Forget Me Not Caring Limited was rated Good across all five key questions at its March 2019 inspection, with no regulatory breaches identified. The service demonstrated strong person-centred practice, safe medicines management, effective partnership working and well-embedded governance systems.
Strengths
· Relatives consistently reported their loved ones felt safe, happy and well supported by knowledgeable staff.
· Medicines were managed, administered and stored safely with up-to-date staff training and regular competency assessments.
· Robust safeguarding policies and procedures in place; all staff had received up-to-date safeguarding training.
· Sufficient staffing levels maintained across supported living schemes, with safe recruitment practices including full DBS checks.
· Person-centred care plans documented individual histories, preferences, communication needs and health care guidance.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Adapting service, design, decoration to meet people's needsGood
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Ensuring people are well treated and supported; equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Planning and promoting person-centred, high-quality care and support; and how the provider understands and acts on duty of candour responsibilityGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
well-led: Continuous learning and improving careGood
This targeted inspection of Forget Me Not Caring, a supported living domiciliary agency for 41 people with learning disabilities and/or autism, found the service remained Good in both Safe and Well-Led domains with no evidence of harm to people. The inspection was prompted by an increase in safeguarding concerns and the absence of a registered manager, both of which were being appropriately addressed at the time of inspection.
Strengths
· Staff were consistent, reliable and had built strong relationships with people they supported
· Medicine administration was well managed with regular competency checks and audits of MAR sheets
· Robust infection prevention and control measures in place, including PPE spot checks and COVID testing guidance implemented
· Quality assurance systems effectively monitored performance including accidents, incidents, care records and medicines
· Lessons were learned from safeguarding concerns with changes made to systems and processes
Forget Me Not Caring received an overall rating of Requires Improvement following a focused inspection in September–October 2022, with Well-led rated Inadequate. Four regulatory breaches were identified covering safeguarding (Reg 13), safe care and treatment (Reg 12), dignity and respect (Reg 10), and good governance (Reg 17), representing a significant deterioration from its previous Good rating.
Concerns (12)
criticalSafeguarding: “information of concern found during the inspection had not been escalated by staff within the organisation. This meant the registered manager was not aware of the concerns”
criticalMedication management: “a person had been supported to take a medicine prescribed on an as needed basis twice daily which should only have been administered during periods of distress”
criticalGovernance: “The provider's governance processes were not effective and had failed to hold staff to account, keep people safe, protect people's rights and provide good quality care”
moderateCare planning: “People's care and support plans did not always reflect their needs and preferences or promote their wellbeing and enjoyment of life. Information was not person-centred”
moderateStaff training: “staff had not received training in understanding the needs of people with a learning disability and autistic people, including the use of communication tools and positive behavioural support”
moderateIncident learning: “The provider had not always managed incidents affecting people's safety well. There was a lack of investigation into possible trends and themes to learn lessons, change practice”
moderatePerson-centred care: “The terminology used by staff in people's care plans, daily records and incident reports was not always appropriate or respectful.”
moderateConsent / capacity: “The provider could not evidence how they had considered people's capacity to make decisions...the provider had not recorded any assessments or best interest decisions in their care plans”
moderateSupervision / appraisal: “Where concerns were highlighted regarding staff communication and practice, the provider had not always ensured staff received supervisions in order to support them”
minorRecord keeping: “information was not always detailed and did not accurately reflect investigation outcomes”
minorComplaints handling: “The provider had a complaints log in place for recording when concerns were raised. However, outcomes and actions were not always clearly documented.”
minorCommunication with families: “some relatives told us they had not received these [surveys]. 'No questionnaire has been sent out for a long time, if ever'”
Strengths
· Staff supported people to play an active role in maintaining their own health and wellbeing, including healthy eating guidance and access to local sports facilities.
· People were supported to participate in a range of leisure and social activities in their local area.
· Provider ensured medicines were regularly reviewed by prescribers in line with STOMP principles.
· Recruitment and selection process included DBS checks to ensure staff suitability.
· Infection prevention and control policy was up to date and staff had completed relevant training.
Forget Me Not Caring Limited is a domiciliary care agency providing personal care to autistic people and people with a learning disability living in supported living settings. At the time of our assessment there were 58 people using the service. We visited the service's office on the 25 and 29 January 2024 and visited people in their supported living settings on the 30 January and 1 February 2024. This is a specialist service used by autistic people and people with a learning disability. We expect health and social care providers to guarantee autistic people and people with a learning disability respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At our last inspection we identified breaches in relation to the management of medicines, risks to people's safety, safeguarding, dignity and respect, and good governance. During this assessment we looked at a number of quality statements under the key questions of safe, effective, caring, responsive and well led. We found the provider had made significant improvements since the last inspection. However, their systems for monitoring the safety and quality of the service were not yet fully embedded and working effectively. The provider was was no longer in breach of regulations 12 (safe care and treatment), 13 (safeguarding) or 10 (dignity and respect). The provider remained in breach of regulation 17 (good governance).
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