Fosse Healthcare - Derby improved from Requires Improvement to Good across all five key questions following a focused follow-up inspection on 1 February 2022, with previous regulatory breaches in safeguarding, medicines management, and governance remedied. Minor residual gaps included occasional missed or late care calls, an unregistered manager, and audit processes still embedding, but no active regulatory breaches were found.
Concerns (4)
minor
Medication management
: “recent audits of eMAR charts had not identified records had not recorded whether one or two tablet medicines had been given where this was an option”
minorMissed or late visits: “People told us they still experienced some variations with the timings of their care calls...One person told us they had experienced the occasional missed call.”
minorGovernance: “audit process needed further time to fully embed improvements in the service”
minorLeadership: “There was no registered manager at the time of our inspection, however the recently appointed manager had begun the process of registration.”
Strengths
· Improvements made since previous inspection; provider no longer in breach of regulations for safeguarding, medicines management, or good governance
· Staff trained in safeguarding, medicines administration, infection prevention and control including COVID-19 PPE use
· Electronic medicines administration records (eMAR) in place with transcription checks and medicines error investigations
· Care plans and risk assessments kept under review and accessible to staff via mobile phones
· Staff completed Care Certificate induction and ongoing competency checks
Fosse Healthcare - Derby improved from Inadequate to Requires Improvement overall following a focused inspection of Safe, Effective, and Well-led domains, with continuing regulatory breaches in safeguarding (Regulation 13), safe care and treatment (Regulation 12), and good governance (Regulation 17). Key failures included untimely safeguarding referrals, inconsistent medicines management audits, ongoing variability in care call timings, and ineffective governance systems that failed to detect notifiable incidents and safeguarding concerns.
Concerns (9)
criticalSafeguarding: “a safeguarding referral had not been made when a person had made an allegation of abuse. The provider told us they accepted a safeguarding referral should have been made”
criticalMedication management: “only four out of the eight electronic medicine administration records (eMARs) seen had evidence this system had been carried out”
criticalGovernance: “Audit processes had not been effective at identifying where statutory notifications had not been submitted to the Care Quality Commission as required.”
criticalGovernance: “audit processes had failed to identify that potential safeguarding incidents had not been referred to the local authority”
moderateMedication management: “the audit took place on the 25 October 2021 looking at administration records that had been completed between the 1 and 7 of August 2021”
moderateMedication management: “one person had had their medicines administered too close together on two separate occasions”
moderateMissed or late visits: “one care staff comes between 7.30 and 8pm. Other care staff come between 9 and 10.30pm and another staff member can come between 10.45 and 11pm”
moderateIncident learning: “the provider did not speak with the care staff who could have made the error and the investigation did not conclude with any outcome”
moderateLeadership: “The previous registered manager had cancelled their registration with CQC in August 2021 and a new registered manager was not in post at the time of this inspection.”
Strengths
· Recruitment processes were in place and followed, including checks on staff suitability to work in care.
· Staff training and competency assessments had improved, including updated diabetes and skin integrity training.
· Care plans had been updated and contained sufficient guidance for staff to follow.
· Staff had access to PPE and had been trained in infection prevention and control measures.
· Provider engaged with health and social care professionals and involved people and relatives in care planning.
Quality-Statement breakdown (14)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
Fosse Healthcare - Derby was rated Inadequate overall following a June 2021 inspection, with breaches of Regulations 12, 13, and 17, placing the service into special measures. Widespread failures were identified across safeguarding, medicines management, missed and late care visits, poor care planning, and ineffective governance, with 22 missed CQC statutory notifications.
Concerns (13)
criticalSafeguarding: “Two people had made allegations that care staff had stolen from them. The registered manager had not made referrals to the police. This left people at ongoing risk of theft.”
criticalMedication management: “One person had paracetamol repeatedly given before the safe four-hour gap. This had already been recognised as a risk by the registered manager but not resolved for the next month.”
criticalMissed or late visits: “Three occasions where they haven't arrived at lunch time. I called and they said they were running late – ten to fifteen minutes away. I waited and waited but no one came.”
criticalCare planning: “Care plans did not provide sufficient or accurate information on people's healthcare needs. Staff had poor quality guidance on how to support people's diabetes needs, skin integrity needs, choking risks.”
criticalIncident learning: “Medicine errors had not been suitably investigated to prevent re-occurrence. There were repeated incidents of staff using medicines from different blister packs.”
criticalGovernance: “We identified 16 notifications had not been made by the registered manager... since this discussion, the registered manager had failed to notify the commission of an additional six incidents.”
moderateStaff training: “Staff reported that their induction and training was basic and did not provide them with enough skills to safely undertake their role.”
