Gemini Exclusive Care received an overall rating of Requires Improvement at its first inspection, with breaches of Regulations 12, 17 and 18 identified relating to incomplete risk assessments and care plans, ineffective governance systems, and poor management of care visit timing and staffing. The service demonstrated genuine strengths in medicines management, infection control and the caring attitude of regular staff, but failed to ensure consistent safe care, robust oversight or adequate record-keeping across the service.
Concerns (10)
criticalCare planning: “Records relating to people's risks and care needs were incomplete and contained misleading information. As a result, staff did not receive all the information and guidance they required.”
criticalGovernance: “There was a lack of oversight and governance systems to ensure people received a safe service. Systems that were in place were not implemented effectively.”
criticalMissed or late visits: “Carers are due at 8.00am but sometimes can be as late as 9.30am which impacts on my commode use. The regular carers are on time, it's the relief staff who can be late.”
moderateStaffing levels: “Staff were working very long days with only short breaks and very few days off to rest. The management set the bar too high for them and their schedules need looking at.”
moderateConsent / capacity: “Where it was deemed people lacked capacity, best interest decisions had not always been recorded.”
moderateComplaints handling: “Records did not provide a clear account of the action taken in response to complaints people had made.”
moderateRecord keeping: “One person's care plan described three different ways in which they were supported to move... care plans contained information about people's previous needs.”
moderateStaff competency: “Some people told us that when their regular staff were not available, the staff who replaced them did not appear as skilled and they had difficulty communicating due to a language barrier.”
minorEnd-of-life care: “Staff had not received training in end of life care. People had not been given the opportunity to record what was important to them at end of life.”
minorCommunication with families: “The provider had not always ensured all people were kept informed of which staff would be attending their care visits and at what time.”
Strengths
· Medicines were managed safely with regular audits, trained staff and competency testing.
· People received care from regular, consistent staff teams who knew them well and were trusted.
· Staff understood safeguarding responsibilities and reported concerns to relevant authorities.
· Infection control procedures were followed; staff used appropriate PPE consistently.
· People were supported with nutrition, health access and involvement in care decisions.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough with choice in a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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 preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Promoting a positive culture; managers and staff being clear about their roles and understanding quality, performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people, continuous learning and improving careRequires improvement
Gemini Exclusive Care, a domiciliary care agency supporting 85 people, improved from Requires Improvement to Good across all five key questions following remediation of previous breaches in safe care, staffing, and governance. The service demonstrated robust systems for risk management, medicines, recruitment, and quality oversight, with only minor gaps noted in the depth of person-centred care planning documentation.
Concerns (2)
minorCare planning: “Some areas of care planning lacked some detail in regard to people's life history, preferences, and likes and dislikes.”
minorCommunication with families: “Some people told us that at times, communication with staff was not always easy because of language barriers.”
Strengths
· Risks associated with people's care had been identified and assessed with clear guidance for staff on how to manage and reduce risks.
· Electronic care planning and risk assessment system implemented and customised to the needs of people using the service.
· Sufficient staffing levels with an electronic call log system to monitor punctuality and identify late calls.
· Safe recruitment procedures including ID checks, employment references, work history, and DBS checks.
· Medicine administration records completed accurately with an electronic MAR system to promptly identify errors.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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
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 guidanceGood
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 supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff; continuous learning and improving careGood