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Inspection carried out on 26 September 2018

During a routine inspection

What life was like for people using this service:

• The service made numerous improvements since our last inspection.

• The safety of people’s support and the quality monitoring of care processes were improved.

• People and relatives told us staff were kind and caring. They could express their views about the service and provide feedback.

• Staff received appropriate training and support to enable them to perform their roles effectively.

• People’s care was personalised to their individual needs. There was sufficient detail in people’s care documentation that enabled staff to provide responsive care.

• There was a complaints system in place, however further improvements are needed to ensure it is always robust.

• The service had processes in place to measure, document, improve and evaluate the quality of care. More time is required to ensure that the processes are effective and sustainable.

• Changes were implemented to the management team to encourage a continuous improvement process at the service.

• The service met the characteristics for a rating of “good” in all key questions.

• More information about our inspection findings is in the full report.

Rating at last inspection:

• The rating of this service at our last inspection was “requires improvement”.

• At our last inspection, there were four breaches of the regulations.

About the service:

• G.R Response Healthcare is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger and older adults, people with physical disabilities, sensory impairments, learning disabilities or dementia.

• The service’s office is based in Langley, and personal care is provided to people in surrounding areas.

• At the time of our inspection, 30 people used the service and there were 30 staff.

Why we inspected:

• All services rated “requires improvement” are re-inspected within one year of our prior inspection.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Inspection carried out on 16 October 2017

During a routine inspection

G.R Response Healthcare Ltd is a small, family-run service located in Slough, Berkshire. It is a domiciliary care agency. It provides personal care to people living in their own houses and flats in Slough, Langley, Burnham and the surrounding areas. It provides a service to older adults; people living with dementia; people who misuse drugs and alcohol; mental health; physical disabilities and sensory impairment. At the time of our visit there were 53 people using the service.

In February 2017, and since our last inspection, the provider changed their name from Goldenrose Community Care Limited to G.R Response Healthcare Ltd. The location name also changed from Golden Rose Community Care Limited to G.R Response Healthcare Ltd.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We previously inspected the service on the 28, 29 and 30 April 2015. The service received an overall rating of ‘good’ with ‘requires improvement’ in the key question, is the service effective. This was because staff who had undertaken relevant training could not confidently demonstrate their understanding of the Mental Capacity Act 2005 (MCA). We made a recommendation for the service to seek guidance on how to ensure the effectiveness of training undertaken by staff.

During this visit we found although care workers’ understanding of the MCA had improved this was not the case for senior management who assessed, managed and recorded people’s capacity and ability to consent. Our rating for this key question has therefore remained at “requires improvement”.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; even though there were policies and systems in place to enable them to do this.

People were not supported to express their views and be involved in making decisions. People felt staff were caring and kind. Staff had a good understanding of their care and support needs and family histories. Staff said they made sure people were treated with respect and their dignity was protected. However, some relatives felt their family members were not always treated with dignity. People were encouraged to be as independent as possible. People’s confidential personal information was securely protected.

People and their relatives gave mixed feedback about staff’s abilities and skills to carry out their job roles. We found the service provided appropriate support to staff to ensure people received effective care. Staff told us they made sure people’s nutritional needs were met. We noted this was in line with what people said they wanted. People were supported to maintain good health.

We could not be confident people would always be protected when an alleged safeguarding incident had happened. People said they felt safe from harm but gave mixed responses about the timeliness of calls. The feedback received demonstrated further improvement was required. We have made a recommendation for the service to seek current guidance on the allocation of staff in order to make sure people receive consistency of care. Where there were identified risks in regards to people’s health and welfare, risk management plans were not always in place. The management of medicines were not always safe.

People and their relatives felt the service was not always responsive to their needs. Where reviews of care were carried out, there were no records of involvement with people or their relatives. We have made a recommendation for the service to seek nationally evidence-based guidance on how to involve people and their relatives in reviews of care. People and their relativ

Inspection carried out on 28, 29, 30 April 2015

During a routine inspection

Golden Rose Community Care Limited is a domiciliary care agency that provides care and support to people in their own homes. On the day of our visit there were approximately 83 people using the service. The agency provides support to people with a range of care needs, which include older people, people living with dementia and people with physical disabilities.

