Date of assessment: 23 September 2025 to 6 November 2025. Guild Healthcare is a domiciliary care service registered to provide personal care to individuals living in their own homes. At the time of our assessment there were 38 people receiving a regulated activity. The Care Quality Commission (CQC) only inspects where people receive personal care. Personal care is help with tasks related to personal hygiene. Where the service does provide personal care, we also consider any wider social care provided during our assessment. At this assessment we looked at all the key questions and all the quality statements. This was a comprehensive assessment covering all quality statements. At our last inspection we rated this service a good. At this inspection we found Guild Healthcare offered a good, consistent service to people. People worked in partnership with the care provider to develop and tailor the service to meet their needs. During this assessment we spoke with 8 staff, 16 people and their relatives and other stakeholders such as health and social care professionals to get their feedback about how people’s personal care needs were being met. This also included speaking to the registered manager, operations manager and care coordinator. We reviewed documentation including policies, care records, training records, recruitment files, governance records, and procedures. The provider had systems and processes in place which were effective in assessing, monitoring, and improving the quality of the service. The management team had robust systems and processes and could evidence they had taken action to continually improve the service. Accidents and incidents were analysed, and trends and patterns were identified to mitigate future risks. The service worked in partnership with people, families, and professionals to plan and deliver care tailored to people's individual needs and preferences. Staff spoke positively about their work, and we found there was a shared ethos of kindness and compassion amongst the care team. Staff members were supportive of each other and told us how they wanted the best outcomes for the people they supported. Care plans were person centred and clear for staff to follow. Staff wellbeing and development was prioritised. Staff were well supported in their role and felt valued. There were staff recognition schemes in place and staff had access to opportunities to develop their skills and knowledge. A comprehensive training programme was in place and staff were supported with career progression. There was a clear culture of openness and positivity.
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Guild Healthcare improved from Requires Improvement to Good across all five key questions, resolving previous breaches of regulations 12 and 17. The service demonstrated safe medicines management, person-centred care planning, and strong leadership with effective governance oversight.
Strengths
· Medicines managed safely with MAR charts audited by registered or care manager; previous breach of regulation 12 resolved
· People received care visits at expected times from familiar staff; staffing well-coordinated with realistic travel times
· Staff received comprehensive induction, regular supervision, and ongoing training including MCA
· Care plans developed collaboratively with people and relatives and regularly reviewed
· Strong positive culture with management visible daily; previous breach of regulation 17 (Good governance) resolved
Guild Healthcare was rated Requires Improvement overall following a March 2019 inspection, with breaches of Regulations 12 and 17 identified due to insufficient risk assessments and inadequate governance and auditing processes. Care staff were praised for their kindness, and the registered manager demonstrated openness to feedback and commitment to prompt remediation.
Concerns (9)
criticalCare planning: “Some risk assessments did not contain relevant guidance for staff in how to mitigate risks. Regulation 12 HSCA RA Regulations 2014.”
criticalGovernance: “Systems and processes did not always identify areas where quality and/or safety were being compromised. Regulation 17 HSCA RA Regulations 2014.”
moderateMedication management: “We did however find some discrepancies in MAR charts and care plans relating to medicines...discrepancies relating to dosage.”
moderateMedication management: “Protocols were not in place for PRN (as required) medicines. This is important to ensure they are given consistently and appropriately by staff.”
moderateRecord keeping: “Auditing processes had failed to identify some issues we found with documentation including medicines.”
moderatePerson-centred care: “Information contained within them was often too brief, and did not reflect a person-centred approach.”
moderateEnd-of-life care: “Care plans relating to people's end of life wishes were brief in content. Some just stated that they had a funeral plan.”
minorConsent / capacity: “Further improvement was needed where people were living with dementia, so their care plans were clear about what decisions they were still able to make.”
minorStaffing levels: “Ten people we spoke with commented on the number of different care staff who visited them...this did leave them feeling unsettled.”
Strengths
· People told us that care staff were kind and caring in their interactions with them.
· Safeguarding systems were in place and all staff had a good understanding of how to protect people from harm or abuse.
· Staff received training relevant to their role including safeguarding, MCA, medicines, moving and handling, first aid, and food hygiene.
· Suitable recruitment procedures were followed with appropriate pre-employment checks.
· The registered manager and provider were open, transparent and receptive to feedback, demonstrating commitment to improvement.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
Targeted inspection of Guild Healthcare focused on medicines management identified concerns with hand-written MAR charts, outdated medicines lists in care plans, and gaps in auditing that had failed to detect issues. The provider took prompt action and submitted a voluntary improvement plan; the previous overall rating of Requires Improvement remains unchanged.
Concerns (5)
moderateMedication management: “for some MAR charts that had been hand-written by staff, these had not, and improvements were required in order to mitigate possible medicine errors or misadministration.”
moderateMedication management: “we did identify some care plans where people's list of current medicines needed updating.”
moderateIncident learning: “incidents where medicines had gone missing from people's homes. We saw that appropriate action had been taken in response to these incidents although the service could have taken more robust action in one case.”
moderateGovernance: “for one person's MAR charts we saw that the auditing system had failed to identify several concerns where practice and recording had failed to meet good practice guidance.”
minorRecord keeping: “We found an employment gap for one staff member and this was brought to the registered manager's attention who acknowledged a full employment history was required.”
Strengths
· Staff had been robustly inducted, trained and supported, with regular competency assessments for medicines administration.
· People and relatives spoke positively about staff knowledge, kindness and safe medicines handling.
· Registered manager took prompt and appropriate action to rectify concerns and submitted a voluntary service improvement plan.
· Medicines policies reflected current good practice and NICE guidance.
· Good communication with people and families, including when things went wrong (duty of candour).
Quality-Statement breakdown (5)
safe: Using medicines safely; Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
safe: Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careNot rated
well-led: How the provider understands and acts on the duty of candour; Engaging and involving people using the service, the public and staffNot rated