GN Care Services Ltd was rated Requires Improvement overall following a focused inspection in November 2022, with breaches of Regulation 19 (fit and proper persons employed) and Regulation 17 (good governance) due to incomplete recruitment records and inadequate quality assurance systems. While safeguarding, medicines management, infection control and partnership working were found to be positive, the provider's governance systems failed to identify recruitment risks, and a new electronic call-monitoring system was still being implemented.
Concerns (4)
criticalStaffing levels: “We found two examples where important documentation such as risk assessments were missing on staff files.”
criticalGovernance: “The provider had undertaken a quality assurance audit...However, this had failed to identify the issues we found with the recruitment of staff.”
moderateRecord keeping: “The provider had failed to make sure robust systems and processes were in place to monitor and audit the accuracy of records maintained in relation to care calls.”
moderateMissed or late visits: “The provider had started to introduce a new monitoring system. They hoped to fully implement this system by the end of November 2022.”
Strengths
· People were protected from the risk of abuse and staff were aware of how to recognise and report signs of abuse.
· People's medicines were managed safely with regular audits and annual competency checks on staff.
· Staff used PPE safely and effectively and infection prevention and control policy was up to date.
· Risk assessments were updated when people's needs changed to keep people safe.
· The provider was open to continuous learning and responded positively to feedback.
Quality-Statement breakdown (9)
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving care; working in partnership with othersGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
GN Care Services Ltd was rated Requires Improvement overall, with a breach of Regulation 17 (good governance) due to inaccurate care call records and lack of oversight of visit times. Despite safe, effective and responsive care, inconsistency of regular staff and weak governance meant caring and well-led were rated Requires Improvement.
Concerns (7)
criticalGovernance: “The provider had no systems in place to audit the accuracy of these records. This lack of oversight meant they could not fully assure themselves staff were attending these calls at the right time”
criticalRecord keeping: “the provider was not maintaining accurate records of the care and support provided to people as they are legally required to do.”
moderateMissed or late visits: “concerns received about missed care calls, the timeliness of care calls and quality concerns about the care and support provided by the service.”
moderatePerson-centred care: “Not all the people using the service received care and support from regular staff... 'I don't get regular carers, I never know who is coming.'”
moderateStaff training: “'More training needs to be done…I think new staff need to have more training…usually carers shadow the more experienced carers. But often new carers come alone and have no idea'”
moderateLeadership: “the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
minorInfection control: “Two people told us there had been occasions when staff had not worn a face mask during a care call.”
Strengths
· Safe recruitment practices with appropriate pre-employment checks
· Staff understood safeguarding and how to report concerns
· Medicines administered safely and as prescribed, with annual competency checks
· Risks to people's safety and wellbeing well documented and managed
· Staff supported people to access healthcare and reported concerns appropriately
Quality-Statement breakdown (20)
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law