Focus Learning, a small domiciliary care service in London, was rated Requires Improvement overall (Inadequate for Well-led) at its March 2022 inspection, remaining in special measures due to continued breaches of Regulations 9, 12, 17 and 20. Persistent failures in risk assessment, care planning, record-keeping and governance were identified, with the provider demonstrating insufficient understanding of duty of candour and the Mental Capacity Act despite having an action plan in place since the previous Inadequate rating in 2020.
Concerns (9)
criticalCare planning: “Care plans lacked detail and were not written in a person-centred manner. The initial assessment of need did not provide information on how and what care should be provided.”
criticalGovernance: “Systems put in place to monitor the service were ineffective. Audits were last completed in March 2021 and failed to identify concerns found during this inspection.”
criticalRecord keeping: “Daily notes provided for 18 to 21 March 2022 were not dated and did not provide a time when care was provided.”
criticalLeadership: “Provider did not have an awareness of the number of breaches from the last inspection and appeared confused when asked how they had met these since our last visit.”
criticalPerson-centred care: “Care plans lacked detail about people's preferences for care and were not written in a person-centred manner.”
moderateConsent / capacity: “There was still a lack of understanding of the principles of the MCA around assessing a person's capacity and best interest decisions.”
moderateIncident learning: “Further improvements were required to ensure learning from incidents and CQC notifications were included in the process.”
moderateComplaints handling: “No records were available despite a complaint made by a relative to the service in 2020. This was not in line with the provider's complaints policy and procedure.”
minorInfection control: “We were not always assured that the provider was preventing visitors to the office from catching and spreading infections.”
Strengths
· DBS certificate for the provider had been updated since the last inspection.
· Provider and office staff had completed safeguarding training and appropriately reported a safeguarding concern to CQC and the local authority.
· Medicine policies and procedures were in place and staff had completed medicine administration training.
· Sufficient personal protective equipment was available and being used appropriately during care visits.
· Provider had completed Care Certificate training since the last inspection.
Quality-Statement breakdown (16)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires 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
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Engaging and involving people using the service, the public and staffRequires improvement
Focus Learning was rated Inadequate overall and placed in special measures, with continued breaches of regulations covering safe care, consent, person-centred care, staffing, complaints, governance and notifications. The manager lacked recent training, robust risk assessments, quality assurance systems and transparency, and had failed to disclose a second service user, complaints and a service user death.
Concerns (12)
criticalCare planning: “People at risk of falls did not have appropriate risk assessments to help reduce the likelihood of falls.”
criticalStaffing levels: “People requiring two carers were at risk of harm as they did not receive two carers to provide support.”
criticalStaff training: “The manager had not completed any recent raining relevant to their role to show they had the knowledge to provide safe and effective support to people.”
criticalConsent / capacity: “The manager had not attended mental capacity act training and required prompting when we checked their understanding.”
criticalGovernance: “The manager did not have any quality assurance systems in place to monitor the service.”
criticalLeadership: “The manager failed to demonstrate good leadership qualities and oversight of the service.”
criticalComplaints handling: “complaints were not being recorded and investigated in accordance with the providers policy and procedure.”
criticalIncident learning: “We did not see any systems in place to show how the service would learn after incidents or when things went wrong.”
moderateRecord keeping: “Records were not always available at the service and when they were, they were not always fully completed.”
moderatePerson-centred care: “People's care plans were more personalised but lacked specific details about preferences and goals people wanted to achieve.”
moderateSafeguarding: “The manager had a criminal records check but it did not include a vulnerable adults check.”
moderateCommunication with families: “Several times I've been shouted at. Management are aggressive and unprofessional.”
Strengths
· Manager understood safeguarding responsibilities and how to report concerns
· Risk of infection was reduced as there was sufficient personal protective equipment which was being used appropriately
· People's privacy and dignity was respected
· One person and their relative told us they felt safe with the service
· Care plan contact information for people's GP had been updated since the last inspection
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentInadequate
safe: Learning lessons when things go wrongInadequate
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law