Date of assessment: 10 December to 23 December 2025. A comprehensive inspection was commenced due to stakeholders sharing concerns of a safeguarding nature. Option Care Ltd is a care at home service registered to provide support to older people, younger adults, children, people living with dementia, a mental health need, a sensory impairment, a physical disability and/or people with a learning disability or an autistic person. There were 61 people receiving the regulated activity of personal care at the start of the inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. Where they do, we also consider any wider social care provided. Due to the service supporting people with a learning disability and/or autistic people, the CQC’s guidance ‘Right Care, Right Culture, Right Support’ was considered as part of this inspection. Staff provided consistently positive feedback about the provider and the quality of care provided by Option Care Ltd. One staff member said, “Option Care prioritises compassion, dignity, respect, person-centred care, safety and empowering independence. The mission is to provide high-quality personalised care that improves lives.” The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. There were systems and processes in place to administer medicines safely however, staff were not always following them and therefore they were not always effective in ensuring safe management of medicines. We received mixed feedback from people and their relatives about their care calls. We reviewed the providers call time data which corroborated these concerns. We found a number of occasions where staff had arrived late or not stayed for the full duration of people’s care visits. We received mixed feedback from professionals about their experience of working with Option Care Ltd. The provider was currently working with one local authority to address and respond to concerns across multiple areas of the service. We had received positive feedback from some professionals who told us they had now seen improvements in the service in response to the concerns. Whilst leaders had some knowledge and understanding of the issues and priorities within the service, oversight and governance of the service was not always effective. Governance systems were not always effective in identifying and addressing risks, and the systems had failed to identify the concerns we found during this inspection. This inspection found the provider to be in breach of the legal regulation relating to good governance. The provider was responsive to all issues raised during this assessment, and the leadership team put immediate measures in place to make improvements where they agreed there were shortfalls. We have asked the provider for an action plan in response to the concerns found at this assessment.
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Option Care Ltd improved from Requires Improvement to Good overall following a focused inspection of Safe and Well-led, resolving a prior breach of Regulation 17 through stronger care records, risk management, and governance systems. Well-led remains Requires Improvement due to the absence of a registered manager since January 2020 and gaps in the recruitment policy for internationally sourced staff.
Concerns (5)
moderateGovernance: “There had been no registered manager in post since January 2020. We found registered manager applications to CQC had been made by managers, but these had been unsuccessful.”
moderateRecord keeping: “the provider had not considered whether DBS checks would be required to support their vetting and recruitment process for staff who were being recruited from abroad”
moderateGovernance: “The provider's recruitment policy did not reflect their recruitment practices using the Home Office Sponsorship Scheme and any associated risks when recruiting from abroad.”
minorIncident learning: “we found one incident which should have been notified to CQC. The provider explained this had been an oversight.”
minorMedication management: “staff would benefit from body maps to help direct and identify areas which require cream application.”
Strengths
· Comprehensive and detailed care records in place providing staff with information needed to support people.
· People's risks had been assessed with care plans describing actions staff should take to mitigate risks.
· Safe recruitment practices used for staff recruited from UK and abroad, including employment and criminal checks.
· Staff trained and assessed as competent in medicines management; safe medicine management practices in place.
· Good infection prevention and control practices observed and checked by managers.
Quality-Statement breakdown (10)
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and 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 staff, fully considering their equality characteristics
Option Care Ltd, a small domiciliary care service in Gloucester, retained a 'Requires Improvement' overall rating following a focused October 2021 inspection, with breaches of Regulation 17 identified for incomplete care records, inadequate medicines management plans, and ineffective governance systems. Strengths included improved recruitment practices resolving the previous Regulation 19 breach, a consistent and caring staff team, and robust infection control measures.
Concerns (7)
criticalCare planning: “the provider had not ensured their own record of the assessment of people's needs and support were accurate and complete.”
criticalMedication management: “people were at risks of not receiving their medicines and creams as comprehensive medicines management care plans were not in place”
criticalRecord keeping: “the provider had not maintained accurate, complete and contemporaneous records for each person. This was a breach of regulation 17”
criticalGovernance: “The provider's monitoring processes and records were not effective in demonstrating how they monitored the service to enable them to drive improvements.”
moderateSupervision / appraisal: “the manager was unable to show us the records they had kept relating to their observations and supervisions of staff, medicines record checks and feedback from people.”
moderateCommunication with families: “Two relatives stated they had requested but hadn't been given access to people's care plans or staff daily records to help them understand people's welfare.”
moderateLeadership: “There was no registered manager in post at the time of the inspection...their management and governance systems had been compromised.”
Strengths
· Safe recruitment practices had been improved since last inspection; regulation 19 breach resolved.
· Consistent staff team familiar with people's needs, reducing risk of unsafe care.
· Effective infection prevention and control practices, including COVID-19 PPE and training.
· Staff felt supported and trained; positive culture led by a hands-on, person-centred manager.
· Manager delivered care alongside staff, providing direct oversight of care quality.
Quality-Statement breakdown (9)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering
Option Care Ltd, a small domiciliary care service supporting five people, received an overall rating of Requires Improvement at its first inspection, with a regulatory breach identified under Regulation 19 for inconsistent safe recruitment practices. While people and relatives praised the caring and responsive nature of staff, significant governance weaknesses were found including incomplete quality audits, inadequate risk management documentation, and insufficient recording of consent and mental capacity assessments.
Concerns (7)
criticalStaffing levels: “limited evidence to show that the provider had explored the gaps in staff's recruitment documents and checks to determine that they were of good character”
moderateGovernance: “systems to monitor the quality of care being delivered such as medicines audits had not always been completed”
moderateRecord keeping: “Records to demonstrate the safe recruitment and development of staff had not always been maintained.”
moderateCare planning: “risk management care plans for some people needed more information to describe the agreed management and monitoring of people's risks and medical conditions”
moderateConsent / capacity: “assessment of people's mental capacity and the outcome was not routinely recorded to help direct staff in delivering care in people's best interest”
moderateLeadership: “effective handover between the managers had not been carried out which meant that the current manager did not have full access to some of the providers operational systems”
minorComplaints handling: “one relative raised a concern with the manager which was investigated and discussed with the relative, although this had not been recorded”
Strengths
· People and relatives consistently reported staff were kind, caring, and supportive, with comments such as 'They treat me well. I have no complaints.'
· Safe medicines management practices were in place with electronic administration records completed consistently.
· Staff had been trained in safeguarding and understood their responsibilities to report concerns promptly.
· People were supported by consistent staffing teams who knew their needs well, with preferred gender of staff implemented.
· Staff worked effectively with other healthcare professionals including social workers, district nurses and occupational therapists.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongRequires improvement
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
Good
well-led: How the provider understands and acts on the duty of candour; Continuous learning and improving careRequires improvement
well-led: Working in partnership with othersGood
Good
well-led: Working in partnership with othersGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staff; working in partnership with othersGood