Heart of Gold Homecare Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained the same. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 always make sure people’s care and treatment were effective because some risk assessments for people’s conditions were not included. However, risk assessments were reviewed regularly and contained a good level of detail.

People did not always have risk assessments for the main conditions they presented with. For one person, they had been diagnosed with hypertension and had a history of strokes, but no risk assessments had been completed in relation to these conditions. Following this being raised within formal feedback, the registered manager provided copies of these risk assessments.

People’s risk assessments were completed by staff who had the appropriate competencies to do so.

The risk assessments which had been completed were comprehensive and person centred. The assessments incorporated information from families and others.

People’s goals, routines and outcomes were captured in their care plans. Communication needs were identified and supported.

Staff knew people’s needs well, had access to the care plans and risk assessments and used these to guide care.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff’s understanding of the main conditions they were supporting was mixed. Some had in depth knowledge of the symptoms associated with disorders such as autism, learning disabilities and dementia, however other staff had a very basic understanding.

The provider’s policies were not always fully completed with various appearing to be incomplete templates. This meant staff did not always have access to full details within policies. Some of the policies and procedures needed reviewing by the registered manager. For example, the training policy did not indicate how frequently in house training should be completed, nor did it specify the requirements for each staff role in relation to training levels. The spot check policy indicated that 4 checks needed to be completed a year which the registered manager confirmed was incorrect.

As mentioned under the safe and effective staffing quality statement, competency checks were being completed but not by a competent professional. In addition to this, staff had access to online and face to face training but there were some inconsistencies with training.

People’s dietary requirements were mainly being met. However, we did identify in entries for one person that they were being provided with foods which were not consistent with what had been suggested by the specialist service. This could be due to the staff not documenting the adaptations made to the food or them not making the appropriate adaptations. Some information in people’s care plans was contradictory regarding eating and drinking; for example, a person’s care plan stated they were able to eat independently, without the need for physical assistance, but then under the title, “What I need help with”, it stated their relatives fed them.

The registered manager told us they had alerts from organisations which told them about any new guidance, best practice or legislation.

The provider did not always work well across teams and services to support people.

The registered manager told us they had limited contact with other services, but people were supported by different teams such as district nurses. The delegated healthcare activities guiding principles for health and social care in England, produced by the Department of Health, outlines the importance of a collaborative approach being taken to reviewing care plans for people with complex needs such as a PEG tube but we did not see evidence of this. The care plan and risk assessment provided details of professionals involved with the person but the details for the district nurses were incorrect for the people that we checked. We have signposted the registered manager to the appropriate guidance for them to read and act on.

The staff, mainly, supported people in line with recommendations made by other services including teams such as the speech and language team and district nurses.

Staff told us they had good working relationships with one another and with other services.

People did not raise concerns about how the team worked together or how they worked with other professionals.

We received very limited feedback from external organisations regarding their working relationship with the provider, despite them being contacted.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were empowered and supported to manage their own health, care and wellbeing needs as much as possible by staff who understood their needs and preferences.

People were involved in regularly reviewing their health and wellbeing needs via care plan reviews where appropriate and necessary.

Staff told us they encouraged and supported people to make healthier choices to maintain their health and wellbeing.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

We saw limited evidence of audits being completed which monitored people’s care and treatment. We were told people’s daily notes were reviewed as part of an audit but did not receive evidence of this.

The results of monitoring were not always used effectively to improve quality. The provider had a quality assurance audit which was broken down into the CQC’s 5 key questions of safe, effective, caring, responsive and well led. It reviewed various aspects of care including whether care was being delivered according to individual needs and preferences, whether staff treated people with kindness and respect and whether there were sufficient levels of staff to meet people’s needs. The audit showed all these measures were being achieved consistently but we were unsure how the provider had come to such conclusions. We discussed this with the registered manager and requested the data which had led to the conclusions to be sent to us, but we did not receive these. In the feedback call the registered manager said they were going to make improvements to this document.

People had outlined their desired outcomes within their support plans which were detailed and person centred. However, from the documentation we received and reviewed, we were unsure how such outcomes were followed up on.

People and relatives told us they were achieving positive outcomes under the care of provider.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The registered manager informed us the provider was not currently supporting anyone on a community deprivation of liberty safeguards (DoLS).

People and their relatives told us staff respected their rights around consent when delivering care. A relative said, “The carers never do anything without checking with me first.”

Staff had completed training on the mental capacity act and DoLS, but their understanding of the key principles were varied.

The provider had appropriate media publications consent forms in place which had been signed and dated by people.