Gracious Healthcare's first inspection rated the service Good overall, with positive feedback on safe, caring, effective and responsive care delivery. Well-led was rated Requires Improvement due to gaps in governance oversight around risk assessments (paraffin creams, smoking), PRN medicine protocols, care plan consistency, and two unnotified CQC incidents.
Concerns (6)
moderate
Governance
: “The provider's oversight of the service had not identified some improvement was required in their risk assessments for people using paraffin based creams, protocols for 'as required' medicines”
moderateRecord keeping: “Systems had not identified some care plans, located in the office, had not been updated and signed to reflect recent amendments contained in the care plans at people's homes.”
moderateIncident learning: “We found there were two incidents not notified to the CQC. We discussed these with the registered manager... they were not aware these two incidents should have been reported to us.”
minorMedication management: “Protocols were in place for medication prescribed to be taken on an 'as required' basis. Some additional detail was needed to make sure it reflected people's communication needs.”
minorCare planning: “Appropriate assessments had not been made for people who smoked... there was limited guidance for staff on how to support the person safely.”
minorStaff training: “Two of the staff training records we looked at had not been signed 'as completed'. For example, when the staff member had completed their induction, their first shadow review or their start date.”
Strengths
· People and relatives consistently said they felt safe and well supported
· Kind and caring staff who knew people well and supported dignity and independence
· Person-centred pre-admission assessments fully involving people and families
· Good staff training including for complex care (PEG, catheter, hoisting, nebuliser)
· Open, transparent registered manager responsive to feedback and acting immediately on issues
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
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 requirements; duty of candourNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Continuous learning and improving careNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated