Focused Healthcare Limited was rated Good overall at its November 2018 announced inspection, with Safe rated Requires Improvement due to inaccurate medicine administration records and incomplete equipment monitoring checklists. All other key questions were Good, with strong safeguarding, person-centred care, responsive complaints handling and effective multi-agency working noted as particular strengths.
Concerns (5)
moderate
Medication management
: “five people's MARs contained gaps with no explanations for them or had missing information on them such as role of transcriber, doses of medicines not signed for”
moderateRecord keeping: “Checklists for tracheostomy, ventilator, weekly equipment changes, hourly ventilator observation charts and ventilator temperature checks were not always recorded as required.”
moderateStaff competency: “Sometimes they take care workers who don't know how to use the hoist or do things...individual staff competencies were not met following training in the safe use of equipment.”
moderateStaffing levels: “They cancel shifts at very short notice...The other two days are always cancelled because they struggle to find carers”
moderateGovernance: “There was a system for reviewing people's MARs but it did not identify the issues we found with the inconsistencies of recording.”
Strengths
· Relatives reported staff were caring, compassionate and respectful, treating people with dignity and privacy.
· Safeguarding systems were robust; all staff completed relevant safeguarding training and knew how to escalate concerns.
· Safe recruitment practices were in place including DBS checks, references, NMC registration verification and right-to-work checks.
· Staff received induction, mandatory training, regular supervision and appraisal, including flexible arrangements for remote staff.
· Complaints were managed well with written outcomes provided to complainants in a timely manner.
Quality-Statement breakdown (19)
safe: Medicines managementRequires improvement
safe: Risk assessment and daily record completionRequires improvement
safe: SafeguardingGood
safe: Staffing levels and recruitmentGood
safe: Infection controlGood
effective: Staff training and inductionGood
effective: Staff competency in specialist equipment useRequires improvement
effective: Mental Capacity Act / consentGood
effective: Nutrition and health care accessGood
caring: Kindness, compassion and dignityGood
caring: Independence and involvement in careGood
responsive: Person-centred care planningGood
responsive: Activities and community accessGood
responsive: Complaints handlingGood
responsive: End of life careGood
well-led: Leadership and management visibilityGood
well-led: Quality assurance systemsGood
well-led: Staff support and communicationGood
well-led: Partnership working with external agenciesGood
Focused Healthcare Limited, providing nursing and personal care to 86 children and young people at home, was rated Good across all five key questions at its announced inspection on 31 March 2016. The sole finding was a minor gap in medicines audit records, which the registered manager had already begun to address by redesigning the MAR documentation.
Concerns (1)
minorMedication management: “the medicine audits did not identify the gaps in the MARs we found they did not have codes on them to explain the reasons for the gaps in these records.”
Strengths
· People were protected from harm with robust safeguarding processes and staff knowledgeable in identifying and reporting abuse.
· Sufficient staffing levels maintained with appropriate recruitment checks including DBS, references, and right-to-work verification.
· Staff received regular training, supervision, appraisal, and spot checks including specialist training such as PEG feeding and tracheostomy care.
· People and relatives were involved in care planning and assessments, with care records reflecting person-centred approaches.
· Complaints system in place with evidence of timely investigation and response to complainants.