Goldcrest Healthcare Service (London) achieved an overall rating of Good at this focused inspection, having successfully addressed previous breaches of Regulations 12 and 17 identified at the February 2022 inspection. The service demonstrated improved risk management, safe medicines administration, robust governance systems, and a person-centred culture supported by effective leadership.
Strengths
· Improved risk assessment and management plans providing staff with clear guidance to mitigate identified risks including choking, falls, skin integrity and moving and handling.
· Robust recruitment process ensuring new staff have appropriate skills and knowledge for their role.
· Medicines managed safely with detailed MAR records including dosage, tablet descriptions and specific warnings; staff competency assessed.
· Electronic call monitoring system used to track visit arrivals and departures, with regular checks and follow-up on any issues.
· Incidents and accidents recorded with lessons learned identified; post-fall assessments completed and sent to GP.
Quality-Statement breakdown (10)
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Continuous learning and improving care; Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
Goldcrest Healthcare Service Limited, a domiciliary care agency supporting 44 people in Hounslow, was rated Requires Improvement overall (Inadequate for Well-Led) at its May 2021 inspection, with continued breaches of Regulations 9, 11, 12 and 17 unresolved since the previous 2019 inspection. Warning Notices were issued for safe care and treatment and good governance, driven by systemic failures in medicines management, risk assessment, incident learning, Mental Capacity Act compliance and ineffective quality auditing.
Concerns (10)
criticalMedication management: “MAR charts did not always include the dosage of the medicines and the frequency of administration.”
criticalCare planning: “People's care plans were not always person centred and did not always identify how people wanted their care provided.”
criticalIncident learning: “One person had experienced a fall in February 2021...there was no record of any action taken. The person's falls risk assessment and care plan had not been updated.”
criticalGovernance: “Audits were carried out of the completed MAR charts...where issues had been identified actions had either not been recorded, or if they had there was no evidence these had been completed.”
criticalConsent / capacity: “The provider could not ensure the relative consenting to the person's care had the legal right to do so under the MCA.”
criticalSafeguarding: “A concern had been referred to the local authority safeguarding team and had been investigated in August 2020 but they had not sent the required notification.”
moderateRecord keeping: “The care plan for one person indicated they experienced a change in support needs following a hospital admission in January 2021, but the care plan had not been updated.”
moderateEnd-of-life care: “End of life care plans did not always refer to the person's end of life wishes and used identical wording for different people.”
moderateStaff competency: “Two care workers were last assessed [for medicines competency] in 2019, one in January 2020 and there was no competency assessment on file for the fourth care worker.”
moderatePerson-centred care: “The records of care completed by care workers following each visit were not always person centred and were focused on the tasks completed and not the person's experience.”
Strengths
· People felt safe when supported by care workers in their own homes.
· Effective infection control processes in place, with PPE worn consistently and COVID-19 guidance circulated to staff.
· Care workers completed a range of mandatory training including moving and handling, health and safety and emergency first aid.
· Regular supervision meetings and spot check visits were carried out for care workers.
· Care plans identified people's religious, cultural and communication needs, and matching language-speaking carers were allocated where possible.
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Goldcrest Healthcare Service Limited received an overall rating of Requires Improvement at this February 2022 inspection, remaining in breach of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to incomplete and outdated risk assessments. Significant improvements were noted across effective, caring, and responsive domains since the previous inspection, with the well-led rating improving from Inadequate to Requires Improvement.
Concerns (7)
criticalCare planning: “risk management plans had not been put in place for all identified risks. For example, a risk management plan for the use of a catheter had not been developed”
criticalRecord keeping: “a risk assessment in relation to choking had not been reviewed since May 2020...the provider had not ensured information was up to date and that staff were following the correct guidance”
criticalIncident learning: “falls risk assessments for two people had not been updated following them experiencing a fall. One person had a fall in November 2021 and in July 2021, but their falls risk assessment was last updated in June 2021”
criticalGovernance: “provider's checks on care plans were not effective in relation to monitoring if a person's consent was received for the care being provided or if best interests decisions were made”
moderateConsent / capacity: “A mental capacity assessment and best interests' decision were not in place for these aspects of care to identify if the person could consent”
moderateMedication management: “MAR for this person indicated a medicine...should be administered in the evening but the records showed it was being administered mid-afternoon”
minorPerson-centred care: “records of the care provided during each visit which were completed by the care workers were not always person centred and were task focused”
Strengths
· Care workers completed mandatory training and received regular supervision, confirmed by records and staff feedback
· Robust recruitment procedure in place with appropriate deployment of care workers ensuring planned visits occurred
· Improvements made to incident and accident recording and investigation, with post-fall protocol in place
· Infection control improvements made including COVID-19 risk assessments and adequate PPE supply
· Care plans improved to include personalised detail on how and where care should be provided
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
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