Gold Care Services Ltd

About the service

Gold Care Services is a supported living service providing personal care to 11 at the time of the inspection. The service can support up to 16 people.

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

Right Support: 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. Staff supported people by promoting their independence through various activities and day to day tasks.

Right Care: People received person-centred care and staff respected people’s privacy and human rights. We saw many examples of people making decisions in relation to their care and relatives making decisions, where appropriate.

Right Culture: Improvement has been noted since the last inspection. The culture within the service showed people felt involved with the running of their homes and staff encouraged people to make decisions. Through various meetings, records and through observations we saw staff include people in the general day to day of the home. People appeared more confident and happier with the service.

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 04 March 2022).

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.

Why we inspected

We undertook this inspection to review potential improvements made at the service. We received information that improvement had been made in relation to the safe and well-led key questions. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gold Care Services 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.

Gold Care Services provides personal care for people who live in supported living accommodation. The people who use the service have a range of needs including learning disabilities and autism with some people requiring one to one support. At the time of our inspection 13 people were using the service living in three separate supported living settings. People rented a room from a private landlord and used shared facilities such as kitchens, living rooms and bathrooms.

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

Quality audits had been introduced, however, they needed to be completely embedded in the service to be effective in all areas. Some areas were still being improved such as end of life care plans and people’s life histories.

There was mixed feedback about staffing levels. Some people told us there were enough staff, whilst others said that at times staff could be rushed in their day to day tasks. We observed staff did not appear rushed and staffing levels were in line with rotas to meet the care needs of the people using the service.

There was improved oversight of the service as a whole by the registered manager, and people told us they felt listened to. Staff also felt that they could raise any ideas or concerns through regular staff meetings. The registered manager and the general manager had worked well with health and social care professionals since the last inspection.

People were kept safe from the risk of harm. People had individual risk assessments that provided guidance and advice for staff. Medicines were managed well and had improved since the last inspection. Infection prevention control (IPC) procedures were being followed by staff in line with government guidance. Accidents and incidents analysis had been introduced to ensure the risk was minimised of future incidents.

People were supported with food and drink and had assessments in care plans. Staff received adequate training and induction processes. The management team were working with social care professionals to ensure capacity assessments were being completed correctly.

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.

People told us they were supported by kind and caring staff. Staff supported people in a compassionate manner and encouraged people’s independence. People had access to activities they enjoyed and staff supported them to maintain important relationships.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: The model of care for the provider and supported living settings promotes independence and the management team had improved staff member’s approaches to giving people choice.

Right care: Improvements had been made to the person-centred detail in people’s care plans. Preferences and life histories had been introduced and were in the process of being embedded in the day to day running of the service.

Right culture: The management team of the home had completed extensive training to begin to implement new values into the staff approach and the general morale within the staffing team had improved. This had a positive effect on people being supported and feeling included, for example, some people were empowered with more responsibilities in the accommodation which had a positive effect on people’s overall confidence with approaching tasks.

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 inadequate (published 05 July 2021) and there were breaches of regulation. The provider had additional conditions added to their registration to comply with. At the time of the inspection the provider was compliant with the conditions and had made improvements. The provider was no longer in breach of some of the previously identified regulations. However, some improvement was still required.

This service has been in Special Measures since 08 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gold Care Services is a supported living service providing personal care to 13 people aged 18 and over at the time of the inspection. The people receiving support had a learning disability and/or Autism. The service supported people in three supported living homes in South London and Surrey.

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

Risks to people were not always assessed and managed correctly. Accidents and incidents were not analysed to ensure trends and themes were identified.

People were not consistently supported with medicines in a safe way. Infection control measures had not always been implemented effectively and government guidance in response to the COVID-19 pandemic was not always followed.

Staff had not always been trained in relevant areas to make them effective in their roles. Some staff told us they did not always feel supported by the registered manager.

Management of the service was unclear as to who was responsible for oversight of each of the supported living homes. This had impacted the effectiveness of quality audits and made areas for improvement difficult to identify.

CQC and the local authority had not been made aware of significant incidents and allegations that had been made within the service. Safeguarding protocols had not always been followed correctly and staff had inconsistent knowledge on how to report concerns.