This inspection took place on 28, 29, 30 April 2015. The provider was given 48 hours’ that the inspection was going to take place. We gave this notice to ensure there would be senior management available at the service’s office to assist us in accessing information we required during the inspection.

At our previous inspection on 22, 24 and 25 July 2014 we found the provider had not met the requirements of the law in the following five areas:-

  • Care and welfare of people who use services
  • Staffing
  • Assessing and monitoring the quality of service provision
  • Notification of other incidents
  • Records

During this inspection we found improvements had been made but further action was required for the service to become fully compliant with the law.

The registered manager has been registered since March 2015. 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 and associated Regulations about how the service is run.

People said they felt safe from abuse. Staff knew how to identify abuse, report concerns and received relevant training. Risk assessments were regularly reviewed to ensure people received safe and appropriate care. There were sufficient staff to provide care to people. People said staff did attend promptly however there were some occasions when care workers were late. Office staff were polite and always called back to update people on what was happening. Appropriate measures were in place to ensure staff administered medicines to people safely.

Staff who had undertaken relevant training could not confidently demonstrate their understanding of the Mental Capacity Act 2005 (MCA). We have made a recommendation the service seek guidance on how to ensure the effectiveness of training undertaken by staff. The service sought consent before people’s care, treatment and support was delivered. People received care and support from staff who received effective supervisions, training and appraisals. The service worked in partnership with other health professionals to ensure people received effective care and support.

People said staff were caring and treated them with respect and dignity. People were involved in the planning of their care, encouraged to exercise choice and be independent. Counselling and support was provided to staff during or after providing care to people who received end of their life care.

Reviews of care were regularly undertaken. Systems were in place to remind management of the dates reviews were to be undertaken throughout the year. People said they were involved in decisions made about their care and support needs. Staff demonstrated good understanding of people’s care needs and family history. Care records showed people’s preferences on how their care was to be provided. People knew how to make a complaint if they had concerns.

People and their relatives told us the service was well managed. The service had systems in place to manage, monitor and improve the quality of the service. The service submitted notifications of incidents to the Care Quality Commission in a timely manner. Staff knew how to raise concerns and felt confident to do this. The service sought feedback from people, those who represented them and staff.

Inspection carried out on 22, 24, 25 July 2014

During a routine inspection

The inspection was carried out by one inspector. We gathered evidence to help us answer our five questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

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?

We found the service was not safe.

We found risk assessments which highlighted potential risks and how to reduce the risks appropriately. However, some risk assessments were not regularly reviewed. This had the potential of placing people at risk of unsafe or inappropriate care.

We spoke with six people who told us they felt safe and knew what to do if they had concerns. We heard comments such as, “I have not had any concerns but if I did, I would ask the staff to leave, call the office or social services”, “I will speak the manager but no staff have ever been abusive or aggressive with me”, “I would speak directly to Golden Rose or social services if they were not helpful” and “I would go straight to the office, my second approach would be to contact social services if the matter was serious.” This showed people who used the service were aware of how to raise concerns of abuse.

We found reviews of care were not regularly undertaken and updated. Staff supervision records were not fit for purpose because they did not allow supervisors to record discussions held with staff and follow up actions agreed. Incident records did not record what action was taken and the outcomes. Changes in people’s circumstances were not updated in care records and medical records were partially completed. Records relevant to the management of the service were out of date. The service had a contractual obligation to the Local Authority to keep records of how much time was spent providing care to people. We reviewed call log records and found the records were not always accurate, with times of visits missing or no record of care provided. The service did not notify the Care Quality Commission without delay of any incidents that affected the welfare and safety of people who used the service. This meant people were not protected against the risk of unsafe or inappropriate care. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to records.

Is the service effective?

We found the service was not effective.