moderateStaff competency: “The registered manager advised that parts of the competency assessment asked staff if they know current guidance and recording their answer as 'yes' or 'no'. This process does not actively test staff understanding.”
moderateRecord keeping: “Daily notes kept by care staff were brief and did not include enough detail on what care was provided. The poor record keeping meant other staff and the management team would be unable to identify changes.”
moderateComplaints handling: “The service complaints policy stated that complaints would be responded to in writing within 28 days, there was no evidence that people's complaints had been responded to as the policy required.”
moderateConsent / capacity: “Capacity assessments had not always been completed to assess if the person could make the decision themselves before informing staff to consult the person's next of kin.”
moderateInfection control: “The service kept no record of which staff had taken tests and the registered manager believed this testing uptake was low. A staff member told us they were unaware that tests were available from the service.”
moderatePerson-centred care: “Care plans lacked detailed information about their physical, emotional and mental health needs. These details are needed so staff can provide personalised and responsive care to people.”
Strengths
· Staff were safely recruited to ensure they were of good character, for example gathering references from previous employers.
· People's life history and beliefs were recorded in their care plans, giving staff guidance on people's diverse lives.
· Staff were able to take people into the community to avoid social isolation.
· The service had information available in alternative formats (e.g. larger font) to support accessible communication.
· People were involved in initial care plan creation and staff involved them in day-to-day decisions about care routines.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Staffing and recruitmentRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Staff support: induction, training, skills and experienceInadequate
effective: Supporting people to eat and drink enough to maintain a balanced diet
Fosse Healthcare Derby received an overall rating of Requires Improvement at its first inspection following registration in April 2016, with medicines not consistently administered safely, visits arriving at inconsistent times, and no registered manager in post. The service was rated Good for effective and caring domains, with staff demonstrating appropriate training, dignity-centred practice, and involvement of people in their care planning.
Concerns (6)
criticalMedication management: “family member should have had twenty three left but there are twenty-four left, they have all been signed for. I have reported that and it isn't the first time”
moderateMissed or late visits: “I never get a rota, they come at all different times, late [or] early... sometimes lunch is at 11.30 which is too early”
moderateGovernance: “The service does not have registered manager. The current manager is awaiting documentation before she can forward an application to be registered.”
moderateRecord keeping: “medicine was given but this had not been recorded on the appropriate charts”
minorComplaints handling: “I complained about the medication, they haven't got back to me about it yet”
minorStaffing levels: “they take on too many clients hence everyone can't get lunch at lunchtime, they need to recruit more staff”
Strengths
· Staff were trained in safeguarding and understood whistleblowing responsibilities
· Robust staff recruitment checks including DBS and employment references were in place
· People were treated with dignity and respect; staff closed windows and curtains to preserve privacy
· Care plans were personalised and people were involved in their development
· Regular staff meetings and supervision supported staff knowledge and development
Quality-Statement breakdown (11)
safe: Medicines managementRequires improvement
safe: Safeguarding and risk managementGood
safe: Staffing and recruitmentGood
effective: Staff training and inductionGood
effective: Mental Capacity Act and consentGood
effective: Nutrition and hydrationGood
caring: Dignity, respect and involvement in care planningGood
responsive: Timeliness and consistency of visitsRequires improvement
Fosse Healthcare Derby improved from Requires Improvement to Good across all five key questions at this July–August 2018 inspection, with notable progress in medicines management, governance, and registered manager leadership since the previous inspection. Minor concerns remained around occasional late visits, staff consistency, and office communication with families, but these did not affect the overall Good rating.
Concerns (3)
moderateMissed or late visits: “Some people told us staff were late, and they were not always contacted by the office.”
minorCommunication with families: “"I must admit it [communication] isn't very good, we've left messages but they don't always get back"”
minorPerson-centred care: “"They need to read the notes more, and there's the odd little blip, some carers will forget to [rearrange furniture to assist with [name] mobility."”
Strengths
· Medicines management had significantly improved since the previous inspection, with regular competency checks and accurate record-keeping.
· Staff were safely recruited with full DBS checks, employment history and references completed prior to commencement.
· People and relatives described staff as kind, caring and respectful, with positive trusting relationships developed.
· Care plans were detailed, regularly reviewed and updated to reflect people's changing needs, preferences and cultural requirements.
· Strong and visible leadership with a registered manager now in post; open and transparent culture reported by staff.
Good
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
Requires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportNot rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Meeting people's communication needsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving care; Working in partnership with othersInadequate
well-led: Engaging and involving people using the service, the public and staffRequires improvement