Fen Homecare

On this page

• 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

At our last assessment we rated this key question Inadequate. We identified 1 continued breach of the legal regulation in governance. The provider still had not implemented processes to monitor and improve the quality of care and experience. They still had not implemented systems to assess, monitor and mitigate risks relating to the health, safety and wellbeing of people. As a result, people did not always have good quality or safe care delivered to them.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The leaders did not always have a clear shared vision and did not always understand the challenges and the needs of people. For example, we saw from rotas that people’s call times were not consistent. People told us they did not always know when the call was taking place or who their carer would be. Although policies and procedures were in place, these were not always followed.

The service had not met their own aims, objectives and expectations. The service did not have the processes in place to demonstrate it listened to and acted upon concerns, were open and responsive to suggestions, and used systems to drive improvement. After our first visit to the office, we raised significant concerns, and the provider responded with an action plan and assurances that immediate action would be taken. When we returned to complete the assessment, we found that not all improvements had been made as expected, and we had to take further action to ensure people’s health and wellbeing was not put at risk. Feedback from the local authority indicated that while initial improvements had been made after the previous inspection, recent concerns had been raised about the service. At the time of the assessment the local authority was not referring new people to the agency.

The care staff found the provider and registered manager approachable. However, the registered manager could not demonstrate they had the skills and competency to lead effectively at all times. They could not tell us how they had kept themselves up to date with learning in adult social care to ensure people received a good standard of care. They did not fully understand their responsibilities, for example to notify the local authority and CQC of safeguarding incidents, the management of risk or for completing quality assurance checks. They did not take action to ensure required improvements were made. The provider had failed to check that the registered manager was fulfilling their duties as expected.

Leadership lacked the necessary skills and knowledge to manage the service effectively. In response to our initial findings, the provider employed a consultant to support necessary improvements. However, although the consultant developed a medication audit, the registered manager did not complete it as expected.

Staff were confident they could raise any issues with the registered manager or provider. Some staff mentioned that they preferred to approach the provider rather than the manager, as they shared the same first language, making communication easier.

The provider had policies and systems in place, which supported people and staff to speak up if they needed.

The registered manager respected and valued diversity in their workforce. Staff confirmed they were valued as part of a team.

The provider had policies in place for lone working and equality, diversity and inclusion in employment.

Leaders did not always understand their roles and responsibilities to ensure good quality, safe care was provided to people. They did not have effective quality assurance systems in place. They had not completed any checks or reviews on people’s care records, risk assessments, people’s capacity or the administration of medicine. At the start of the assessment, the registered manager stated that they did not know how to access, review, or update people’s care plans on the computer system to ensure they were current and reflected people’s current needs.

Quality assurance systems were not robust and did not operate effectively to ensure people consistently received good quality care and support. There had been no audits at the provider level to identify the shortfalls found within the assessment. The provider had not implemented clear responsibilities, roles, systems of accountability and good governance. The provider's oversight of staff knowledge and competencies was insufficient to ensure staff were skilled and trained to carry out their roles. The provider had no quality systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people. The registered manager did not have effective oversight of the service. They had not undertaken their own checks and audits to ensure staff were capable to do their roles. The registered manager and the provider were not aware of the extent of the concerns found during this assessment. The provider has been receptive to feedback.

People and relatives were happy with how the service engaged with other health and social care partners when required. One person told us, “[Registered Manager] brilliant. [Registered Manager] tries to help in every way and comes out to check we’re happy.” One relative told us, “Yes, [the registered manager] is very helpful.” They gave an example of when a new hoist and bed had been delivered recently, and manager told them to call when they were delivered, and they would ensure staff were there to hoist their family member back into bed.

Staff worked well with others when required. They were open to advice and support. One staff member told us that the district nurse would leave them advice if they wanted anything done differently.

As a result of our findings, the local authority implemented measures including reviewing people's care and requiring the provider to submit daily information to ensure people were receiving safe care. Information was not always provided to the local authority in a timely manner.

The registered manager knew how and when to share information, and who with. Information from healthcare professionals wasn’t always documented in people’s notes or care plans.

The registered manager stated that they didn’t see their job as “knowing the clients” but that it was their role to manage the service. However, this had meant a lack of understanding of people’s needs meant that staff had not always received the appropriate training. Care staff told us they could raise issues and ideas for improvements at staff meetings.

The service did not focus on continuous learning, innovation and improvement across the organisation. The provider stated that due to financial restraints caused by their inadequate rating from our previous assessment, they had to let key staff go and were expecting there to be issues identified during the assessment. They did not actively contribute to safe, effective practice and research. The service could not demonstrate they had a good understanding of how to make improvements happen or that they used reflective and collective practice to problem-solve and make improvements. Despite being given opportunities for improvement, the service had not used these to ensure people’s experiences were the best they could be.