Fisher Healthcare East Anglia - Norwich improved from Inadequate to Requires Improvement overall, exiting Special Measures, but remained in breach of Regulations 12 and 17 due to incomplete risk assessments, inaccurate care plans, and ineffective governance and audit systems. Strengths included safe medication management, good staff training and recruitment, strong multi-agency communication, and a positive, person-centred culture under improved leadership.
Concerns (7)
criticalCare planning: “One person had an identified risk of choking but their nutrition and hydration risk assessment stated they were not at risk.”
critical
Care planning
: “One person had a grade 1 pressure sore earlier in the year, but there was no reference to this in their care plan or risk assessment.”
criticalGovernance: “Governance and performance management was not always reliable and effective. Systems were not regularly reviewed. Risks were not always identified.”
moderateRecord keeping: “Care records were not always updated following reviews with people who used the service and/or their relatives or following identified changes in need.”
moderateGovernance: “Although some audits were being completed, they were not robust in identifying all gaps and errors.”
moderateIncident learning: “Records for keeping track of specific incidents were not always up to date and accurate, which did not allow oversight into their management.”
moderateSafeguarding: “The safeguarding log contained incidents which were not referred to the Local Authority for safeguarding as they did not fit the criteria and were not always notifying CQC.”
Strengths
· People were receiving their medication correctly following improvements since the last inspection.
· Staff demonstrated a good understanding of safeguarding responsibilities and felt comfortable raising concerns.
· Sufficient staff were deployed and travel time was considered to ensure people received consistent, reliable care.
· Healthcare professionals praised timely, proactive communication and appropriate referrals from the service.
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Continuous learning and improving care; duty of candourGood
well-led: Engaging and involving people using the service, the public and staff; working in partnershipGood
Fisher Healthcare East Anglia Ltd was rated Inadequate overall following a focused inspection of safe and well-led domains, with multiple regulatory breaches including unsafe medicines management, failure to refer safeguarding concerns, inadequate recruitment checks, and ineffective governance oversight. Enforcement action was taken with conditions imposed on the provider's registration across four regulations, and the service was placed in special measures.
Concerns (10)
criticalMedication management: “Medicine administration records (MAR) did not show people had received their medicines as prescribed. We found several gaps in these records that had not been identified for investigation.”
criticalSafeguarding: “Staff had raised an allegation claiming a member of staff had verbally abused a person using the service. They did not refer this to the local authority safeguarding team or CQC as is required.”
criticalGovernance: “The governance structure in place was not effective at monitoring the quality and safety of the care provided. The provider had no effective oversight of the quality of care being provided.”
criticalIncident learning: “Incidents had not always been reported for investigation and where they had been, not investigated. This is important so that lessons can be learnt to prevent incidents to people's safety from re-occurring.”
criticalInfection control: “Five of the nine people/relatives we spoke with told us staff did not always wear the relevant personal protective equipment (PPE) to reduce the spread of infection.”
criticalStaff competency: “A DBS was performed for one staff member in August 2018. This showed the staff member had been convicted of a criminal offence in 2016. No assessment of the risk this may pose to people was conducted.”
moderateStaffing levels: “A relative told us, 'They (staff) come about an hour later because they have been given extra calls to deal with. Sometimes they have turned up just as I am about to dish up lunch.'”
moderateRecord keeping: “When staff had indicated they had raised an incident by either ringing the office or the on-call duty staff member, a contemporaneous note of the action taken had not been made.”
moderateLeadership: “Four staff said they did not feel fully supported. They stated they did not feel listened to or valued and that concerns they raised were not investigated or taken seriously.”
moderateCommunication with families: “A person said, 'I do have a problem with the office. I am not told who I am getting, and they are constantly changing the rota. I must do the ringing around to find out who is coming.'”
Strengths
· People described carers as polite, caring and approachable.
· The provider sought assistance from the local authority regarding staffing pressures during the COVID-19 pandemic.
· The provider was actively recruiting new staff to address staffing shortfalls.
· In most cases, two staff attended calls where required, with family stepping in safely where needed.
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Learning lessons when things go wrongInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving careInadequate
Fisher Healthcare East Anglia Ltd was rated Requires Improvement overall following its first inspection in March 2019, with breaches of Regulations 12 and 17 due to incomplete medicines records, lack of MAR auditing, inconsistent risk assessments, and significant governance deficits inherited from a period of management instability. The newly appointed management team was viewed positively by people, staff and commissioners, with caring and responsive practice rated Good, and a clear improvement trajectory underway.
Concerns (8)
criticalMedication management: “MAR charts we viewed had not been audited and so it was unknown if these were recording errors or represented administration errors.”
criticalGovernance: “Care reviews and quality control audits were disorganised and significantly behind schedule. medicines administration and daily logs had not been systematically audited for over three months.”
criticalRecord keeping: “Accurate, complete and contemporaneous records had not been kept in respect of each service user in the carrying on of the regulated activity.”
moderateMedication management: “There were no separate protocols for 'as required' (PRN) medicines.”
moderateCare planning: “one person who was at risk of developing pressure ulcers, did not have an appropriate skin care risk assessment or care plan.”
moderateSupervision / appraisal: “Staff had not been consistently provided with regular supervision (planned for a minimum of three times annually).”
moderateConsent / capacity: “Mental capacity assessments had not always been carried out where there was evidence of fluctuating or impaired mental capacity.”
minorIncident learning: “They did not have a systematic recording process for analysing incidents, outcomes and themes, nor lessons learnt for future practice.”
Strengths
· People reported being treated with kindness, dignity and respect, with positive feedback about all care staff.
· Care plans were person-centred, written in people's own words, reflecting individual backgrounds, preferences and needs.
· Staff demonstrated good safeguarding awareness and knowledge of abuse types and reporting procedures.
· New management team was open, approachable and had stabilised the service, avoiding missed visits during transition.
· Comprehensive recruitment process and active programme to improve staff retention and consistency.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Working in partnership with othersInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support with openness; duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careRequires improvement