Guild Healthcare

Guild Healthcare is a domiciliary care agency that, at the time of the inspection, was supporting 58 people living in their own homes within the local community. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided

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

We had concerns at our last inspection and rated the service requires improvement in two key questions and overall. We also found two breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made in relation to how the service was monitored and audited which had resulted in improvements in the management of risk, medicines and compliance with the Mental Capacity Act. The service was no longer in breach of the regulations.

There were sufficient numbers of safely recruited staff available to meet people's needs. People received their care visits at the times they expected, for the length of time agreed, and from staff they were familiar with. One person’s relative said, “There are enough staff to carry out the care package. We have one carer for most of the time and the replacements for time-off etc are fairly regular. I’m kept up to date with a weekly schedule and if there any unforeseen changes I’m promptly kept informed.”

Medicines were managed safely, and staff were appropriately trained. People and their relatives were assured that safe infection control measures were taken by staff such as wearing PPE and following infection control procedures to reduce the risks of infection.

People receiving the service and their relatives both told us they were satisfied with the standard of care and support provided. People were cared for and supported by staff who were suitably trained. Assessments of people's support needs and wishes were carried out before they were provided with a service. Where staff were responsible for assisting people to eat and drink, their dietary needs and wishes were assessed and met. People were supported to stay healthy and well, and to access relevant community health and social care services as and when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. One person’s relative said, " I feel that my [family member] is safe and receives the care and support they need. The care package was put together in consultation with me as my [family member] lacks the mental capacity for any discussion.”

The service was well-led by a management team who maintained good oversight of the service and who were passionate about delivering quality care and achieving the best possible outcomes for people.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 May 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Guild Healthcare on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Guild Healthcare is a domiciliary care agency that, at the time of the inspection, was supporting 58 people living in their own homes within the local community. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

The service had policies and procedures in place in relation to medicines administration and management and these had mostly been effective. However, we did find some concerns with processes including the need to update people’s current medicines within their care plans and better auditing for one person’s medicines administration record (MAR) charts. The service’s quality monitoring audit had failed to identify these.

Following several medicines incidents, the service had taken appropriate action although further measures could have been put in place to further safeguard. We had confirmation shortly after our inspection site visit that these had been taken. We also promptly received a service improvement plan that demonstrated what action they would be taking in response to our findings. This provided us with assurances.

Overall, we found people had received their medicines as prescribed and that staff had good knowledge of medicines administration and management. Staff had been robustly inducted, trained and supported in this aspect of their role and the provider regularly assured themselves, through competency assessments, that staff had the appropriate skills to administer medicines. One staff member told us, "I was amazed at the amount of training I received.”

The people who used the service, their relatives and staff all spoke positively about the service, medicines management and the responsiveness and communication of the management team. One person who used the service said of the staff, “I am not sure on the (medicines) training staff do but they seem so knowledgeable and kind; they are amazing at their job.” Whilst a relative told us, “I have seen the supervisors look through the medicines to make sure they are okay. I have not had any issues with staff and feel they are all good at their job.”

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

Rating at last inspection

The last rating for this service was requires improvement (report published on 01 May 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about medicines management. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make some improvements. Please see the Safe and Well-led sections of this full report.

Following our inspection site visit and the feedback given on our findings, the service took prompt action to rectify the concerns identified which provided us with assurances. A service improvement plan was also promptly and voluntarily submitted that provided further assurances of how those actions were to be embedded into practice.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ People told us that care staff were kind and caring in their interactions with them, but sometimes they had lots of different care staff which left some people feeling unsettled.

¿ Auditing processes needed to be more robust and detailed to enable the service to identify where improvement was needed.

¿ Further improvements were needed to ensure risk assessments and care plans were accurate and sufficiently detailed. We have made a recommendation about this.

¿ The principles of the Mental Capacity Act (2005) were adhered to. However, documentation should be made clearer as to decisions that people are still able to make for themselves.

¿ People were supported to eat and drink enough to maintain a balanced diet. Further information was however required within care plans with reference to people’s dietary needs and food preferences.

¿ There were sufficient staff to cover all visits. Recruitment procedures were in place to ensure staff were suitable for their roles.

¿ People had access to healthcare professionals when required.

¿ Staff knew how to care for people and received training in their roles, and support from the registered manager.

¿ The registered manager and provider was open and transparent and welcomed feedback from us. They demonstrated a commitment to putting systems in place which would promptly address the issues we found.

¿ There was a warm and friendly culture at the service. Staff felt supported and valued. The provider was committed to ensuring that a person-centred approach was sustained.

Rating at last inspection: At the last inspection the service was rated Good (Report published September 2016).

Why we inspected: We inspected this service in line with our inspection schedule for services currently rated as Good.

Enforcement: Action we told the provider to take is outlined at the back of the report.

Follow up: We will continue to monitor this service according to our inspection schedule in line with the rating of ‘Requires Improvement.’

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

This announced inspection took place on 1 and 2 September 2016. The provider was given 48 hours’ notice because the registered manager is sometimes out of the office.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff received training to protect people from harm and they were knowledgeable about reporting any suspected harm. There were a sufficient number of staff employed and recruitment procedures ensured that only suitable staff were employed. Risk assessments were in place and actions were taken to reduce risks which had been identified. Arrangements were in place to ensure that people were supported and protected with the safe management of medicines.

The provider had procedures in place in relation to the application of the Mental Capacity Act 2005 (MCA). Staff we spoke with confirmed they had received training regarding MCA. The registered manager and the staff were knowledgeable about these. They were aware of the circumstances they needed to be aware of if people’s mental capacity to make certain decisions about their care changed.

People were supported to access a range of healthcare professionals and they were provided with opportunities to increase their levels of independence. Health risk assessments were in place to ensure that people were supported to maintain their health. People received adequate amounts of food and drink to meet their individual preferences and nutritional needs.

People confirmed that their privacy and dignity was respected and their care and support was provided in a caring and a patient way.

Appropriate recruitment checks had been completed to ensure that staff were suitable to provide care and support for people using the service.

A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People could raise concerns with the staff at any time.

The provider had quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. People and their relatives were able to make suggestions in relation to the support and care provided and staff acted on what they were told.

There were links with the external community. A staff training and development programme was in place and procedures were in place to review the standard of staff members’ work performance