Archived: Forever Homecare

Forever Homecare is a service providing care and support to people in their own home. At the time of the inspection the service was supporting 36 people, and we were told everyone received support with personal care. The service provided both regular daily visits to people receiving personal care and live-in staff members providing a 24-hour support service. The service supported people in Buckinghamshire and Berkshire.

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 supported by a service that was not well managed or monitored. Audits were either not in place, or not effective to assess, monitor and drive improvement in the quality and safety of people's support. The provider had failed to ensure everyone using the service had received an assessment of their needs and we found some people did not have a care plan in place. We also found the service had failed to display their CQC rating at their office base and website. Effective systems were not in place to meet the requirements of the duty of candour and the service had failed to inform the Commission of some information they are required to.

A manager had been appointed following our last inspection. The manager had engaged with people and families, who indicated their experience of service management had improved. Comments from family members included, “Much better since January”, “It’s now on an even footing, things running smoothly” and “I haven’t seen a difference in things good or bad. However [manager’s name] is very nice, very nice.” During the inspection the manager frequently visited people’s homes to discuss concerns, however we found written records were often absent and the office space was disorganised.

We found risks to people using the service were not clearly identified and managed. People’s care plans often contained outdated information or lacked sufficient detail to provide staff with enough information about how to safely manage risks. We also identified significant concerns in relation to the safe management of medicines, concerns regarding staff testing for COVID-19 and a lack of recording and oversight in relation to accidents and incidents.

The service identified required learning for staff and had sourced a new training provider, however training records showed significant gaps in training across the staff team. We identified several concerns in relation to the recruitment and deployment of staff. Since our last inspection staff rotas had been adjusted to consider travel time, and people and families indicated timekeeping had improved. People’s comments included, “Pretty much on time. Let me know if they are going to be late”, “95% of the time they are on time” and “They don’t come on time, they are late.”

Care plans did not always provide staff with details of people’s likes, preferences or protected characteristics. Since our last inspection we found people were more likely to receive support from regular staff and this also considered people’s cultural and language needs. People told us staff treated them with respect and communicated effectively. Feedback from families included, “They all speak Punjabi”, “They know how to communicate with Dad” and “They know how to make a cup of tea the way she likes and when she wants.” People described positive interactions with staff, with comments such as, “Very kind and respectful” and “The staff are all nice to me.”

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 inadequate (published 4 March 2021).

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 focused inspection of this service on 25 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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. The overall rating for the service remains inadequate. 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 Forever Homecare 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 person-centred care, safe care and treatment, safeguarding from abuse, recruitment and staffing practices, good governance, duty of candour, assessing people's mental capacity to consent to care, display of CQC ratings, and in informing the Commission of information they are required to.

Please see the action 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Forever Homecare is a service providing care and support to people in their own home. At the time of the inspection the service was supporting 47 people, and we were told everyone received support with personal care. The service provided both regular daily visits to people receiving personal care and at times provided some live-in staff members providing a 24-hour support service. The service supported people in Buckinghamshire and Berkshire.

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

Most people we spoke with provided negative feedback regarding their care, although there were some examples of mixed feedback and a smaller number of positive comments. One family member told us, “They are kind and respectful and treat her with dignity, they are lovely.”

Many people raised concerns regarding the timing of visits. People did not receive a copy of their weekly care rota, meaning they were unsure who was coming or when they were due to arrive. One person commented, “There isn’t a rota; it’s a rush sometimes. The timings are not easy.” Another family member added, “There is little consistency; the carers are always changing.”

Some people complained staff arrived late and left early or missed visits. One family member told us, “Occasionally a carer wouldn’t show up at all. Once they didn’t turn up for three days.” Another person told us, “They don’t stay the right amount of time, they do go early.”

Some people described examples of receiving poor care, such as items being left out of reach or their front door being left open. Feedback showed people were not receiving high quality person-centred care. One family member told us, “They don’t give her any dignity. They tried to change her in the lounge until I told them not to.” One person using the service told us, “They talk to each other in their own language. I ask them to speak English but they don’t. When they do speak English I can understand them.”

