Gold Hill Care

People’s experience of using this service and what we found

People told us they were supported by staff who were kind, caring and compassionate. Comments from people included, “I can’t tell you how brilliant they are,” “They’re wonderful” and “They’re never anything but professional.”

People were not always protected from unsafe medicine management. The service did not fully comply with national guidelines regarding records relating to medicines. Some people were supported with the administration of their prescribed medicines without this being identified as required and no medicine administration record being in place.

People were supported by staff who had received initial and ongoing training to ensure they had the right skills and attributes to work with them.

People received effective care. Staff worked with external health and social care professionals to ensure people’s needs were met. People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported support this practice.

People were encouraged to be independent and supported to engage in community activities they enjoyed.

Staff were happy in their role and felt fully supported by the registered manager. Staff told us there was good team work and morale was high. We found all staff demonstrated a commitment to provide a high-quality service and improve the quality of life experienced by people they supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 28 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicine management and administration 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager in place. 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.

Overall we found the service to be well managed. Staff appeared to be committed to offering a good service and had confidence in the senior staff and registered manager. People received medicines from staff who had been trained. However, they did not always comply with the requirement to record what medicines they had administered to people. Despite several attempts by the registered manager to address this problem, it was still ongoing. We spoke with the nominated individual following the inspection, and measures were to be put in place to ensure this situation was improved with immediate effect.

We also had concerns that when a medicine error occurred, medical advice was not always sought for people. We have made a recommendation to the provider to improve their practice in this area.

Prior to care being provided an assessment of people’s individual needs was carried out. From this information a care plan and risk assessments were drawn up. Some people told us they were involved in reviewing their care. Documents verified this. Through talking with staff it was apparent staff were familiar with the individual needs of the people they supported.

People spoke positively about the care they received and the skills and knowledge of the staff. Where people were being cared for by regular staff it was clear that strong relationships had developed. People were pleased to have regular carers. Where visits to people may have been delayed, staff telephoned people to inform them of the situation. An on call facility was available for people and staff to call outside of office hours for support or guidance.

Prior to staff being employed the necessary checks were carried out to ensure their safety and suitability to work for the service.

People told us they believed staff were sufficiently trained to meet people’s needs. Training records showed 78% of staff were up to date with the training deemed mandatory by the provider. Staff received induction training and continuous support throughout their employment. This took the form of supervision, spot checks, competency checks, staff meetings and appraisals.

The service was complying with the Mental Capacity Act 2005 (MCA). We found mental capacity assessments had not always been completed appropriately, for example they were not time or decision specific. The registered manager implemented a new form which highlighted these areas and would improve their accuracy.

Where people required support with food and drink this was provided by staff. People were also supported to maintain good health, with staff being vigilant in noticing health changes in people and responding appropriately.

People told us staff were caring. Staff projected a caring nature when we spoke to them. Staff knew how to protect people’s privacy and dignity, and placed value in doing this. People told us staff were kind and compassionate. Staff knew the importance of supporting people to be as independent as possible. There was evidence staff had gone over and above what was expected of them in the course of their work, to support people and show kindness and sensitivity.

People told us they knew how to complain but they had never needed to. The provider had a complaints procedure in place, and records showed it was used effectively.

Both people and staff told us they felt the service was well managed. It was apparent in the records the provider had actively sought feedback from people and staff either through questionnaires, care reviews, home visits or through complaints. Actions had been taken in response to the information received to improve the service to people.

Staff felt supported and committed to provide the best quality of care they could. They were clear about the expectations of their role, and felt they performed well. As a result of positive support, staff valued the management team, and expressed high levels of job satisfaction in their roles.

People told us they had signed general consent forms for information about them to be shared appropriately. Each file we reviewed confirmed this had been done, and consent had been correctly documented.

Staff told us that there was enough detail in the care support plans to be able to assist each person.They said they always read the information and checked verbally with people that nothing had changed.

We heard there had been very few complaints about the service. We reviewed the complaints file and saw they had been dealt with efficiently and in a timely manner.

There was a recruitment process in place to ensure that staff had the right skills and qualifications to work with vulnerable people.

Records were usually accurate and fit for purpose. They were securely stored and the provider had a policy for retention and destruction.

We found people's needs were assessed and their care and support was planned and delivered in line with their care plan.

The service had a system in place to ensure people were protected against the risk of abuse. Staff we spoke with understood their duty of care and responsibilities in relation to safeguarding people from harm. People told us they felt safe with the staff who entered their homes to provide them with support and knew who to speak to if they had any concerns.

People described staff as 'very obliging, friendly, meticulous and professional." One person told us 'I have no concerns about the Gold team in actual fact I treat them as my friends.'

People experienced care and support that met their needs. However, there was inconsistency in assessing risks and providing guidelines for staff to follow. This had the potential of placing people's welfare and safety at risk.