Gold Care Services Ltd improved from Requires Improvement to Good following a focused inspection of the Safe and Well-Led key questions, with no breaches of regulation identified. The service demonstrated strong safeguarding practices, effective governance, person-centred culture, and meaningful improvement since the previous inspection.
Strengths
· People and relatives reported feeling safe and well supported, with individualised risk management including creative solutions such as edible sensory gardens.
· Medicines were administered correctly with completed MARs, safe storage, regular audits and competency checks for all staff.
· Staffing levels were maintained via a dependency tool ensuring 1-2-1 hours were covered; safe recruitment procedures including DBS checks were followed.
· Safeguarding protocols were in place and staff were knowledgeable about reporting concerns; the service worked collaboratively with the local authority on safeguarding matters.
· A positive, person-centred culture had been embedded, with people more independent, happier, and actively involved in decisions about their care.
Gold Care Services Ltd improved from Inadequate to Requires Improvement and exited Special Measures, with medicines, safeguarding, MCA and incident learning no longer in breach. However, a continued breach of Regulation 17 (good governance) was identified, with quality audits, life histories and end-of-life care plans still needing to be embedded.
Concerns (7)
criticalGovernance: “We have identified a breach in relation to good governance at this inspection.”
moderateGovernance: “Quality audits had not highlighted required improvements that were noted at the inspection”
moderateCare planning: “there was still work to be completed on people's life histories.”
moderateEnd-of-life care: “Improvement was also required on the completion of end of life care plans for people being supported by the service.”
moderateStaffing levels: “people and relatives told us that there was a high turnover of staff and sometimes staffing levels seem low.”
moderateStaffing levels: “another member said, 'We never have enough staff, we're always rushed.'”
minorCommunication with families: “some relatives did not always feel that they were asked for their feedback as regularly as they could be.”
Strengths
· Medicines were managed well and had improved since the last inspection.
· Infection prevention control (IPC) procedures were being followed by staff in line with government guidance.
· Accidents and incidents analysis had been introduced to ensure the risk was minimised of future incidents.
· Staff received adequate training and induction processes.
· People supported by kind and caring staff who promoted independence and choice.
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and management; Using medicines safely; Preventing and controlling infection; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to live healthier lives, access healthcare services and supportGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolation; 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, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; engaging people, public and staffRequires improvement
well-led: Duty of candour; working in partnership with othersRequires improvement
Gold Care Services Ltd was rated Inadequate overall and placed in special measures, with continued breaches of regulations 11, 12, 13, 17 and 18 covering consent, safe care, safeguarding, governance and notifications. Risk assessments, medicines management, infection control, safeguarding referrals and managerial oversight across the three supported living locations were all found to be unsafe or ineffective.
Concerns (12)
criticalMedication management: “Recording of medicines was inconsistent... bottles had been opened, however, staff had not dated when this had occurred. This left people at risk of being administered medicine that was out of date”
criticalCare planning: “Risk assessments were not always completed. For example... a person at risk of seizures did not have a risk assessment in place.”
criticalSafeguarding: “the management team had not made the relevant referrals following safeguarding concerns being reported to them. Retrospective referrals had to be made”
criticalIncident learning: “no audits or reports were being generated from these records to identify trends and patterns... No preventative measures had been put in place”
criticalInfection control: “staff were not following COVID-19 infection control government guidance. On several occasions staff were seen not to wear face masks whilst providing support”
criticalStaff training: “the registered manager confirmed only approximately 50% of the staff had received autism training, however nearly 100% of the people being supported were diagnosed with autism.”
criticalConsent / capacity: “People had restrictions in placed on them without evidence of consent given or best interest decision process.”
criticalGovernance: “there had been no overarching quality assurance audits completed for the service since the last inspection.”
criticalLeadership: “The general manager and the registered manager confirmed that they had lost oversight of this separate supported living location... This meant there was no overarching management of the service.”
moderateSupervision / appraisal: “The registered manager has never stepped foot in [one of the supported living locations] in the four years I've worked there. I don't know [registered manager] and wouldn't know how to get support.”
moderateRecord keeping: “There was no documentation in the care plan to demonstrate whether their mental capacity had been assessed to consent to that decision”
moderateCommunication with families: “Some professionals shared frustrations with communication and lack of updates from the management team.”
Strengths
· Care practices upheld and respected people's dignity, with caring interactions observed between staff and people supported
· Registered manager followed thorough recruitment processes including DBS checks, references and interviews
· Staff had an induction programme including training and shadowing of senior staff
· Improvement seen in health and safety, including fire safety policies and management of hazardous cleaning materials
· Staff supported people to access healthcare services and chase appointments/test results in a timely way
Quality-Statement breakdown (10)
safe: Assessing risk, safety monitoring and management; Using medicines safely; Learning lessons when things go wrong; Preventing and controlling infectionInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceNot rated
effective: Staff working with other agencies; Supporting people to live healthier lives, access healthcare servicesNot rated
effective: Assessing people's needs and choices; Supporting people to eat and drinkNot rated
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well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careInadequate
well-led: Engaging and involving people using the service, the public and staff; Duty of candourNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Working in partnership with othersNot rated