We found safe care and treatment was not provided. People were not safeguarded from abuse and risks to them, including infection control risks in relation to COVID-19. Safe medicine practices were not followed. Accident and incidents were not effectively managed and there was no evidence of learning from these incidents to prevent reoccurrence.

Safe recruitment practices were not followed. We found staff were not always supervised and trained in line with the provider's policy. Staff we spoke with reported they were able to contact the office, or an on-call person, to seek advice and support when needed.

The records and systems in the service did not support best practice on the application of the Mental Capacity Act 2005 to ensure people were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests.

The service was not well managed or monitored. The service did not have a registered manager in place. The provider had failed to undertake effective oversight and supervision of the service manager who was responsible for key aspects of the service including safeguarding adults. At the time of our site visit, the service manager was in the process of handover with a recently appointed care manager.

Some people expressed concerns regarding the management of the service particularly in relation to communication. One person told us, “I have to chase everything. They are very helpful, but I have to chase.” Other comments from families included, “I don’t know who the managers are” and “I would raise queries and questions; no one would come back to me.” One person summarised their concerns by telling us, “I wouldn’t recommend the company because of lack of communication, poor timekeeping and lack of management.”

The service failed to make the required notifications to us and did not understand their responsibility under the duty of candour regulation. There was no duty of candour policy in place and we made a recommendation the provider refers to current guidance to develop and implement an appropriate policy.

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 good (published 17 August 2017).

Why we inspected

We received concerns in relation to the safe management of medicines and management arrangements for the service. The service did not have a registered manager in place. As a result, we undertook a focused inspection to review the key questions of safe 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 changed from good to inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Forever Homecare 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 safe care and treatment, safeguarding from abuse, recruitment practices, good governance, duty of candour and in informing the Commission of incidents and information they are required to.

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Forever Homecare is a small, family-run service located in the central business district of Slough, Berkshire. The service provides care at home to older and younger adults in Berkshire and Buckinghamshire. Only personal care is regulated by us, and our inspection has excluded evidence about other support types offered by the service. At the time of our inspection, the service provided care to about 31 people and this was growing. There were approximately 15 staff with more being recruited to increase the capacity of the service to cater for more care packages.

The service must have 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.

At the time of our inspection there was a registered manager.

This is our first inspection of the service since their change in registration with us. The service changed their location since our last inspection.

We found people were protected against abuse or neglect. Staff attended training that ensured their knowledge of safeguarding people was up-to-date. People had personalised risk assessments tailored to their support requirements. We saw sufficient staff were deployed to provide people’s support. We made a recommendation about the service’s medicines policy.

Staff received appropriate induction, training, supervision and support from the service’s management. This ensured their knowledge, skills and experience were appropriate for their caring roles. We saw people’s consent was obtained before care packages commenced. The service needed to ensure that where consent was given by another party (such as a relative with a power of attorney ) that appropriate checks of documentation were completed and stored. People were sometimes supported with their nutrition and hydration. Staff respected people’s choices for meals and enabled them to be as independent as possible in the preparation of food and drinks.

Staff at Forever Homecare were caring. The service had received many compliments about the care received. Responses to surveys we carried out and people and relative’s feedback demonstrated that staff were kind and compassionate. The service had appropriately considered communication barriers in the provision of personal care and implemented strategies to ensure people and their relatives could have effective conversations with staff.

People had appropriate support plans in place which were regularly reviewed. We found the plans contained detailed information relevant to each person who uses the service. There was an appropriate complaints system in place and the management team handled any concerns promptly.

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.

The service was well-led. There was a positive workplace culture and staff felt that management listened to what they had to say. We saw there were a variety of audits and checks completed by the management to measure the safety and quality of care. The service had developed their own improvement plan and worked continually towards improving their support to people and those important to them.