Some people had restrictions in place that did not have clear documentation to confirm how lawful consent was obtained and how decisions were made in people’s best interests. People were not always supported to have maximum choice and control of their lives. Staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

People’s support needs were not always consistently recorded and risks to them were not always appropriately identified and assessed.

Right Care:

Care practises upheld and respected people’s dignity. We saw examples of caring interactions between staff and people that were being supported.

Right Culture:

The culture in the service was having a negative impact on the support that was being provided to people. Due to a breakdown in communication within the management team, appropriate oversight to ensure effective care was not evident.

The provider and the management team have acknowledged there was improvement to be made in the service and were working with the local authority to address concerns as quickly as possible. This was to ensure improvement were made to the quality of support people received.

People told us they felt supported and felt included and involved in the running of the service.

The registered manager followed safe recruitment processes and attempts had been made to continue staff appraisals and supervisions throughout the pandemic.

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 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan to make improvements and to confirm if they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, consent to care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Risk assessments in place were detailed and person centred. However, some people’s risk had not been identified. The provider did not always properly assess risks relating to the environment and people’s healthcare needs.

The service applied the principles and values of Registering the Right Support. This meant people who used the service were able to live as full a life as possible and achieve good outcomes that include control, choice and independence. However, some best practice and legislation around how people were supported in the least restrictive way possible and in their best interests had not been followed.

The provider did not have effective systems in place to monitor, assess and improve the service. The provider had not identified the issues we found during our inspection so had not made the necessary improvements to be compliant with the fundamental standards.

Staff knew how to keep people safe and used lots of different way to communicate with people to find out how they were feeling and what choices they wanted to make. Care records helped staff know what was important to people and how they wanted to be supported. Information was available for people in a way they could understand.

There were enough staff to keep people safe, staff received training to keep them up to date with their skills and knowledge and recruitment checks made sure staff were safe to support people.

Staff supported people to follow their interests in the community and at the service. They helped people keep in contact with their family and friends. During our inspection people were very active getting ready with staff to go out or making plans for their day.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 15 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full 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.

At this inspection we found the service continued to meet the regulations and fundamental standards and remained good.

The service had two registered managers in post. Each manager was responsible for their own designated supported living units, one manager covered two sites while the other managed one. 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.

People told us they felt safe living at Gold Care Services and staff knew how to protect people from the risk of harm. Staff were aware of each person’s individual safety both in the service and in the community and worked hard to minimise risk while still encouraging people’s independence.

Staff supported people to be as independent as they wanted to be and encouraged them to follow their own activities and interests.There were enough qualified and skilled staff at the service. Staffing was managed flexibly to suit people's needs so that people received their care and support when they needed it. Staff had access to the information, support and training they needed to do their jobs well.

Care records focused on the person and were updated according to any changes in people’s health and wellbeing. People were supported to have their health needs met. We saw that people’s prescribed medicines were being stored securely and managed safely.

Staff understood people’s individual needs and supported people with dignity and respect. People were involved in decisions about their care and were supported to be as independent as they could be with buying food and meal preparation.

The registered managers continued to provide good leadership. Staff felt supported and there was open communication. The provider had a number of audits and quality assurance systems to help them understand the quality of the care and support people received and look at ways to continually improve the service.

Further information is in the detailed findings below.

We used a number of different methods to help us understand the experiences of people using the service because some of the people who lived at this accommodation had complex needs. This meant they were not able to tell us their experiences. We spoke with the relatives of two people using the service who told us they were 'very pleased' and 'very happy' with the care their relatives received. We spoke with the registered manager and two staff members. One staff member told us 'I like it here, I wouldn't change a thing'.

During our inspection we saw staff always treated people with respect and dignity and people were supported to make informed decisions about how they lived their lives.

We saw that policies and procedures had been put in place to ensure the safety and wellbeing of people using the service and we saw evidence of a quality assurance system regularly monitored by the provider.

We spoke to the local authorities reviewing officer. They told us they had reviewed the placements of three people using the service. They told us the relatives of all of the people they reviewed indicated they were very happy with the support their family members received and felt they were able to approach staff if they had any concerns. All of the people who use the service had good daytime activities and staff were aware of people's individual needs.

We found that important information relating to the care and support needs for one person using the service was not readily available or accessible to staff. This could lead to this person receiving inappropriate care and support from staff.