We saw instructions on how care was to be carried out was clear. For example, in one care plan a person was identified as having difficulty eating. Staff were instructed to assist the person with their meals at a steady rate and to ensure the person was given adequate breaks to enable them to take fluids. We saw instructions on the days and times care was to be delivered, with step by step instructions of what staff should do and in what order. This meant the care delivered was centred on people’s individual circumstances.

There was no evidence to show whether two of the staff had received an appraisal of their performance during their employment. We saw an appraisal record for one staff dated 30 April 2014, however this was the only appraisal the staff had in the two and half years of working for the service. This meant the service did not have appropriate arrangements in place to support staff. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to supporting workers.

Is it caring?

We found the service was caring.

We spoke with six people and their representatives. People spoke positively about the care they received. We heard comments such as, “They’re all just brilliant. They do listen. I feel safe as houses”, “They’re respectful and friendly, we’re comfortable with them” and “I feel cared for by X”. This meant people were happy with the care, treatment and support delivered.

Is it responsive?

We found the provider was not responsive.

Care plans viewed were comprehensive covering areas relevant to people’s needs such as, waking and dressing; mobility; personal hygiene and medication. Each area showed the care needs identified, planned outcomes and how they would be achieved. For example, under ‘waking and dressing’, it showed a person’s preferred time of getting up, with staff being instructed to ensure they arrived at that time to carry out personal care. The outcome was the person was kept clean, hygienic and presentable throughout the day. This showed the delivery of care reflected people’s needs and preferences. However, risk assessments and care plans were not regularly reviewed to reflect people's changing circumstances.

Is it well-led?

We found the service was not well-led.

We found the service did not have systems put in place to monitor, manage and improve the quality of the service. There were no systems to audit care plans or ensure care and risk reviews were regularly undertaken. We reviewed three staff files and saw supervisions did not occur regularly. One staff who had been employed by the service for approximately two and half years only had one appraisal meeting. Two other staff who worked for the service for two and half years and 13 years had not been appraised at all. There were no systems to log complaints or concerns and analysis trends. The service did not provide an action plan by 31 October 2013 as requested by the Care Quality Commission due to previous non-compliance. We found the service did not have systems put in place to monitor, manage and improve the quality of the service. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation assessing and monitoring the quality of service provision.

Inspection carried out on 8, 14 August 2013

During a routine inspection

We spoke with five people about their personal experience of the care and support they had received. We heard some mixed comments about the service. Generally,the comments made about the care staff were very positive. One person said "I am always listened to if I want something done in a particular way, and they address me in a respectful manner." Another said they liked the staff attending them as they were competent. However,several people told us that they sometimes felt as if the appointment was rushed.

We were told that people generally felt safe and well-cared for. However, several people said they had to remind the staff to wear an apron when assisting them with their personal care.

The staff received training in the safeguarding of vulnerable adults. This had given them the skills and appropriate knowledge to deal with any incidents or allegations.

People told us that staff mostly arrived on time, and if two people were required, they always came in a team of two.

We heard from one relative who previously used the service. He told us that he did not feel his concerns had been addressed to his satisfaction. The agency director and the care manager had visited this person at home to try to resolve his concerns.

Not all records were kept securely or able to be located promptly when needed. This was in contravention of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Inspection carried out on 2 October 2012

During a routine inspection

We spoke with five people about their experience of the care and support they received from Golden Rose Community Care. They were positive, in particular about the care workers; "They are very good". They told us their care workers listened to them and provided care in the way that they asked them to. People receiving care told us they felt safe.

People told us they had a consistent team of care workers providing their care. For example, one person told us they had four visits each day provided by a team of only six care workers. This provided continuity for them and meant they did not have to keep getting used to new care workers all the time. Another person told us whilst their calls were sometimes later than they would ideally like, care staff were "very effective" when they came.

People told us they had regular contact with the service. This was through their team of care workers, the supervisors who visited them to assess their care and periodic surveys they were asked to complete.

People told us they had no trouble in contacting the office, including out of hours. We saw the home held documentation included out of hours contact details. One person told us a specific concern over the time of their visit had been satisfactorily addressed.