Gentle Healthcare Services is a domiciliary care agency registered with the Care Quality Commission (CQC) to provide personal care and support to people living in their own homes. At the time of this assessment 4 people were receiving a home care service from this provider. The service was rated requires improvement at their last inspection (published 18 May 2022). This was because we identified multiple breaches in relation to the way the provider managed risks people might face, staff recruitment and supervision, and the effectiveness of how they operated their quality monitoring systems. We undertook this assessment to check the provider had implemented the action plan we required them to complete after their last inspection to show us they had improved. This assessment was short notice announced and conducted by a single inspector on 29 and 30 October 2024. We assessed 21 quality statements related to the 3 key questions, Is the service safe, effective and well-led? For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. At this inspection we found improvements had been made by the provider. This was because the provider had addressed all the concerns we identified at their last inspection. These improvements included better management of risk, staff recruitment and support, and how the provider operated their quality monitoring systems. This meant they were no longer in breach of regulations and people were not at risk of harm. The overall rating for the service has therefore improved from requires improvement to good based on the findings of this inspection.
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First inspection of Gentle Healthcare Services rated Requires Improvement overall, with three breaches identified in safe care (Reg 12), staffing (Reg 18) and good governance (Reg 17). Risks to people were not consistently assessed, staff training and supervision lacked effectiveness, and quality assurance processes failed to identify shortfalls, though people felt safe and well cared for by respectful staff.
Concerns (9)
criticalCare planning: “People's care plans had not always included all the necessary information to ensure risks to people were assessed as necessary.”
criticalStaff training: “some staff had very recently completed training in relation to people's support of dignity, they did not understand this concepts”
criticalSafeguarding: “Some staff could not tell us what types of abuse they should be identifying and reporting to the manager as necessary.”
criticalGovernance: “Quality assurance processes in place were not always operated effectively... no systems in place to ensure that on-going checks were carried out”
moderateCare planning: “people's care plans were not detailed enough and required more information to ensure effective care delivery.”
moderateSupervision / appraisal: “Although the manager told us they carried out regular supervisions, records were not available to ensure that any actions agreed were followed-up on”
moderateRecord keeping: “there was no evidence to suggest that staff's references were obtained... Staff's job interviews were also not recorded”
moderateLeadership: “The manager of the services was not aware of their regulatory responsibility to notify the CQC about the events that affect the care provision.”
moderateSafeguarding: “the safeguarding policy viewed required updating... safeguarding policy and procedure did not include the description and types of abuse.”
Strengths
· People felt safe and well cared for by staff who knew them well and respected them
· Medicines were managed safely and staff understood safe administration responsibilities
· Effective infection control with appropriate PPE use in line with government guidance
· People supported to eat and drink in line with cultural preferences and beliefs
· Staff well matched with people to meet cultural and language needs
Quality-Statement breakdown (20)
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: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support; induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choicesGood
effective: Supporting people to eat and drink enough with choice in a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare servicesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; 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: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood