Future Care Enable Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 1 breach of the legal regulations in relation to safe care and treatment. The provider failed to establish a culture of learning and systems for monitoring service quality and identifying deficiencies. People’s risk assessments, care plans, and equipment management was poor and lacked the required information to promote safety. However, people generally felt safe and satisfied, and appreciated the support provided.

This service scored 34 (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 failed to foster a culture of learning within the service. There was no clear system in place to monitor and review the service's quality, identify any deficiencies, and drive improvements. We have provided further details on this issue under the "well-led" key question. People and relatives gave us mixed feedback about the service. One person told us they had made multiple requests for a change of staff with the manager but had not seen any changes. Another person told us the provider was responsive to their concerns and acted quickly. One person told us, “We complained about the timekeeping, and it was dealt with to our satisfaction.” The registered manager told us they regularly made contact with people and visited them in their homes to gather feedback and make changes.

The provider lacked a consistent process for assessing people's needs. We found shortcomings in the provider's systems for consistently and effectively assessing and monitoring the health and safety of individuals. Staff were able to give us examples of when they had worked with external health professionals to meet people’s health and care needs and people’s records indicated they had been supported by other health professionals, such as speech and language therapists. However, the advice and guidance from these professionals was not clearly recorded in people’s care plans increasing safety risks to them.

The provider failed to identify some incidents which required a safeguarding notification, for example, medicines records indicated people may not have received their medicines correctly and indicated people had been given too much medicine. The provider’s own quality checks had failed to identify this to allow them to review and take appropriate action. Staff and leaders knew how and when to report concerns, but they failed to escalate a situation to the local authority safeguarding team as required. This meant people were not always protected from the risk of harm and abuse. However, people and relatives told us they felt safe. A relative said, “[Relative] feels very safe in their care. They respect [Relative] and offer them choices. Staff are aware of their needs and wishes.”

The provider failed to always assess the risk to the health and safety of people using the service. Risk assessments were not always in place or did not contain enough detail, which meant mitigation measures to keep people safe were not always available to staff. For example, we found some people required equipment to support them to mobilise, there were no assessments in place to instruct staff how to do this safely. Care plans did not contain enough information to support people with their health, for example in relation to management of diabetes. Staff told us they thought people were safe. Staff said they had access to the care plans and risk assessments and could actively contribute to their development when things changed.

The provider did not have a robust process in place to monitor equipment in use by staff in people’s homes. During a home visit we found one person’s equipment servicing had expired. This had not been identified by the provider. This meant the provider could not be assured staff were using equipment that was safe for use. We spoke with the registered manager who was unclear of the legal requirements for the frequency of lifting equipment servicing. This meant there was an increased risk of injury to people and staff as equipment servicing could be missed.

The provider did not follow robust recruitment practices. We found missing and inaccurate information in staff recruitment records. For example, whilst employment references were obtained, these were not always from people’s previous employment or from jobs listed on their applications forms. There was no explanation on file to explain why different references were obtained. We could not be assured pre-employment checks were correct or robust. For example, for one staff member it was unclear if an enhanced criminal records check had been completed as we were only able to locate a basic certificate in their file. For another staff member, we found an enhanced criminal records check on file, however it listed a different employer, and we could not find evidence a live update check had been completed. We received mixed feedback about staff working in the service. One person told us they didn’t get along with their carer and requested they were changed, they told us the provider was in the process of arranging this. Staff were described as understanding, supporting care needs, and being respectful.

Care plans did not include sufficient detail in relation to Infection Prevention and Control (IPC). For example, some people had catheters in place. We did not find any reference to IPC in relation to supporting people with catheter care, this placed people at risk of infection. The provider had an IPC policy in place. The provider had adequate stores of personal protective equipment on hand and available to staff. We observed appropriate amounts of personal protective equipment was available and in use during people’s care visits.

Medicines were not managed safely. Processes were not in place to manage medicines safely. Audits of medicines had not been completed consistently and did not identify the areas of concern noted during this assessment, we have reported on this further in the well-led section of the report. We found medicines administrations records (MAR) were inconsistent. For example, MAR charts were handwritten and had not been transcribed correctly from the prescription or pharmacy label, this meant some people may have received more medicines than prescribed resulting in possible overdose. Medicines to be given ‘as required’ were not managed safely. For example, one person was prescribed a medicine to be given ‘as required’ for a heart condition, records showed this medicine had been given 3 times a day, every day for the month of July. People who were prescribed medicines to be taken as and when required did not have detailed protocols in place to guide staff when these should be administered. This put them at risk of receiving these medicines incorrectly. The provider was using 2 systems to manage medicines: electronic and handwritten. We found conflicting information between the systems. This meant staff did not have accurate and up to date information about people’s medicines. This placed people at risk of not receiving their medicines correctly. People did not provide us with any direct feedback in relation to medicines, only acknowledging staff supported them with the administration of medicines. As a result of our findings the provider arranged further training and development for staff and a review of systems and processes. We will check for improvements at our next assessment.