Forget Me Not Caring Limited

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The provider’s governance processes were not always robust in identifying and addressing concerns in the quality and safety of people’s care. Improvements were not fully embedded and learning was not always shared in order to drive progress and ensure people achieved good outcomes. The service remained in breach of regulation 17 (good governance). The management team had clearly defined roles and responsibilities and the culture of the service was open and inclusive.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had undertaken a restructure of the management team since the last inspection, with more clearly defined roles and accountabilities. The management team had a clear vision for how they planned to make improvements in the service. However, we received mixed feedback from staff about how effectively this vision was shared and how involved staff were in discussing improvements. Comments included, "There's definitely improvement since the last inspection, management cascading things down to us has improved," "There's no formal recording to ensure information is cascaded if we're not in when things may be discussed," and "To be 100% honest, we don’t put ideas forward, they tell us what's new and what's changed." The culture of the service had improved since the last inspection, with staff feeling more positive about the support they received. The provider told us they were continuing to address poor culture and performance issues where necessary and used the information gathered from people, relatives, and staff to assist in identifying concerns.

The provider sought feedback from people, relatives and staff via visits to the services, meetings and questionnaires. However, these processes were not always robust with some relatives and staff feeling communication could be improved. The provider told us they planned to increase the number of face to face staff meetings and review how people and their relatives were involved in the service to improve communication and feedback.

The management team had clearly defined responsibilities and staff knew who to contact when needed. The management team demonstrated how they had focused on specific areas of improvement following the last inspection and were open about the improvements still required. The provider had recently recruited an operations manager to give additional support to the management team in implement more long term quality improvement monitoring processes.

Staff spoke positively about the approachability and visibility of the management team. Staff told us leaders had the skills and knowledge needed to make the necessary improvements. Comments included, "[Registered manager] is very approachable and always makes time to speak to me," "Everyone in head office is doing their role and there is much more structure in the processes and systems," and "Since the last inspection, I have noticed a lot of improvements, things seem to be getting more organised, and structured. It’s definitely a work in progress as there were a lot of improvements needed and some of those changes can’t happen overnight."

The provider had a Freedom to Speak Up and Whistleblowing policy in place for staff to follow. However, no Freedom to Speak Up guardian was named within the policy and staff were not able to identify who it was. Most staff spoken to were unclear on what was meant by the term Freedom to Speak Up. The provider was not carrying out regular, structured supervisions for all staff to enable them to feedback and share concerns confidentially on a one to one basis.

Staff told us they were able to raise concerns. One member of staff said, "I have always felt listened to and have no concerns with going to any of my senior management team with concerns, complaints or worries." Despite feeling comfortable raising concerns, staff told us they did not always have enough opportunities to discuss issues. Supervisions were not taking place regularly and staff meetings were not always effective in providing the opportunity for two way conversations to share concerns and learning. Staff were not able to identify the provider's 'Freedom to Speak Up Guardian'. This is the named person responsible for supporting staff to speak up when they feel unable or uncomfortable doing so in any other way.

The provider had policies in place to support fair recruitment, induction, and supervision processes. Staff had access to training and development opportunities and the provider offered all staff appropriate support to develop and progress.

Staff told us there was an open and welcoming culture in the service and they felt comfortable speaking to the management team to ask for support or raise concerns.

Staff told us the provider's governance processes had improved since the last inspection. However, further improvements were needed to ensure more robust systems were in place for supporting staff training, supervision and learning. Where new systems were being introduced, it was taking time to embed these and ensure staff were confident in using the new recording formats. One member of staff said, "A lot of processes have been put in place; medicines folders and changing of care plans and safeguarding and incident forms. It will need time to embed, which is causing slow progress. It can be challenging." The provider told us they had implemented their new processes for monitoring the quality and safety of people's care following the last inspection and this had led to improved oversight. The management team acknowledged improvements were still ongoing to ensure these systems were robust and they were introducing further support by recruiting an operations manager and arranging external quality audits to monitor their progress.

The provider had implemented an electronic compliance workbook, which provided the management team with oversight in key areas of the service such as care planning, safeguarding and staff support. However, this system was not yet fully embedded and further improvements were needed to demonstrate how information was being used to minimise risk and improve people's outcomes. We identified gaps in the oversight of safeguarding, the management of risk, the monitoring of daily notes and care plans and the analysis of incidents. The provider did not have robust processes in place to ensure people achieved good outcomes and meaningful goals. The provider's processes for monitoring the submission of CQC notifications were not always robust and this meant information was not always shared in a timely manner in line with the provider's regulatory responsibilities.

The provider had processes in place to seek support from other health professionals. During the assessment we saw evidence of health referrals, care reviews and multi-disciplinary team meetings with other health professionals.

The provider worked in partnership with a range of different health and social care professionals. We received mixed feedback from health professionals about the quality of people's care plan and risk assessment documentation and how well staff communicated and followed recommendations. Despite these concerns, health professionals told us staff were welcoming and friendly, and the provider had made improvements since the last inspection to promote communication and ensure more person-centred care.

People told us they enjoyed a range of activities in the community, such as attending college and undertaking voluntary and paid work placements within the local area. People's care plans demonstrated they received regular input from relevant health professionals involved in their care.

Whilst the provider had identified learning and implemented new systems following the last inspection, we found their processes were not effective in driving continuous improvements and learning. For example, where things went wrong, such as an increase in medicines errors or a number of similar incidents within 1 service, there was a lack of analysis to understand why this had happened and to learn from this in order to make improvements. The provider had not always ensured staff had the time or opportunity to develop their learning from incidents. People and their families were not always fully involved in discussing what improvements had been made and evaluating whether these improvements were working effectively.

The provider told us their focus had been on implementing the new management structure and addressing the immediate concerns from the last CQC inspection and local authority quality audits. The management team had prioritised improving care plan documentation, staffing and performance management, and introducing clearer safety and quality monitoring systems. The provider confirmed their focus was now on embedding and improving these processes and they would be monitoring their progress through their ongoing service improvement plan.