A Norwich home care provider has been placed into special measures after an inspection by the Care Quality Commission found that service users were “not safe” and “at risk of avoidable harm”.
The CQC inspected Fisher Healthcare East Anglia to review the key questions of ‘safe’ and ‘well-led’ after receiving concerns in relation to the management of medicines, infection control, safeguarding people from risk of abuse, staffing levels and the management of the service.
At the last inspection in March 2019, the service was rated ‘Requires Improvement’ for these key lines of enquiry, but a follow-up review in November 2020 found them to be ‘Inadequate’.
The report said: “The provider did not have effective oversight of the quality and safety of care being provided to people. The provider’s representative whom the provider had told CQC was responsible for this task, had not conducted any monitoring or assessment of the standards of care on their behalf.
“Both the provider’s representative and manager demonstrated some shortfalls in their practice. This had resulted in appropriate actions not always being taken to reduce risks to people’s safety.”
Risks to people’s safety had not always been adequately assessed or managed, inspectors said, with some people not receiving their correct medicines.
In September 2020, staff recorded on two occasions that they were concerned one person may have taken some of their medicines by mistake. The medicines were not stored securely, and the person’s care record indicated they lacked insight into their own safety.
Three months later, staff raised a concern following a care visit that several tablets had gone missing and could not be accounted for. This showed the person’s medicines had remained unsecure since September.
“Although the provider told us they had spoken to the family regularly about the matter, they had not taken all reasonable steps to try to protect the person from risk of harm such as raising the issue with the local authority as a safeguarding concern. They had also failed to assess and record the risks the unsafe storage of medicines presented to the person,” the report said.
Fisher Healthcare East Anglia also failed to notify the CQC of important incidents as required by law. For example, the regulator had not been made aware that a person had been found during a care visit covered in bruises or that a service user had allegedly been verbally abused by a member of staff.
The nominated individual conducted their own investigation into this allegation, but this was not robust, according to the CQC.
“They did not obtain statements from all staff present at the time of the alleged abuse or suspend the member of staff pending the investigation. They closed the investigation following their discussion with the staff member involved who denied the alleged abuse had taken place,” the regulator said.
The provider had also been alerted in October 2020 to allegations that some staff had not been wearing appropriate PPE when delivering care to people in their own homes.
The CQC said: “They failed to act on this urgent concern to ensure people were safe from the spread of infection during the pandemic until our inspection over a month later.”
The service has been told to make “significant improvements” before a reinspection in six months or it could lose its registration.