Gemcare South West - Extra Care Scheme

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

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

This service scored 32 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Some people told us their care delivery felt like a set of tasks to be carried out. One person said, “I'm just a job to do. Staff treat me like a piece of meat.”

Care plans did not consistently contain details about people’s preferences, likes, and dislikes. We found for some support needs, care plans did not exist or needed more detail, so staff knew how to support people. For example, some people were living with specific health needs and medical conditions. There was limited information about how this impacted their lives and what staff could do to support them.

People did not always benefit from being supported by staff who had time to get to know them. In addition, care plans were not always up to date.

Some people told us their regular staff knew them well and supported them in line with their preferences.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

Most people told us they did not receive the care and support that had been paid for. Care visits were not always carried out at the agreed time and care staff did not always stay for the duration of the visit.

People did not always receive continuity of care with the same staff. The service employed agency staff. People told us staff came from other units. Visit records showed people received care from a number of different staff members. For example, one person had 20 different staff visit over 64 visits.

One person said, “It’s good care when it’s the regular [staff] but when its staff from the other sites they don’t know what to do so I spend most of the time telling them what to do. That makes it a rush.”

Some people told us they received care from some regular staff who knew them well. Comments included, “There is a core of carers there all the time who have become more familiar” and “They [Carers] are very dedicated to the job and I think they are quite experienced.”

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s communication needs were not always detailed within their care plans and their needs were not consistently met. The service did not meet the requirements of the Accessible Information Standard by identifying, recording, flagging, sharing and meeting the information and communication needs of people with a disability or sensory loss. For example, one person was registered blind. There was no additional information in their care plan on how staff should support with communication. The person told us some staff did not realise they could not see, and this made things difficult for them.

The service had not made information available to relatives when they wanted it. One relative told us they had difficulty gaining access to their loved one’s care records. They told us, “I have only just got access to the app where they record things, but it took me months to get access and they kept postponing my access and delaying with a password. It's a standard tick sheet but I don't know if it's always filled out honestly and transparently as well as accurately.”

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

Some people told us they had not raised concerns with the service as they were not confident their views would be respected, taken seriously, and treated compassionately, without negative repercussions.

Some people told us when they made complaints or raised concerns, they were not listened to and action was not taken to resolve issues. Comments included, “If I try to speak to someone it’s as though I am being fobbed off, they say it will get better, but it doesn’t. I am not sure what the answer is?” and “We have had several issues particularly over recent times. I also find them very poor at communication.”

The service had a complaints process. However, where people had raised formal complaints, actions had not always been taken to resolve issues.

Some people told us they had no complaints and felt able to speak with staff.

The provider did not make sure that people could access the care, support and treatment they needed when they needed it.

People did not consistently receive their agreed care at the time they needed it. People told us visits were not always carried out in a timely manner when support was needed and there could be delays. The service did not have effective oversight to ensure people’s care was delivered as agreed.

Some staff told us they had not been listened to when trying to escalate concerns to management about people’s care. One staff member said, “Communication is a big thing and ringing Blackpool (on-call) is difficult and sometimes we have to ring the domiciliary care office and it just rings and rings.”

Records relating to monitoring known risks were not fully completed. This meant the provider could not be assured people would receive the care, treatment and support they needed in a timely way.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

People did not always have good outcomes and experiences. They did not always know who was going to attend their care visit, when it was going to take place, and staff did not always stay the full length of the visit.

Staff told us how they treated people equally and without discrimination. However, one person told us, “Some carers don’t answer me, I feel hurt and upset, I know they are busy, I may be physically disabled but I am a person just like them.”

No one was receiving end of life care at the time of our assessment. Where people had advanced wishes about end-of-life care, these were included in their care plan.

However, staff told us about the recent death of a person using the service which they found traumatic. They said they did not feel supported by the service and gained support from a visiting professional. Staff told us they had asked for training in end-of-life care.