The Care Quality Commission (CQC) has rated Forever Homecare in Slough inadequate overall following an inspection in August.
Forever Homecare is a service providing care and support to people in their own homes. At the time of the inspection it was supporting 36 people. The service provides both regular daily visits to people to help them with their personal hygiene and eating, and live-in staff members offering a 24-hour support service, across Buckinghamshire and Berkshire.
When the service was last inspected in January, it was rated inadequate overall, and it was placed in special measures*. The provider then produced an action plan outlining how it intended to make improvements. The inspection in August was carried out to review the service and check it had followed the action plan and that improvements had been made.
However, following the latest inspection, the rating for the service remains inadequate overall and it is also rated inadequate for being safe, effective and well-led. The service therefore remains in special measures which means that it will be closely monitored, both by CQC and the local authority, to ensure that people are safe. CQC is also considering what further enforcement action to take.
Rebecca Bauers, CQC’s head of inspection for adult social care, said:
“When we inspected Forever Homecare, we found multiple issues and failings. Although a manager was now in place since the last inspection, we found a disorganised service that wasn’t being well managed. Staff were not properly trained, people’s care plans were outdated, lacking in detail, or even non-existent, and audits were not in place to monitor and drive improvement in people’s care. It was also evident that when staff were recruited, the service did not follow proper processes to ensure they would be able to care for people safely, including checks on whether the person they were recruiting had a criminal record.
“It was clear that Forever Homecare was not being well run and this posed a real risk to people’s safety. For example, the manager was not aware of who in the service was on blood thinning medication, so had not put measures in place to manage any potential risks associated with the side-effects. And the care plan of one person, who could not be left unsupervised during meals because they experienced swallowing difficulties, said "I do not have any swallowing difficulties. I enjoy normal diet and fluids and can eat independently.”
“A lack of good documentation around medicines also meant the service wasn’t ensuring that some people were given medicines safely in line with the manufacturer’s instructions.
“In addition, we found that the service was not displaying its current CQC rating publicly at the office or on its website, which it is required to do. By not doing so, people could be misled about the quality of the service.
“Clearly, this is a situation which cannot continue. We have told the provider that it must now make urgent improvements in order to keep people safe and we will continue to monitor the service closely to ensure that these are made. If we are not satisfied that sufficient improvements have been made, we will not hesitate to take further enforcement action.”
Inspectors found the following issues at the service:
- Effective systems were not in place for the safe recruitment of staff. Some staff did not have a valid DBS certificate (a check on a person’s criminal record), gaps in employment were not explored, references had not always been taken, and reasonable adjustments were not explored for staff with identified health conditions. This meant that the service did not know whether staff were safe to care for people
- The service sometimes failed to ensure that there were enough suitably trained members of staff available to assist a person. Sometimes only one member of staff was available to help people who needed additional support, which meant they could be placed at risk of harm
- Some people did not have a care plan in place. This meant staff had either minimal or no written guidance to refer to in relation to people's assessed needs. People who had a diagnosis of dementia, diabetes or epilepsy, did not have information in their care plan to ensure that staff were aware of the support that those people needed. Some people had care plans, but not all of these had been updated. For example, one person was receiving care in bed, yet their plan said they were showering weekly, using a walking frame and using the toilet independently. Care plans also frequently listed people's religion as "not to be mentioned" and inspectors found limited indication that people’s religious or cultural needs had been explored
- During the last inspection service had failed to ensure appropriate infection control measures in response to the COVID-19 pandemic were in place. Inspectors found that were still some issues which meant that the service was not in line with national best practice guidance and not all staff were not being regularly tested for COVID-19 in line with government guidelines which could place people at risk of contracting the infection
- Staff were not always given access training to help them manage people's specialist needs. Some staff expressed concern about their colleagues' ability to safely use moving and handling equipment such as a hoist. The service had not completed competency assessments to verify whether staff understood how to manually handle people safely
- Not all members of staff had completed recent safeguarding training and only some staff had access to the service's safeguarding and whistleblowing policies. During the inspection two staff members said they had not received the policies, and one had searched online for two days to try to identify where they could raise concerns externally
- Several staff had not received training in relation to the Mental Capacity Act** and in some cases, there was no evidence that a needs assessment had been completed to check whether the person could consent to the package of care in place
- Risks to people were not clearly identified and managed. Risk assessments were either not present, had not been updated in a timely manner, or lacked sufficient detail to help staff understand and respond to risks
- Staff competency to administer medicines had not been robustly assessed. A member of staff expressed concern about the competency of colleagues to safely administer medication, describing concerns about visiting people's homes and finding tablets on the floor
- People were not protected from risks of avoidable harm as incidents and accidents were not always appropriately recorded, reported or followed up. Only two incidents had been logged during 2021, yet feedback from staff and information from a family member identified events which had not been logged as incidents or accidents, such as falls, and staff providing single handed support when two members of staff were required for safe moving and handling
- There was no accident policy or formal audit processes in place to identify wider learning from incidents across the service.
Full details of the inspection are given in the report published on our website.
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