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Inspection carried out on 25 July 2018

During a routine inspection

Gian Healthcare is a Domiciliary Care service registered to provide personal care and support to people who live in their own home, predominantly in the Stockport area of Greater Manchester.

We last inspected Gian Healthcare in April 2017 where the service was rated as Requires Improvement overall and in the Effective and Well-led key questions. This was due to breaches of regulation 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, due to concerns found relating to staff induction, supervision and quality monitoring systems.

This latest inspection took place on 25 July 2018. We gave the service 48 hours’ notice to ensure the registered manager would be in the office to facilitate the inspection. At the time of this inspection, four people were receiving domiciliary care support from Gian Healthcare, however only two were in receipt of a regulated activity which was personal care. Other people who used the service received support with domestic tasks such as cleaning and other household tasks.

We found appropriate action had been taken to address the concerns found at the inspection in April 2017.

There was a registered manager in post. 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.

The service had a robust recruitment process to help ensure people employed were suitable to work with vulnerable people.

Safeguarding policies and procedures were in place and the staff demonstrated a good understanding of safeguarding concerns and the process to follow if they suspected abuse had taken place.

Risk assessments were in place and support plans devised to mitigate any risks presented to people.

Appropriate systems were in place to manage people’s medication.

Staff told us they were well supported and were inducted in to the service and received ongoing training to support them to undertake their role. We found improvements had been made to the staff induction and supervisions processes which had been a concern at our previous inspection in April 2017.

The service was working within the legal requirements of the Mental Capacity Act (MCA) 2005 and staff displayed a good understanding in this area.

Appropriate systems were in place to ensure people received good nutrition and hydration and that specific diets were catered for such as for those people with diabetes.

The feedback we received was that staff were kind and caring towards people.

Each person who used the service had an appropriate care plan in place which provided person centred information about how they liked their care to be delivered.

There was a complaints policy in place and we saw any complaints had been responded to appropriately.

Each person who used the service had their own care plan in place which provided detailed information about the care and support they required from staff.

We received positive feedback about management and leadership. Systems and processes were in place to monitor the quality of service being delivered.

A range of policies and procedures were in place to ensure appropriate guidance could be sought when needed.

Inspection carried out on 6 April 2017

During a routine inspection

This was the first inspection of Gian Healthcare since they registered with the Care Quality Commission (CQC) on 10 April 2015.

This inspection took place on 6, 11 and 12 April 2017. The inspection was announced to ensure that the registered manager or other responsible person would be available to assist with the inspection visit.

Gian Healthcare is a Domiciliary Care service that is registered to provide personal care and support to people who live in their own home. At the time of this inspection there were no domiciliary care clients receiving a service. Since the service registered in April 2015 they had provided a service to two domiciliary care clients. However they were providing care staff to Manchester City Council (MCC) to cover shifts in their supported accommodation service which is owned by MCC.

When we visited the service there was a registered manager in post. 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.

During this inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staff induction, staff supervision and the lack of formal systems to assess and monitor the standard and quality of service delivered to people. The registered manager and the director were responsive to our feedback and told us they were committed to further improving the service delivered to people by Gian Healthcare.

We were told that newly employed staff undertook an induction process. However this process was not formally recorded so there was no evidence to support the statement.

We saw records that indicated not all staff had received regular supervision or that those staff employed over twelve months had received an annual appraisal to help make sure they were carrying out their duties safely and effectively.

Due to the shortfalls found during this inspection process the quality assurance processes needed to be further developed because the quality systems in place had not been robust enough to identify the issues found during this inspection.

The registered manager and the director understood their legal obligation to inform the Care Quality Commission of any reportable incidents that had occurred at the service.

There were no domiciliary clients at the time of the inspection which meant that we were unable to check and review if there were accurate recordings of medication administration. However we did see that staff had access to a medication administration policy and that medication administration training is included in the mandatory training, which we were told all staff must undertake prior to assisting anybody with their medication. We saw evidence of staff medication training and competency checks in staff files.

We were unable to check and review any support plans and risk assessments at the time of this inspection, as the service was not supporting any domiciliary care clients. Support plans and risk assessments direct staff members on how to provide safe care and support to people taking into account the person’s personal preferences and encouraging independence. We found that the service had appropriate systems and documentation templates in place to develop care and support plans and risk assessments when the service next provided a domiciliary care service.

Those staff we spoke with understood their responsibilities to protect the wellbeing of the people who used the service and were clear about the action they would take if an allegation of abuse was made to them or if they suspected that abuse had occurred.

The service had good recruitment processes to ensure only suitable staff were employed.

Staff spoke with were