Archived: Golden Heart Healthcare Services Limited

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. In addition we received some information of concern prior to the inspection alleging that the provider was using staff who did not have the right to work in the UK which we also intended to check.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Golden Heart Healthcare Services on our website at www.cqc.org.uk

Golden Heart Healthcare Services provides domiciliary care to older people living in their own homes in and around South London. Some people received live-in care. Several people were living with dementia and some had physical disabilities. Our inspection findings indicated there were 12 people using the service at the time of our inspection, although we were unable to confirm this. This was because the number of people the registered manager told us were receiving a service initially did not match numbers shown on staff rotas and in information the registered manager sent us after the inspection. This indicated the service was not managed effectively.

The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

At our last inspection we identified people were at risk of receiving care from staff who may be unsuitable. During this inspection we found that two staff recruited since our last inspection had no recruitment documents on file which indicated the registered manager had not carried out any checks on their suitability. In addition other staff did not have references, criminal records checks, proof of address and evidence of the right to work in the UK. We forwarded this information to UK Border Agency (UKBA) for further investigation. In addition we raised a safeguarding alert with the local authority due to concerns of people receiving care from staff who had not been checked thoroughly to ensure they were suitable to work in this sector.

Although the provider had reviewed risk assessments relating to people’s individual needs these were insufficient. They did not always follow Health and Safety Executive (HSE) guidance and there was a lack of guidance for care staff on how to reduce risks to people. The were no suitable risk assessments in place relating to some people’s risks which meant the provider could not be sure they were doing everything possible to mitigate risks to people.

The registered manager had put in place an induction for new staff and told us they would use the Care Certificate so new staff would reach a nationally recognised standard of skills and knowledge during their induction for new staff starting after 1 February 2017. The registered manager put a training programme in place to include annual mandatory training for all staff in topics such as safeguarding, medicines administration and first aid. However, staff did not receive training or competency assessments in using hoists safely even though one person required a hoist to transfer. In addition staff were not receiving formal supervision and appraisal from the registered manager to help them develop in their role. This meant people were at risk of receiving unsafe care from staff who had received inadequate training and support from the registered manager.

The provider had not put in place quality assurance processes to ensure internal systems and processes were checked so the service could continually learn and improve practice. The provider still did not have suitable arrangements in place to seek feedback from people, and also from staff, on the service.

The provider had not notified the CQC of significant events including an allegation of abuse as required by law.

At this inspection we identified repeat breaches of Regulations 12, 17, 18, 19 of the Health and Social Act (2008) Regulated activities and a new breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We have taken urgent action and we are taking further action against the provider in relation to the repeat breaches of regulations and this will be added at the back of this report after representations and appeals processes have concluded You can see the action we took in relation to Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Golden Heart Healthcare Services provides domiciliary care services to people living in their own home in South London and surrounding areas.

At the time of this inspection there were five people using the service. The service provides personal care to older people, some of whom are living with dementia or have physical disabilities. Some people are provided with a live in care staff to support them with their care on a 24 hours a day, seven days a week basis.

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 2008 and associated Regulations about how the service is run.

Each person using the service had a care plan in place. Care plans were not person centred. They gave very little detail about the care and support a person required and there was lack of information on the actual care package that had been commissioned.

Within the care plans there were some risk assessments in place which addressed the risks associated with moving and handling and falls. However, the provider did not assess people’s individual risks associated with their care and support. There was a lack of information or guidance available for care staff on how to reduce or mitigate identified risks such as risks of recurrent urine infections, pressure ulcers and risks associated with medicines.

People receiving care and support had not signed their care plan agreeing to the care and support that they received. However, people that we spoke with confirmed that care and support was always provided with their permission.

Care staff we spoke with were able to explain their understanding of safeguarding and the actions that they would take if they suspected abuse to be taking place. However, the registered manager was unclear about the actions to take where an allegation of abuse had been made. This included reporting concerns to the local authority or to the CQC.

The registered manager was unable to provide any evidence that care staff had received an induction prior to commencing employment or training in any of the topics such as moving and handling, first aid, safeguarding or medicines administration. The provider could therefore not provide the assurance that staff had the necessary skills to care for people safely.

The registered manager followed certain safe processes when recruiting care staff. Criminal record checks, identity and visa checks had been completed. However, the registered manager did not obtain written references which confirmed conduct in previous employment and why their previous employment had ended.

People and the one relative we spoke with were happy with the care and support that they received. Care staff knew the people they were supporting and carried out their duties while showing respect and maintaining their dignity and privacy.

Care staff we spoke with told us that they felt supported by the registered manager and had regular supervision with her. However, these were not recorded. The registered manager told us that she regularly met with all care staff and completed observations of care practices but did not record these.

A medicines management policy was available which care staff had access to. Medicines administration was managed safely and appropriate arrangements were in place in relation to the recording and administration of medicines. However, care staff that we spoke with confirmed that they had not received any training in medicines administration.

The provider had a complaints policy which gave people direction on who to contact if they had an issue or concern to raise. However, records were not kept of any complaint or concern that had been raised. There were no records of what action had been taken and the outcome of the complaints’ investigations.

There was no available quality assurance processes in place to ensure that internal systems and processes were checked in order to highlight issues and concerns so that the service could continuously learn and improve practises. People had not been asked to take part in a survey or feedback had not been obtained about the quality of the care and support that they received.

At this inspection we found breaches of Regulation 12, 17, 18, and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to people receiving safe care and treatment, the provider having effective governance systems, training of staff and recruitment checks on staff. You can see what action we told the provider to take at the back of the full version of the report.