About the service:

The service is based in the London Borough of Barking & Dagenham. The service provided personal care to adults living in their own homes. The CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, 28 adults used the service and there were 21 staff.

People’s experience of using this service:

• Since the last inspection, we found a number of improvements had been made.

• Most risks had been identified and assessed, which provided information to staff on how to reduce these risks to keep people safe.

• Quality assurance and monitoring systems had been introduced since our last inspection to make continuous improvements.

• Assessments for people who may lack capacity had not always been carried using the principles of the Mental Capacity Act 2005. We made a recommendation in this area.

• There were sufficient staffing levels to support people. Staff had been trained in safeguarding vulnerable adults and knew how to keep people safe.

• There was a safe recruitment process in place to ensure staff were suitable to support people.

• Staff had the knowledge, training and skills to care for people effectively.

• Staff received supervision and support to carry out their roles.

• Staff knew what to do if people were not feeling well.

• People needs and choices were being assessed regularly through review meetings to achieve effective outcomes.

• People told us that staff were friendly and caring.

• People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights.

• People had been involved with making decisions about their care.

• Care plans were person centred and included clear information on how to support people.

• People were aware of how to make complaints if they wanted to and staff knew how to manage complaints.

• Staff felt well supported by the management team.

• The service met the characteristics for a rating of ‘Good’ in all the key questions we inspected. Therefore, our overall rating for the service after the this inspection was ‘Good’.

• More information is in our full report.

Rating at last inspection:

• At the last inspection on 19 February 2018 the service was rated ‘Requires Improvement’. Our last report was published on 24 March 2018. We identified two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk assessments, medicine management and good governance.

Why we inspected:

• This was a planned inspection based on the rating of the last inspection. The inspection was part of our scheduled plan of visiting services to check if improvements had been made and the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

We carried out an announced inspection of Fern Care Services Limited on 19 February 2018. Fern Care Services Limited is registered to provide personal care to people in their own homes.

The CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection, the service provided personal care to 35 people in their homes.

At our last inspection on 24 July 2014 the service was rated ‘Good’. During this inspection, we found breaches of health and social care regulations that may put people at risk of harm. Therefore, the service has been rated as Requires Improvement.

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks were not always robustly managed. We found care plans did not contain suitable and sufficient risk assessments to effectively manage risks. This placed people at risk of not being supported in a safe way at all times.

People and relatives told us that medicines were given on time. However, there were discrepancies in people’s medicine records that had not been investigated and records did not detail the medicines dosage and frequency.

Staff had not received training on the Mental Capacity Act 2005 (MCA). Some staff did not know the principles of the MCA. Assessments had been carried out on people’s mental capacity, which found people had capacity to make decisions.

Staff had not received specialist training, such as on PEG feeds and catheter care, which they required to do their jobs effectively.

Care plans were inconsistent. Some care plans did not include the support people would require in relation to their current circumstances. Pre-assessments forms had not been completed in full to assess people’s needs and their background.

Effective quality assurance systems were not in place. The registered manager carried out visual audits, which had not identified the shortfalls we found during the inspection, to ensure people were kept safe at all times.

Accurate and complete records had not been kept to ensure people received high quality care and support.

Staff were aware of how to identify abuse and knew who to report abuse to, both within the organisation and externally.

Pre-employment checks had been carried out to ensure staff were suitable to provide care and support to people safely.

There were arrangements in place to ensure staff attended care visits. Staff told us they had time to provide person centred care and the service had enough staff to support people.

People were being cared for by staff who felt supported by the management team.

People had access to healthcare if needed.

People’s privacy and dignity were respected by staff. People and relatives told us that staff were caring and they had a good relationship with them.

Complaints and concerns were investigated but had not been responded to in a timely manner. We made a recommendation that response to complaints are sent in a timely manner. Staff were aware of how to manage complaints. People and relatives knew who to raise complaints and concerns to.

Staff, relatives and people were positive about the management. People’s feedback was sought from telephone and surveys.

We identified two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk assessments, medicines and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.

People expressed their views and were involved in making decisions about their care and treatment. They told us that they were treated with dignity and respect and that they were able to make choices over their daily lives. A relative said "we were able to show them exactly what we needed them to do and how to do it." People were happy with the care and support they received. One person said "it's important that they arrive on time and they do." People's needs were assessed and care and treatment was planned and delivered in line with their individual support plan.

The carers we spoke to understood what constituted abuse and the different signs and types of abuse that may occur. People we spoke with said that if they had any concerns about abuse they would report them to the management. All staff had received safeguarding training within the last year. People said they would report any concerns to the management. One person said "(The manager) told me in the beginning that I can tell her anything."

Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. Staff received appropriate professional development. Staff told us that they received induction training. They told us that the induction programme was good and that it prepared them well for doing the job. Staff supervision took place every three months. Staff said that they received adequate training that was relevant to their role.

People who used the service spoke positively about Fern Care Services and informed us that they were happy with the care they received. They told us that they felt safe when carers visited and found carers to be polite and caring. One person we spoke to said, “I have no complaints about the service, the service is great.” A second person said, “Everything is great with them.”

However, other evidence in relation staff recruitment did not ensure that the service had robust recruitment checks. The service also did not provide regular training to the staff team to ensure that people’s needs were met by competent staff.

We also found that people did not experience care, treatment and support that was planned with them and delivered in a way that protected their safety.

The service did complete annual quality assurance surveys, to regularly assess and monitor the quality of services that people received.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was announced. At our last inspection on the 25 April 2013 we found the service met all the regulations we checked.

Fern Care Services Limited provides personal care to people in their own homes. At the time of the inspection the service was providing care to 43 people. The service provided support to a variety of people which included older people, people with physical disabilities, people with learning disabilities, people with sensory disabilities and people under the age of 18.

There was a registered manager at the service who was supported by a deputy manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Some staff felt they could be supported more and we noted that appraisals were not taking place once a year. This was a breach of Regulation 23 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The action we have asked the provider to take can be found at the back of this report.

The majority of staff told us they felt supported in their induction and ongoing training so they could

provide effective care and had specialist skills and knowledge needed when caring for people.

People and their relatives commented positively about the relationships formed with the service and care staff. Relatives said that care staff were very kind to their family members and treated them with respect.

The service made and maintained good relationships with people and their relatives. People spoke positively about how safe they were using the service. People told us that the service was very “hands on” and people felt comforted that they could contact the managers at any time of the day, as an out of hours telephone line was provided.

People were involved in their care planning and they were asked the type of care they wanted when they joined the service. This was reviewed when changes were needed. People said they were happy with the care plans and said that care staff did the tasks they were supposed to when visiting their home. People were also supported to maintain contact with health professionals and the documentation was kept on changes to people’s health needs.

Management were always available at the service and care staff and people who used the service confirmed this. They said they could always speak to the manager, deputy or somebody at the office if they had anything they wished to discuss. The service also carried out audits to ensure the service people received was of a high standard. People’s comments in questionnaires and spot checks showed they were pleased with the care given to them.