Background to this inspection
Updated
10 September 2021
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 Care Act 2014.
Inspection team
This inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency which provides personal care to people living in their own houses and flats. There was one person using the service at the time of this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was no longer managing the service. A new manager (referred to as "the manager" in this report) had been appointed but had not yet applied to be registered to manage this service.
Notice of inspection
We gave the service 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 30 June 2021 and ended on 23 July 2021. We visited the office location on 23 July. The other days were spent reviewing records and speaking to staff, a relative of the person who used the service and the local authority.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included safeguarding alerts and feedback received about the service. We sought feedback from the local authority. We used all of this information to plan our inspection.
During the inspection
We spoke with the relative of the person using the service about their experience of the care provided. We spoke with four members of staff including the new manager, the nominated individual on behalf of the company and two care workers.
We reviewed a range of records. This included risk assessments, medicines records and care records. We looked at one staff file in relation to recruitment and we looked at staff training records. We also reviewed a variety of records relating to the management of the service, including policies, audits and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
10 September 2021
About the service
Golden4 Care is a domiciliary care service providing personal care to people in their own homes. There was one person using the service at the time of the inspection.
People's experience of using this service and what we found
The relative of the person using the service was happy with the standard of care provided. They said the care workers knew the person's needs well and thought the standard of care provided was good.
Medicines were not managed safely due to a lack of details and accurate information in the risk assessment and medicines administration records. Care workers followed the presciber's directions but the records and management oversight did not reflect the actual practice.
The management team carried out checks to monitor the quality of care people received however the auditing of medicines records was not effective as the lack of detailed information about the medicines had not been picked up.
The service's recruitment procedure was not followed robustly.
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.
Care workers were trained, supervised and subjected to spot checks to ensure they were providing safe care. They also had annual appraisals.
Rating at last inspection and update
The last rating for this service was Requires Improvement (published January 2021) and there were three breaches of regulations identified. The concerns related to the unsafe management of people's risks and medicines, poor recruitment processes and failure to effectively assess risks and the quality of the service.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. We served a warning notice due to the breach of regulation about good governance.
After the warning notice we received information indicating improvements but at this inspection we found not enough improvement had been made and there were continued breaches of regulations at this inspection. The service remains rated as requires improvement.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan, complied with the warning notice and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of safe, effective and well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion but were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Golden4 Care on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care (medicines), staff recruitment and governance at this inspection.
You can see what action we have asked the provider to take at the back of this report. In response to the breach identified regarding good governance, regulation 17, we will be writing to the provider asking them to provide an action plan in response to the issues identified and to provider time specific updates on the progress of actions taken.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.