Background to this inspection
Updated
7 June 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 17 March and ended on 11 April 2023. We visited the location’s office/service on 17 March 2023.
What we did before the inspection
We reviewed information we had received about the service since our last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 13 January 2023 to help plan the inspection and inform our judgements.
During the inspection
We spoke with 2 people who used the service and 7 relatives to understand their experience of care provided. We spoke with 5 staff including support staff and the registered manager who was also registered as the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records including 4 people's care plans, risk assessments and records relating to the provision of care. We looked at 4 staff files in detail and reviewed additional recruitment checks, training records and supervisions and appraisals. We looked at records relating to the management of the service including audits and policies and procedures. We also used technology such as video calls to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation.
Updated
7 June 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
At the time of the inspection, the location did not predominantly provide care or support for people with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group and the provider was supporting some people from this population group.
About the service
Heart of Gold Homecare is a domiciliary care agency providing personal care to 23 people at the time of the inspection. The service supported older and younger adults and children.
People’s experience of using this service and what we found
Right Support: People generally received support in line with their assessed needs. Assessments of people’s needs provided staff with guidance; however, some care plans would benefit from additional detail to improve the level of person centred information for staff to follow. People's choices were promoted by staff who had a good understanding of how to promote people’s independence. Support was in place to enable people to access the community. Staff supported people to achieve their goals, take part in chosen activities and pursue interests.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Right Care: People's care was not always provided safely. Medicines were not always managed safely; people’s medication administration records (MAR’s) were not always completed correctly; timings of calls did not always allow for sufficient time between the administration of people’s medication and paperwork relating to the application of creams and the use of thickening agents had not always been completed. Risk assessments associated with the provision of people's care generally provided staff with guidance on how to support people safely; however, additional detail was needed to improve person centred information and potential harm levels recorded within risk assessments needed review. People and relatives were happy with care and support provided by staff who had an understanding of how to protect people's privacy and promote their independence.
Right Culture: The providers governance systems required further development; audits were regularly completed; however, they generally only checked the recording of information rather than also focusing on practice and people’s experience of care. Audits did not always reflect our findings at this inspection and had not always informed improvement. Staff did not always receive training in key areas before commencing employment. The provider evidenced oversight of staff’s compliance with training, but they had not always ensured courses were completed in a timely manner. The providers recruitment systems required further development; staff recruitment records were incomplete, when the provider had not been able to obtain previous employment references, they had not completed risk assessments to ensure the suitability of candidates to work with vulnerable adults and children. However, we did not evidence any impact and people were happy with the support they received. The provider demonstrated values to place people’s needs and rights at the heart of everything they did and we felt issues identified related to the governance of the service
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
This service was registered with us on 24 April 2022 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.