Focus Care Link

First Care Link (FCL) is a domiciliary care service providing personal care to older people, people with dementia and people with physical disabilities. 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 there were 108 people using the service.

People’s experience of using this service and what we found

Due to an issue with the service digital care planning system, risks in relation to people receiving treatment and care were not always managed appropriately. Quality assurance systems were in place, but these were not effective as they did not identify some of the shortfalls identified during our inspection. We found shortfalls in the implementation of the new digital care planning system. The registered manager told us that the information has not transferred from the old to the new system. This meant there was a risk that care was not always managed appropriately. The registered manager acted on our feedback from the inspection and was in the process of addressing the issues identified.

People told us they felt safe receiving the service and policies and systems were in place to help protect people from the risk of harm, abuse, and improper treatment. Medicines were administered following best practice. Staff told us they felt supported, and we saw that they had been safely recruited, appropriately inducted, trained, and that their competency to perform their role, was assessed. People told us they had confidence in the staff's abilities and that they treated them with compassion.

People's nutritional and hydration needs were met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People who used the service, relatives and care workers told us that office staff were supportive and addressed any issues most of the time.

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 good (published 2 May 2018)

Why we inspected

We received concerns in relation to missed and late calls and the management of pressure ulcers. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to guidance in how to respond to minimise risks assessed in relation to people receiving care and governance systems within the service.

We have made recommendations for the provider to seek guidance from a reputable source on staff deployment and how calls are scheduled or planned to meet people's needs and on administering time sensitive medicines and the impact this might have on people.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The service had 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.

When we last visited the service on 7 and 8 July 2017 the service was rated Good overall, with a ‘Requires Improvement’ rating in the safe question. This was because individual risks to people were not always assessed and medicines were not always managed safely.

At this inspection we found that the service had made improvements to ensure people were safe. People told us they felt safe with care workers from Focus Care Link. People had up to date risk assessments in place which included guidance for care workers on how to reduce and manage risk. Medicines were well managed and recorded. The service had followed safe recruitment processes to ensure they only employed suitable staff. Care workers were aware of their duties in relation to infection control when working in people's homes. Care workers had received training in safeguarding adults and understood their responsibilities to identify and report any concerns.

We received mixed feedback from people receiving care. Some told us staff arrived on time, and others said this was not always the case. The registered manager acknowledged that punctuality was an area the service was always seeking to improve and she shared with us the various improvement strategies that had been introduced to improve punctuality.

The service carried out appropriate pre-employment checks to ensure only suitable staff worked at the service. References and security checks were carried out as required.

Care workers received regular supervision and appraisals that helped them to perform their duties. They also received spot checks from care coordinators whilst they were working with people.

Care workers understood the Mental Capacity Act 2005 (MCA) and we found that people's consent was sought before the service provided care to them.

People's nutritional needs were met by care workers who would cook meals for those who required this type of support.

The service supported people to access healthcare services. Staff sought healthcare professional advice and input when needed.

Care workers were kind and caring. People receiving care and their relatives told us care workers were considerate and respectful. People were involved in planning their care and support.

People received care in line with their assessed needs. The service reviewed people's needs and ensured care workers had sufficient guidance to meet their changing needs.

People had opportunities to share their views about the service. The service acted on people’s feedback to improve service delivery. People knew how to make a complaint should they need to.

The registered manager used a variety of methods to assess and monitor the quality of service provided to people. These included regular internal audits of the service, surveys and spot checks to seek the views of people about the quality of care being provided.

Focus Care Link is registered to provide personal care to people living in their own homes primarily in the North London boroughs of Camden, Islington and Barnet. At the time of the inspection, there were 169 people using the service. The service employs 106 care staff.

The service had a registered manager who was also the registered provider. 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.

Risks were not always adequately assessed for people using the service. During the inspection we identified risks to people which had not been identified by the provider. General risk assessments were in place and were reviewed regularly.

