Falcon Care Agency Ltd received a Good rating across all five key questions at its first CQC inspection, with particular commendation for its proactive, person-centred approach and strong registered manager leadership. No regulatory breaches or areas requiring improvement were identified.
Strengths
· Proactive risk identification and mitigation praised by social workers: staff 'find solutions before the problem has even become a problem'
· Robust medication management with daily electronic oversight by registered manager and clearly defined protocols
· Strong person-centred care with tailored care plans capturing individual preferences, cultural needs and communication requirements
· Highly engaged registered manager described as open, honest and inclusive by people, relatives, staff and professionals
· Consistent staffing with no missed calls reported and contingency arrangements always available
Quality-Statement breakdown (26)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
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 staffGood
well-led: Continuous learning and improving careGood
Falcon Care Agency Ltd received an overall Inadequate rating following a March 2023 inspection that identified widespread and serious failures including unlawful restraint, absent MAR charts, missing DBS checks for 22 of 38 staff, and 9 safeguarding referrals to the Local Authority. The provider's registration was suspended under urgent enforcement action for breaches of Regulations 12, 13, 17, and 19, and the service was placed in special measures.
Concerns (13)
criticalSafeguarding: “One person was found to be restrained by staff without legal authority. A staff member told us the person gets angry when they are restrained, indicating restraint caused the person distress.”
criticalMedication management: “None of the people being supported with medicines had Medicine Administration Records (MAR) Charts in place. People were at risk of overdose as staff did not have enough information to administer these safely.”
criticalCare planning: “Risks to people using the service were not assessed or mitigated. For example, a person was at high risk of falls. The registered manager advised inspectors that the person fell most days. However, there was no falls risk assessment in place.”
criticalStaff training: “Staff did not always have the training and skills to support the people they worked with. This included some staff failing to have received training in areas such as first aid, adult and child safeguarding, moving and handling, and medicines.”
criticalGovernance: “There was a lack of robust systems and processes within the service to monitor and review the quality of service people received, along with a failure to effectively respond to and record improvements.”
criticalLeadership: “A closed culture was prevalent within the service. Examples included the workforce comprising of family members or close friends, restrictive practices being used, and unsafe staff recruitment practices.”
criticalConsent / capacity: “Where people were deemed to lack capacity, formal assessments had not been carried out to assess whether they needed support with decision making. Staff had no guidance in place.”
criticalIncident learning: “The registered manager failed to understand their duty to be open and honest when things went wrong. Multiple safeguarding incidents had occurred within the service however, these were not shared with both the CQC, and external healthcare professionals.”
moderateStaff competency: “Some staff competency assessments had been completed, however, they failed to evidence how the member of staff had demonstrated competence in each specific area.”
moderateSupervision / appraisal: “The provider was unable to evidence that they were regularly supporting staff through supervisions, appraisals and spot checks.”
moderatePerson-centred care: “People's care plans lacked information to help staff get to know people well, including people's preferences, personal histories and backgrounds.”
moderateRecord keeping: “There was a lack of order in record keeping and some documents, audits and checks we asked for could not, or were not, made readily available to us.”
minorCommunication with families: “The provider was unable to demonstrate robust systems in place to seek views about the quality of the service from people, or their relatives.”
Strengths
· The provider's infection prevention and control policy was found to be up to date.
· There was some evidence of working with local authorities.
· One complaint received was addressed by the registered manager who liaised with the relative to resolve the matter.
Quality-Statement breakdown (21)
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: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Falcon Care Agency Ltd is a domiciliary care agency providing personal care. The service provides support to youngers adults with dementia, physical disabilities and long-term mental health conditions. At the time of our inspection there was 1 person using the service. We expect health and social care providers to guarantee people with a learning disability and autistic people 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. We carried out this assessment between 11 March 2024 and 22 March 2024. We assessed a total of 14 quality statements from the safe, effective, caring, responsive and well-led key questions and found areas of good practice. The scores for these areas have been combined with scores based on the key question ratings from the last inspection. As the scores for this service were low following their last inspection, this has resulted in the combined scoring providing an overall rating of requires improvement. We looked at the following areas as part of the assessment, safe and effective staffing, involving people to manage risks, safeguarding, learning culture, medicines optimisation, assessing needs, consent to care and treatment, delivering evidence based care and treatment, treating people as individuals, independence, choice and control, person-centred care, providing information, capable, compassionate and inclusive leaders and governance, management and sustainability.
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safe:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted inspection of Falcon Care Agency Ltd, conducted while the service was under suspension with no active service users, found that some improvements had been made against prior breaches of Regulations 12, 13, 17 and 19, though these could not be fully verified. The overall rating remains Inadequate and the service continues in Special Measures, with full review of regulatory breaches deferred to the next comprehensive inspection.
Concerns (5)
criticalSafeguarding: “the provider's systems and processes placed people at increased risk of avoidable abuse and improper treatment. This was a breach of Regulation 13 (Safeguarding)”
criticalMedication management: “the provider failed to ensure the proper and safe management of medicines.”
criticalCare planning: “the provider failed to identify and mitigate serious risks to people's health, safety and wellbeing. This was a breach of Regulation 12 (Safe care and treatment)”
criticalGovernance: “Systems and processes had not been established or operated effectively to ensure a quality service. This was a breach of Regulation 17 (Good governance)”
moderateStaff competency: “References from some previous health and social care settings had not been in place.”
Strengths
· Risk assessments were in place for a range of issues including managing distressed behaviour, supporting people to eat safely, and environmental risks such as fall prevention.
· Recruitment systems showed evidence of good character checks, references and criminal records checks for staff.
· Staff demonstrated understanding of safeguarding and reporting obligations.
· Audits and quality performance processes introduced since suspension notice.
· Registered manager understood duty of candour and statutory notification requirements.
Quality-Statement breakdown (6)
safe: Assessing risk, safety monitoring and managementInsufficient evidence to rate
safe: Staffing and recruitmentInsufficient evidence to rate
safe: Using medicines safelyInsufficient evidence to rate
safe: Systems and processes to safeguard people from the risk of abuseInsufficient evidence to rate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInsufficient evidence to rate
well-led: How the provider understands and acts on the duty of candourInsufficient evidence to rate
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityInadequate
caring: Supporting people to express their views and be involved in making decisions about their careInadequate
caring: Respecting and promoting people's privacy, dignity and independenceInadequate
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
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: Working in partnership with othersRequires improvement