Forest homecare Suffolk is a domiciliary care service providing a regulated activity of personal care. The service was providing care and support to people in their own homes. Not everyone who used the service received personal care. 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. At the time of our inspection visit and assessment there were between 30 and 40 people receiving personal care packages from the service. We conducted this assessment to follow up on our previous judgement of Inadequate and requirements we made. At this assessment we have found positive and sustained improvement and have re-rated the service as Good. Staff knew how to keep people safe, what to do if they had concerns and confident matters would be addressed. Staff were recruited safely, received training, and were kept informed. Medicines were managed safely within the service and infection prevention and control procedures were in place to ensure everyone was safe. Forest Homecare (Suffolk) worked well with partners and the community. Everyone understood their role and were clear in their part of making the service work well. Improvements had been sustained and built upon.
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Forest Homecare Suffolk received an overall Inadequate rating following a focused inspection in March 2023, with breaches of Regulations 12, 17, and 18 identified across medicines management, missed and shortened care calls, and wholesale governance failures. The service was placed in special measures, representing a significant deterioration from its previous Good rating in 2019.
Concerns (12)
criticalMedication management: “There are always tablets remaining that [family member] hasn't had. I've found tablets on the floor. A whole packet of tablets as well.”
criticalMissed or late visits: “78.1% of calls (5555 of care calls in total) had no travel time built in... 14% of people had less than half of the planned duration delivered.”
criticalStaffing levels: “The timings are all over the place. They are usually late, it's happening a lot recently, I think they are short staffed.”
criticalGovernance: “The provider had failed to establish effective quality assurance and governance systems that identified areas of risk and improvement needed within the service.”
criticalLeadership: “The registered manager did not have enough oversight of the service. They did not maintain a presence at the service or undertake any management audits.”
moderateCare planning: “A risk assessment for one person stated there was no issue with their skin integrity. This was despite them using three topical creams for their skin.”
moderateRecord keeping: “People's care records did not always include clear guidelines for staff in how to manage risks to their care.”
moderateStaff training: “The provider had not heard about this training and staff working for Forest Homecare Suffolk had not undertaken it [Oliver McGowan Mandatory Training].”
moderateConsent / capacity: “Staff training in record keeping needed to be improved in relation of the use of the Mental Capacity Act 2005 (MCA).”
moderateIncident learning: “The provider was not able to demonstrate how they monitored or managed missed, late and shortened care calls. There was no system in place to enable this.”
moderatePerson-centred care: “People were not empowered to influence the care and support they received.”
minorCommunication with families: “We've not had any surveys. They don't listen. Communication isn't as good as it should be.”
Strengths
· Staff had received training on how to safeguard people from the risk of abuse.
· Relevant pre-employment checks including DBS checks, references and proof of identity had been carried out.
· The provider supplied staff with PPE and people confirmed it was used during care visits.
· The management team demonstrated their understanding of duty of candour.
· Half of people and relatives spoken with said they were happy with the service and would recommend it.
Quality-Statement breakdown (12)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongInadequate
well-led: Managers and staff being clear about their roles and understanding quality performance, risks, and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive, and empoweringInadequate
well-led: Continuous learning and improving careInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Working in partnership with othersRequires improvement