Medicines were not always safely managed. There were inconsistencies between what care plans and medicines risk assessments stated as to what medicines support people received. Daily records completed by staff in relation to medicines support people received differed from what instructions were given as part of the care plan.

People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of the types of abuse to look out for and how to raise safeguarding concerns.

The service maintained sufficient staffing levels and people told us that carers generally arrived on time. The service monitored late and missed calls and took action when necessary.

The provider obtained consent for care in accordance with the Mental Capacity Act 2005. Staff had received training in MCA.

Complaints were logged and monitored for trends and learning points identified were actioned.

Person centred care plans were recently implemented which were comprehensive and reflected what was important to the person. Care needs were regularly reviewed and updated to meet the changing needs of people who used the service.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff were also safely recruited with necessary pre-employment checks carried out. Staff received regular supervisions and annual appraisals.

The management team enabled an open culture that encouraged staff and people to discuss issues and ideas. People were given the opportunity to provide feedback at service user forums and through an annual survey.

The provider had a quality monitoring system in place to ensure standards of service were maintained and improved.

Our inspection team was made up of one inspector. As part of this inspection we spoke with seven people who used the service, two relatives, the registered manager and three care staff. We also reviewed records relating to the management of the home which included four care plans and four staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

There were detailed care plans for each person who used the service, which included risk assessments. There was an out of hour's phone number to deal with emergencies. Staff had emergency first aid training.

Is the service effective?

The service undertook assessments with the person who used the service or a relative to identify their support needs. People who used the service gave written and verbal consent for the care they received.

Is the service caring?

People who used the service or a relative had been involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. A person who used the service told us, 'They are patient, kind and nice to me.'

Is the service responsive?

The service liaised with other health professionals to meet the needs of people who used the service. People's individual needs had been assessed and staff were aware of their needs. People who used the service knew how to make a complaint, although none had been made in the past year.

Is the service well-led?

The service was using the skills and knowledge of staff members to provide the required service to meet people's needs. Staff meetings were being held regularly and the staff we spoke with confirmed they felt able to make suggestions and voice concerns.

There were processes to monitor and improve the quality of service delivery such as an annual service user questionnaire.

We were also told that there were discrepancies regarding Criminal Records Bureau (CRB, now the Disclosure and Barring Service) checks of care workers employed by the provider.

We spoke with the registered manager and three field co-ordinators. We randomly selected the care records of people using the service for inspection and looked at other records regarding the service. We found no evidence of people's care records being improperly maintained or of any concerns relating to staff CRB checks.

We spoke with the registered manager, an administrator and a care co-ordinator and looked at records of the recruitment process, staff files and training records.

We found evidence to show that the information given to us was unsubstantiated and that the provider was meeting the relevant standards.

A person using the service told us, 'The care is very good' and that the care workers 'Are kind and friendly.' Another person said, 'Yes, the care plan meets my needs. If I need it changed, I know I can speak to the office and they'll sort it for me.'

At our last inspection, in November 2012, we identified that one of the carers employed by the provider was using a false identity. Accordingly, we set a compliance action regarding the provider's recruitment procedure. At this inspection we saw that the procedure had been improved and that satisfactory checks were carried out, to comply with the action and the requirements of Regulation 21 (a) and (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider had a thorough induction process for new members of staff and an ongoing training programme. Staff were happy in their work and told us they were well supported by management.

There was an effective system for monitoring the quality of the service and obtaining feedback from people using the service.

One person told us they were 'very happy with the service.' Another said the care workers were 'polite and never rude.' A relative said they 'certainly had no complaints about the service.'

During our inspection, it was established that one of the care workers employed by the provider was using a false identity, which showed a failing with the provider's existing procedure for vetting prospective workers. The worker was immediately dismissed and the police informed. We were told that a new, more robust, procedure had been introduced.

The provider had a thorough induction process for new members of staff and an ongoing training programme. Staff felt well supported by management.