Background to this inspection
Updated
13 April 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 3 inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
This service also provides care and support to people living in a 'supported living setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.
Registered Manager
The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was announced. We gave notice of the inspection because some of the people using the service could not consent to a home visit from an inspector. This meant that we had to arrange for a 'best interests' decision about this. We also needed to be sure the registered manager would be in the office to support the inspection.
Inspection activity started on 17 March 2023 and ended on 23 March 2023. We visited the office location on 21 March 2023, and we visited people on 22 March 2023.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We visited 2 houses and met with 5 people who used the service to get their feedback about the care provided.
We had contact with 2 relatives and 8 people for feedback about the service. During the office visit we met with the regional manager, the service improvements officer, and the learning disability manager. We also spoke to 5 members of staff. The registered manager was unavailable for the inspection. We reviewed a range of records. This included 7 people's care records and selected medicines records. We looked at 5 staff files in relation to training and supervision and a variety of records relating to the management of the service.
Updated
13 April 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Guardian Homecare is a domiciliary care service providing personal care to people who live in their own houses and flats. At the time of our inspection, people were being supported by the service. 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 also provides care and support to people living in a supported living setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at personal care and support. Support is primarily provided to people with learning disabilities and autistic people. People live in shared houses.
People's experience of using this service and what we found
The provider was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right Support
Staff did not always support people with their medicines in a way that promoted their independence.
People were supported to make decisions and staff communicated with people in ways that met their needs. Staff supported people to play an active role in maintaining their own health and wellbeing.
Right Care
Staff understood how to protect people from poor care and abuse and how to recognise and report any concerns.
Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right Culture
The provider did not have effective systems in place to monitor the quality and safety of the service. For example, we found concerns with the provider's oversight of call times and medicines management.
Not all staff had felt valued and supported but this was improving following the involvement of the provider at the service.
People and those important to them, were involved in planning their care; however, we received some mixed feedback about how well the provider communicated with others.
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 March 2018).
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support, right care and right culture.
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 good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
Enforcement and recommendations
We have identified breaches in relation to medicines management 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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we inspect next.