plans are kept up to date. I have discussed them with the main carer.' A person who used the service said, 'They always arrive on time and stay the whole time. If they have finished they ask if there is anything else I want them to do.'

A person who used the service told us, 'I feel very safe when they visit me. They always ask if I want the door locking. They leave everywhere secure.' They also said, 'They seem to do everything as it should be done. That must be down to the training they have.'

A person who used the service told us, 'I feel it (the agency) is very well run and very professional. The time keeping is generally very good. They deal with anything I ask of them to the best of their ability. '