Golden World Care Service is a domiciliary care agency, registered with the Care Quality Commission (CQC) to provide personal care to people in their own homes. At the time of this inspection, 10 people were receiving care from the provider. The service’s previous inspection, published on 23 June 2022, rated the provider as Requires Improvement due to breaches of legal requirements. These breaches related to safeguarding, risk management, staff training and support, infection prevention and control, medicines, complaints, and governance systems. This focused inspection was undertaken to check if the provider had made the required improvements. We gave 48 hours' notice of our on-site visit, ensuring the registered manager would be available to support the inspection. Inspection activities took place from 23 to 25 September 2024, with office visits on the first two days. We reviewed four key questions – Safe, Effective, Responsive, and Well-led – all previously rated Requires Improvement. We found that the provider had addressed most concerns identified in the last inspection, including those related to safeguarding, staff training and support, medicines, complaints, and person-centred care. However, while governance systems had improved, they were not fully effective. The systems failed to identify new issues with record keeping and accessibility concerning risk management and pre-employment checks for new staff. These issues were discussed with the provider, who addressed them by the second day of inspection. We found no evidence of harm to people, but the provider’s ongoing failure to identify and rectify record-keeping and accessibility issues indicated a continued breach of regulations regarding governance. Consequently, we have repeated this breach. Despite these concerns, sufficient improvements were made overall to raise the service’s rating from Requires Improvement to Good.
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Golden World Care Service was rated Requires Improvement overall, with breaches of regulations 12, 13, 16 and 17 covering safe care, safeguarding, complaints and good governance, and a warning notice issued for governance failures. Despite caring, kind staff and good partnership working, medicines management, risk assessments, safeguarding training, infection control, complaints handling and quality monitoring systems were all inadequate.
Concerns (19)
criticalMedication management: “Some medicines administration record (MAR) charts were missing information, some were not dated correctly and some were illegible in parts.”
criticalMedication management: “One person had duplicated MAR charts, which made it unclear how much medicine they had been given.”
criticalStaff training: “Staff medicines training was not up to date. This meant staff lacked current knowledge about how to manage medicines safely.”
criticalIncident learning: “The provider had not carried out accident and incident audits. Therefore, the provider did not have a system in place to learn why things had gone wrong”
criticalSafeguarding: “Some staff lacked sufficient knowledge and understanding about the types of abuse people could experience, how to recognise signs of abuse and how to report abuse.”
criticalSafeguarding: “The provider had not informed the local authority of a potential medicines error resulting from a person having duplicate MAR charts for March 2022.”
criticalCare planning: “People's risk assessments and care plans did not always contain detailed and specific information for staff to manage risks safely.”
criticalInfection control: “The provider did not have a COVID-19 testing policy in place for staff. COVID-19 testing for staff was not carried out in line with Government guidance”
criticalComplaints handling: “The provider did not have an effective system in place to record, investigate and respond to complaints.”
criticalGovernance: “The provider had not established sufficient systems and processes to effectively monitor and improve the quality and safety of the services provided”
criticalGovernance: “The provider had not carried out regular audits and the audits carried out had not identified the issues we found during the inspection.”
moderateStaff competency: “Staff did not always have their competency to administer medicines appropriately checked in accordance with guidance.”
moderateCare planning: “The provider had not reviewed some people's risk assessments for one year and had not reviewed one person's risk assessment when their needs had changed.”
moderateInfection control: “The provider had not carried out individual COVID-19 risk assessments for staff.”
moderateMissed or late visits: “One person had complained about care workers' timekeeping on three separate occasions during a period of seven months”
moderatePerson-centred care: “Some people's risk assessments and care plans did not contain detailed personalised information for staff to support them as an individual, in line with their preferences.”
moderateCommunication with families: “if you needed to contact them out of hours or at the weekend, the number given did not work, I found this worrying”
moderateStaff training: “Not all staff had received training that could help them support people with specific needs, for example, dementia care.”
moderateLeadership: “[registered manger's name] has too many tasks on to fully concentrate on putting the processes in place.”
Strengths
· Staff were kind, caring and knew people well, treating people with dignity and respect
· Safer recruitment processes including DBS checks were in place and there were enough staff
· Staff supported people to eat and drink and maintain their health, including cultural preferences
· The service worked well with healthcare professionals, GPs, district nurses and local authorities
· Specialist PEG training was provided and staff demonstrated detailed knowledge in administering it
Quality-Statement breakdown (23)
safe: Using medicines safely; Learning lessons when things go wrongNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Supporting people to live healthier lives, access healthcare services and supportNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationNot rated
responsive: Meeting people's communication needsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Working in partnership with othersNot rated
well-led: How the provider understands and acts on the duty of candourNot rated