Gemcare South West - Extra Care Scheme

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 30 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Some people told us they were not treated with kindness, compassion and dignity. They told us “Some of them (staff) are not very nice”; “Some staff won’t make conversation and ignore me” and “There are 2 carers who seemed to always be together who come into [relative’s] room at times and make unnecessary remarks about something that upset [them].”

Some people said they were not treated with respect. People said, “I asked to be covered in the shower and staff said no”; “Some staff are rough as anything with me, rush, rush, rush”; and “Care staff are disrespectful.”

We spoke with 3 people who showed clear signs of emotional distress, including tearfulness. This was directly linked to the care they were receiving from the service.

Other people told us they were happy with their regular care staff. They said, “The carers are all very good, kind very caring but they don’t have enough time for everyone they look after” and

“They look after me. [Staff member] comes to see me – [they are] brilliant and other people come in and they are all very kind.” A relative told us, “The staff will even do things in their own time. For example, one of the carers plates up a roast dinner that [they] cook at home and takes it to my relative.”

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Care plans were not always person centred and lacked information about the person, their wishes and preferences.

People told us the poor delivery of the service meant they did not feel treated as individuals and communication was difficult at times. One person told us, “They’ll come in 2 of them and they talk to each other in their own language which is difficult and then when they talk to us, they talk English, but it is not the English I am used to so that gets a bit awkward.” People had raised concerns around communication in a recent tenant’s meeting.

People’s personal goals and aspirations were not supported. One person told us they had not been out of their home in 12 months other than to attend hospital appointments and would like help with this. They had mentioned it to staff but this had not been escalated to appropriate agencies.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.

People told us they did not have choice and control as staff did not have enough time to support them. Visit records showed people’s visit times were variable which meant they were unable to plan their day effectively. One person said, “I base my life on continuity and routines to manage my conditions, I don’t think the care company register that.”

Where people had asked not to have certain staff members this had not always been respected. One relative told us they had raised concerns about a staff member who was not attending visits, was late, and was not delivering care as agreed. After they raised concerns, they were reassured the staff member would not visit again. The relative said, “They’re still sending [staff member name], they’re on the list regularly.”

Some people told us they were not supported to be as independent as possible. One relative said, “I'm not sure that they have the time to help [person’s] independence as I think they are in such a rush. For example, they use the wheelchair, whereas I try to get [person] to walk with [their]frame which takes longer but that's just because of the shortage of staff.”

Some people told us they were prevented from making decisions. One person told us how staff used to order them a takeaway at teatime. They said, “They won’t order now as they say you are not allowed to have it because you are diabetic you shouldn’t eat takeaway.”

However, the service had supported and increased a person’s independence which resulted in them managing their own medicines.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff told us they were unable to quickly respond to people’s needs to avoid any preventable discomfort, concern or distress as there were not enough staff available.

People reported delays in receiving support after using their call bell to summon staff support.Comments included, “There have been several times where my relative has rung the bell on [their] wrist and normally, they would come but it's been quite a long time before they arrive recently” and “I can press the button on my wrist for emergencies – when I call, they have not come up. We have been told now it is emergencies only to ring the bell, so I call and then they say it is not an emergency we’ll come up when we can.” One person described how they recently fell in the shower. They said, “I pressed my emergency button, and I was pressing it for 2 hours before anyone came” and “I was laid on the bathroom floor from 5.45pm until 11.00pm and they didn’t stay with me, they just left me.”

The provider did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

Experienced staff were passionate about delivering good care for people, but they were frustrated they couldn’t achieve this under their current working conditions. Most staff told us they did not feel valued and treated in a way which supported their wellbeing. Comments included, “I feel very depressed and have made preparations for a letter to hand my notice in as I no longer want to work for a company who don’t respect us” and “It is appalling to be honest with you, we are feeling down.”

They did not feel their workload was manageable. Staff said, “It is very stressful, recently there has only been one member of staff in when there should be at least 3, so double up visits weren’t done” and “We have had 5 calls not allocated on 1 day over a weekend and were told to sort it ourselves.” Visit records showed staff were not getting regular breaks.

Staff told us they did not feel listened to. Comments included, “No support for us staff and we have had so many managers who have been pushed to the limit, and they have left as it seems like they were being bullied” and “I do not feel I am able to talk to any member of management, and I don’t know who I would approach with any issue.”

Staff told us they did not always feel safe. They said there were times where they had been in the units on their own, as other staff had not arrived, and they were unable to meet people’s needs. Comments included, “When people go sick Gemcare never sort any cover, staff members being left on their own in the building of an evening when there is meant to be 2 people in the building.”

People and relatives raised concerns about staff wellbeing. They said, “We know the main carers and sometimes they are just rushed off their feet” and “I do think that the staff want to do the best for the residents and so it's quite frustrating for them when they don't have the time to do things as they would really want to. I do feel the carers feel a lot under pressure.”