Fortress Care Services was rated Inadequate overall at this February 2018 inspection, remaining in special measures after failing to make sufficient improvements since the previous Inadequate rating in August 2017. Continued and repeated breaches were identified across safe care, staffing, recruitment, governance, and leadership, with the provider demonstrating a lack of transparency, poor incident learning, and inadequate oversight of service quality and safety.
Concerns (13)
criticalCare planning — “one person's falls risk assessment dated 1 February 2018 stated that the person had had no falls in the previous year...We found that this person had a significant fall on 10 January 2018”
criticalSafeguarding — “the provider had only recently made this referral in January 2018 when the issue was identified during our August 2017 inspection. This did not demonstrate a proactive approach to safeguarding”
criticalStaffing levels — “We were not assured that this level of staffing ensured enough flexibility to cope with a sudden absence of a key member or members of staff.”
criticalGovernance — “three people had had falls in the last year that needed attendance at A & E...The provider had failed to notify us of these serious injuries”
criticalIncident learning — “There was no evidence that the provider fully investigated incidents and learned from them to drive improvement as we found concerns at this inspection mirrored those we had found previously.”
criticalLeadership — “The provider was not always open, honest and transparent...Sometimes we identified concerns and key information by chance when looking at other matters.”
moderateStaff training — “one person had last had moving and handling training 11 November 2015. One member of staff only had a multi topic certificate issued by the provider on 23 March 2017.”
moderateMedication management — “We found no accurate stocktaking which meant we could not check to see if people had received the correct amounts of medication.”
moderateRecord keeping — “information, such as that about recent falls or involvement of healthcare professionals had been archived...files were stored in the garage which meant we could not be assured of the security”
moderateSupervision / appraisal — “supervision of staff, especially live-in staff, was very infrequent...We saw very few records of staff supervision and no recorded sessions for some staff.”
moderateComplaints handling — “a formal complaint from a healthcare professional had not been investigated...The provider failed to carry out a timely investigation into a complaint made by a healthcare professional.”
moderatePerson-centred care — “We found no information relating to people's religious or cultural needs...One person's plan did not mention that the person considered themselves both deaf and blind.”
moderateStaff competency — “live-in carer told us about their condition but they did not know what it was and could not tell us if anything made the condition better or worse.”
Strengths
· Some individual carers demonstrated excellent, compassionate care and were highly praised by people and relatives.
· Staff received training in safeguarding, infection control, and the Mental Capacity Act 2005.
· Some improvements to care plan format since last inspection, with recent reviews completed in January/February 2018.
· Staff supported people well with eating and drinking, with food nicely presented and kitchens kept clean.
· Provider sought regular feedback from people using the service and relatives, who found them approachable.
Fortress Care Services remained Requires Improvement overall with Well-led rated Inadequate due to a continued breach of Regulation 17, the fourth consecutive inspection where governance failings persisted. Shortfalls in medicines guidance, care planning, COVID-19 testing and risk assessment for staff showed the provider had not learned from previous inspections.
Concerns (9)
criticalGovernance — “The provider had failed to ensure that they operated effective systems to assess, monitor and mitigate the risks relating to people's health, safety, and welfare.”
criticalLeadership — “The continued breach of Regulation 17 demonstrates to us that the nominated individual and registered manager continue not to have an understanding of their roles and responsibilities.”
moderateMedication management — “Records did not always provide consistent guidance about how to administer the persons medicines... there was still insufficient guidance in place for new staff to follow”
moderateIncident learning — “The registered manager and nominated individual did not demonstrate learning from previous events... They had not applied this learning to the person receiving care during this inspection”
moderateInfection control — “The registered manager and the care co-ordinator had both visited the person's home without first testing for COVID-19. This put the person at risk of contracting COVID-19.”
moderateCare planning — “Records did not always provide consistent or complete guidance in how to meet the person's needs.”
moderateRecord keeping — “Records were not consistently completed... there were no records of the times each staff member had provided care to the person.”
moderateStaffing levels — “risks for staff, which could impact on the person's care, had not always been formally assessed... working with one person for long periods without a break.”
minorEnd-of-life care — “The person's care plan contained no information about their preferences for their end of life care... Staff told us they had not had training in end of life care.”
Strengths
· Staff were trained to administer medicines and their competency was assessed
· Live-in care worker knew the person extremely well and provided caring support
· Staff received regular supervision, appraisal and refresher training
· Relative was very complimentary, saying '[Care worker] is fantastic, especially during the pandemic'
· Staff worked effectively with external healthcare professionals such as GPs
Quality-Statement breakdown (18)
safe: Using medicines safely; Assessing risk, safety monitoring and managementNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience