GGW Care Limited received an overall Inadequate rating following a October 2023 inspection, with the service placed in special measures due to persistent and repeated breaches of Regulations 9, 10, 12, 13, 17 and 19 spanning five consecutive inspections since 2018. Critical failures centred on ineffective governance, unsafe medicines management, poor safeguarding processes, unsafe recruitment practices and contradictory care records, despite enforcement action and warning notices issued at prior inspections.
Concerns (12)
criticalSafeguarding: “There were not always processes to identify where action may be needed to reduce the risk of abuse. No assessment of possible risks had been completed. There was no risk management plan in place.”
criticalMedication management: “Staff were not administering medicines in accordance with the health professionals' instructions. Where medicines were prescribed to be administered before eating staff were routinely administering them after food.”
criticalGovernance: “Their system of quality monitoring did not identify the concerns and breaches of regulation we found. There were no care plan audits to identify the issues of discrepancies and contradictory information.”
criticalStaff competency: “For 4 members of staff we found full recruitment checks had not been carried out in line with the regulations. This included new DBS checks, references and gaps in employment history.”
criticalCare planning: “Care plans and assessment records we viewed contained contradictory information about how people should be safely transferred which placed people at risk of staff following the wrong information.”
criticalLeadership: “The registered manager did not always have an up to date picture of people's needs. About half the people we spoke with were not sure who the registered manager was.”
moderatePerson-centred care: “Staff did not always have guidance on how to provide person centred care. Care plans did not always guide staff on people's individual preferences, likes and dislikes.”
moderateCultural competency: “Care plan records did not show how people's needs under the Equality Act, such as their culture, religion or sexuality had been discussed or considered.”
moderateRecord keeping: “Records such as a list of all employees were not readily available when inspectors requested on the first two days of inspection. We found discrepancies in staff records.”
moderateSupervision / appraisal: “For another 2 staff members there was no record to evidence they had completed their induction training.”
moderateIncident learning: “The registered manager had also failed to notify us of a Police incident earlier in the year as required.”
minorConsent / capacity: “For 2 people best interest meetings, particularly in relation to consent to care or medicine management were not always clearly recorded to evidence the assessment of each separate decision.”
Strengths
· Staff followed safe infection control practices and people confirmed staff wore appropriate PPE including gloves, shoe covers and aprons.
· There were enough staff to meet people's needs with no missed calls during the inspection period and an electronic call monitoring system in place.
· The provider sourced new training providers and staff reported receiving appropriate training including online and face-to-face sessions.
· People and relatives consistently praised individual care workers as kind, caring, patient and knowledgeable about their needs.
· People and relatives felt confident raising complaints and knew how to do so; most felt issues were resolved.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
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: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Supporting people to develop and maintain relationships to avoid social isolationRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Continuous learning and improving careInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staff; working in partnership with othersRequires improvement
GGW Care Limited is a domiciliary care agency providing personal care to people living in their own homes. At the time of this assessment 23 people received a service. The service had been rated inadequate and in special measures since the report of our last inspection was published on 23 February 2024. This was because we found the service remained in breach of regulations. Our inspection report identified the provider repeatedly failed to effectively manage their governance systems, assess and monitor risk, safely manage medicines, safeguard people from abuse, recruit staff safely and train and support staff sufficiently, as well as not always treating people with respect and dignity, or as an individual. We undertook this comprehensive assessment to check the provider had followed the action plan we asked them to send us and had improved. We gave the provider 24 hours’ notice of our inspection. This was because we needed to ensure the registered manager would be in their office to support the inspection. Inspection activity started on 25 June and ended on 2 July 2024. We looked at all 5 key questions and all the quality statements. We found the provider had made enough improvement to remove the service from special measures. However, although the service had improved, we have rated them requires improvement overall and for the key questions safe and well-led. This is because the provider needs to demonstrate they can continue to improve the service over a more sustained period of time. Areas in which the service had improved since our last inspection included, effective operation of quality assurance systems; better understanding of lessons learnt when things go wrong; better protection of people from abuse; more robust recruitment checks on new staff; better training and support for staff; safer management of medicines; effective systems to assess, monitor and manage risks and treating people as individuals and with greater respect and dignity.
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safe:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted KLOE inspection of BeeAktive Care (February 2023) found continued and new regulatory breaches across Safe and Well-led, including safeguarding failures, unresolved missed-visit alerts, inadequate risk assessments, and poor governance transparency. The overall rating remains Requires Improvement, with medicines management the sole area of demonstrated improvement.
Concerns (9)
criticalSafeguarding: “Care records showed staff used restrictive practice in relation to another person, which placed them at risk. Appropriate legal processes had not been followed in relation to this.”
criticalSafeguarding: “staff were not following the safe moving and handling practices they recommended for one person. This could place them and staff at risk of injury. We raised this as a safeguarding alert.”
criticalGovernance: “Systems to monitor the quality and safety of the service were not effectively operated. The provider had not identified that missed support alerts were not always resolved on the day.”
moderateCare planning: “Three people and their relatives told us they had not seen a written care plan for the support provided. One relative remarked, 'We have not received a written care plan since we commenced having carers several months ago.'”
moderateIncident learning: “Accident and incident reports did not always include a full description of the incident or identity the necessary actions needed to reduce risk of reoccurrence.”
moderateMissed or late visits: “Six people and relatives spoken with said that their calls were late particularly at weekends and of these 3 said they were not contacted by the office or by care workers.”
moderateRecord keeping: “Live-in care plans were not robust and did not provide clear guidance on the tasks and expectations of staff at night.”
moderateStaff training: “New in post care coordinators were completing assessments of people's care. However, there was no record that they had received any relevant training in this area.”
moderateLeadership: “The registered manager had told us they had obtained consent for our calls to people as part of the inspection. However, of the 13 people spoken with no one had been asked for their consent.”
Strengths
· Medicines management had improved since the last inspection; people received their medicines on time and staff competence in administering medicines had been assessed.
· People and relatives felt safe with their regular care workers and praised the quality of direct care provided.
· Some environmental and health-needs risk assessments were in place and staff demonstrated awareness of individual risks.
· The provider had introduced a new staff training system and engaged an external consultant to review quality monitoring.
Quality-Statement breakdown (6)
safe: Systems and processes to safeguard people from the risk of abuseInsufficient evidence to rate
safe: Assessing risk, safety monitoring and managementInsufficient evidence to rate
safe: Using medicines safelyGood
safe: StaffingInsufficient evidence to rate
well-led: Continuous learning and improving careInsufficient evidence to rate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInsufficient evidence to rate
BeeAktive Care received an overall rating of Requires Improvement for the third consecutive inspection, with continued breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to unsafe medicines management, inadequate risk assessments, and ineffective oversight systems. A Warning Notice was served for governance failures, while some improvements were noted in MCA compliance and infection control.
Concerns (11)
criticalMedication management: “a pain patch prescribed to be administered every 72 hours was not always administered according to these instructions and longer gaps were recorded.”
criticalMedication management: “no detailed risk assessment in relation to administering medicines via PEG feeding...did not guide care staff to identify and assess risks in relation to medicines administration.”
criticalGovernance: “shortfalls in the systems to oversee call monitoring, oversight of medicines and risks...Audits carried out did not identify these concerns.”
moderateRecord keeping: “discrepancies in staff training records...Some staff were recorded as delivering a full day of care visits on the same days they were recorded as completing multiple training courses.”
moderateCare planning: “one person's catheter risk assessment did not identify the possible risks to alert staff or record when issues should be reported to district nurses.”
moderateMissed or late visits: “poor oversight of the call monitoring system which meant that late or missed calls may not be identified...One staff member had a punctuality rate of 28 per cent.”
moderateStaff training: “Records did not demonstrate staff had all received the training they needed to perform their role...some staff had provided support prior to their work shadowing.”
moderateLeadership: “There was a chaotic atmosphere during the inspection...Files we asked for were in locked cupboards where the staff member had left the building with the key.”
moderateIncident learning: “incidents were not considered for possible learning or improvements.”
minorComplaints handling: “feedback from people and their relatives suggested they had raised complaints informally which while resolved were not recorded on the complaints tracker to identify learning.”
minorStaffing levels: “an additional driver would reduce the number of late calls in the Surrey area due to traffic...no evidence these issues had been considered by the provider.”
Strengths
· People and relatives felt safe and described staff as kind and caring.
· Infection control measures were in place and staff had access to appropriate PPE.
· Mental Capacity Act compliance had improved since the last inspection; staff received MCA training and completed mental capacity assessments.
· Assessments of people's needs were completed before care commenced, involving people and their relatives.
· Staff supported people's nutritional needs and communicated with health professionals appropriately.
Quality-Statement breakdown (14)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires 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: 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