Archived: Goldsborough - Maldon

Goldsborough Maldon provides a domiciliary care and reablement service to people in their own homes. The domiciliary care service provided care and support to 151 people and 74 staff supporting them. The reablement service provided care and support to 324 people with 106 staff supporting them and had started operating in May 2016.

A registered manager was registered with CQC to manage the domiciliary care service but was on maternity leave during the time of our inspection. The provider had put in place an acting branch manager to oversee the management of the domiciliary care service and an acting manager for the reablement service. The post of registered manager for the reablement service was in the process of being filled. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service did not have appropriate systems in place to keep people safe. Risks to people’s health and wellbeing were assessed but not managed effectively to keep them safe and there were insufficient numbers of staff available to meet people’s needs.

Systems were not in place to ensure people received their medicines safely and in a timely way because missed calls and late or early calls were putting people at risk of not receiving their essential medicines.

A supervision and appraisal process including competency checks for staff in carrying out their role was in place but was not consistent across both services.

People were not receiving support and assistance with their nutritional or hydration needs as staff were not turning up within a specified time or calls were being missed completely. People could not be assured that they would receive their necessary drinks and meals as part of their planned arrangements for care.

The service was not always courteous and respectful to people who used it. People did not know when the service was being provided and by whom and they did not receive the service at a time of their choosing. This did not always show the service was caring.

The service was not responding appropriately to people’s needs. People were receiving less than an acceptable level of service as they were being left without essential care and support.

Whilst complaints and concerns were being logged, the management had not acted on the information about the quality of care people had received or looked at how people’s concerns could be used as an opportunity to improve both of the services provided.

Some quality assurance systems were in place but were not being used monitor and evaluate the service effectively to provide a high quality service.

There was no visible leadership in the service or clear vision or values. The management arrangements were in state of disarray as there were significant changes going on with the location. However, the provider had started to make improvements to the service to keep people safe.

Care and support plans were sufficiently detailed and provided an accurate description of people’s care and support needs. Staff had most of the right information, skills and knowledge to provide care and support to people.

A recruitment process was in place to protect people and staff had been recruited safely.

Staff told us that they were mostly supported in their role and received encouragement to do their job well.

Staff understood people’s needs and provided care and support accordingly. People were treated with compassion and kindness by staff who provided their care.

You can see what action we told the provider to take at the back of the full version of the report.

We looked at people's support records as well as information relating to the management of the agency. This included staff training and supervision records. We assessed the provider's arrangements for monitoring the quality of the services provided.

There were procedures in place to provide staff with a range of training relevant to the needs of people who used the agency. This provided them with the information they required to provide safe and effective care and support to people who used the service.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Relatives told us that sometimes there had been missed calls and this could put people at risk because their needs were not being met. A relative told us that things had improved. They said, 'Things have picked up in the last month. We are getting a bit more consistency from the same three care staff.' Another relative told us that they felt their relative was safe.

One relative told us that they had raised concerns about medication and they had not been addressed promptly which was not safe for their family member. Since this incident procedures around medication were improved and a process for monitoring medication was put in place.

Is the service caring?

Feedback from people who used the service and from relatives was complimentary about some staff but less positive about others.

A relative told us that one member of staff was 'very caring' and 'makes [my relative] laugh and cheers them up' but another member of staff 'does not relate at all well' to the person. Another relative told us, 'In general the staff are caring, respectful and polite."

One person described staff as, 'Very caring and helpful' and said, 'They go over and above and go out of their way to help.'

Is the service effective?

Some people and relatives were happy that they had continuity of care because this meant that staff knew them well and how to meet their needs. Others were not happy because they felt they had too many changes of staff providing their care. One relative told us, 'If [my relative] keeps getting new staff they don't know, it's very unsettling as they are on their own.' They added that continuity of care had been poor in the past but that the provider was trying to improve this.

A person who used the service told us, 'In the past timing wasn't always good but recently it has improved.'

Is the service responsive?

People said that the standard of care and support could vary depending on the staff sent to support them.

A relative told us that a member of staff had phoned the person's GP a couple of times when they were not well which they found reassuring. Another relative described how one member of staff stayed for an additional two hours when they were concerned about a person's medical condition.

A person who used the service told us that staff were able to respond, 'If I have differing need on different days.'

Is the service well-led?

Two relatives said that there had been poor communication from the office staff and a lack of organisation within the agency. Two people told us that care staff had not arrived to help them and that the office staff did not inform them or arrange for another member of staff to visit. A relative told us 'It was the inconsistency more than anything, that was the problem, but that's improving.'

The provider had made changes to try to improve the service by managing staff schedules and duties more effectively. One member of staff said that sometimes they would get called at short notice but on the whole they had notice of their visits and work schedules. Another member of staff said the management of rotas has improved, they were given more notice of their visits and work schedules and their 'off duty' time was more regular. They were having every other weekend off and this had had a good effect on morale.

We gathered comments from people and their relatives being provided care by the domiciliary care agency, and from the carers providing care.

We checked, and people told us that carer's gained consent before they provided care.

One person told us: "The care is very good, I can't fault it." We were also told: 'You can always rely on them.'

People receiving care said they felt safe with the carers in their homes. They also told us that they knew how to express any concerns they might have.

People said they were notified by the office staff if the carer was running late or there was a change of carer due to sickness.

We found the provider was not following their complaints procedure.

We found records were kept appropriately for the benefit of people provided care.

People told us they had been given information before they started to use the service and were visited by a supervisor. One person told us, "A senior visited and asked about my care plan and if I was satisfied, they wrote it all down." Another person said, "I had a visit and a phone call in the last six months."

People said they felt safe and had no concerns about the care provided. They told us that they felt confident to express any concerns they might have.

We spoke with staff who said they received regular training, supervision and felt well supported.