Date of assessment: 17 November – 16 December. Heart of Gold Homecare is a domiciliary care agency who at the time of the inspection were supporting 32 people, 16 of which were receiving personal care as a regulated activity. A regulated activity is an activity relating to health or social care that is prescribed in the Health and Social Care Act 2008 (Regulated Activities) regulations 2014 and requires registration with the CQC. The service provided support to autistic people and people with a learning disability. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. There were 3 breaches of regulation identified at this inspection which were in relation to safe care and treatment, safeguarding and good governance. The provider’s management of safety incidents required improvement. Not all staff had a good understanding of safeguarding, and some safeguarding concerns had not been escalated appropriately. The registered manager was completing competency assessments with staff but did not have the appropriate qualifications to do so. Staff had access to training in key skills, but some staff’s completion rates were low. Audits for infection prevention and control and the person’s home were not up to date. Medicines management required improvement. However, staff assessed risks to people, acted on them and kept good care records. Staff supported people with eating and drinking, however there were some improvements required. Some policies and procedures required a review, the outcomes of people needed closer scrutiny, the service needed to work more closely with healthcare providers such as district nurses, and staff required further training and knowledge of the key conditions they were supporting. However, staff worked well together for the benefits of people they were supporting, advised them on how to lead healthier lives and understood the importance of consent being sought. Staff supported people to maintain their independence, choice and control. The provider supported staff to stay well and had appropriate measures in place to ensure this. People’s care plans, risk assessments and daily notes, overall, were person centred. There were appropriate systems in place to ensure people and their relatives could provide feedback. The registered manager was knowledgeable about how people the provider was supporting were likely to be discriminated against. The provider had visions and values, although some were not being fully achieved. The registered manager had not identified the key issues identified during the inspection. The systems used were unreliable in identifying key concerns. Continuous improvement was considered but this was made difficult due to the audit systems not being as effective as they should be. The provider did not always work effectively with other partners. However, the staff felt respected, supported and valued and felt there was a good culture. Staff were aware of how to raise concerns including ‘speaking up’. The registered manager ensured staff were treated equally and fairly. We have asked the provider for an action plan in response to the concerns found at this assessment.
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Heart of Gold Homecare Ltd was rated Requires Improvement overall at its first inspection in March–April 2023, with breaches of Regulations 12 and 17 identified in relation to unsafe medicines management, incomplete recruitment records, missed or late care calls, and ineffective governance and audit systems. Caring and Responsive were rated Good, reflecting positive feedback from people and relatives about staff compassion, cultural sensitivity, and community access support.
Concerns (11)
criticalMedication management: “one person did not have their allergies recorded on their MAR, medicine names were spelt incorrectly and incorrect doses were handwritten on the MARs.”
criticalMissed or late visits: “people did not receive care at the time identified in their care plan...gaps which were either too short or too long between calls...occasionally calls had not been recorded at all.”
criticalGovernance: “audits did not reflect our findings at this inspection in relation to gaps and inconsistencies within records...rarely included detailed comments in relation to the auditors' findings.”
criticalStaff competency: “staff recruitment records were incomplete...provider had not completed risk assessments to ensure the suitability of candidates to work with vulnerable adults and children.”
moderateRecord keeping: “Body maps to help with the application of creams were in place but had not been completed.”
moderateStaff training: “staff did not always complete mandatory training courses in a timely manner...evidence of several months passing before staff completed training.”
moderateIncident learning: “in most incident forms we reviewed, the provider had failed to complete the section which assessed what could prevent the accident or incident reoccurring.”
moderateSafeguarding: “some staff were not sure who they would contact outside of the provider if they had safeguarding concerns. 'I don't know who to ring outside of the company.'”
moderateSupervision / appraisal: “entries into spot check and supervision records where the provider identified the same issue for several consecutive months with the same members of staff.”
minorCare planning: “some care plans would benefit from additional detail to improve the level of person centred information for staff to follow.”
minorConsent / capacity: “Some staff's understanding of the MCA was limited.”
Strengths
· People and relatives were positive about staff's compassion, dignity, and respect for independence.
· Strong cultural and religious competency, with staff recruited from varying backgrounds to meet people's diverse needs.
· Provider worked well with external agencies to promote health and wellbeing.
· Registered manager was praised as accessible and supportive by people and relatives.
· Infection prevention and control practices were effective and PPE used correctly.
Quality-Statement breakdown (22)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
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 guidance
Requires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff working with other agencies; supporting people to live healthier lives and access healthcareGood
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: Meeting people's communication needsRequires improvement
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Supporting people to maintain relationships and take part in activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles; continuous learning and improving careRequires improvement
well-led: Promoting a positive person-centred, open and inclusive cultureGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people, the public and staff; working in partnership with othersRequires improvement