Gemcare South West Plymouth

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant people’s needs were not always met.

The provider was previously in breach of the legal regulation in relation to person centred care. Improvements were found at this assessment, and they were no longer in breach of this regulation.

This service scored 50 (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 received care that reflected their individual needs, risks and preferences, although some aspects of care have now improved.

People’s care plans included daily routines and some preferences, for example how they wished to be washed and supported at home. Records for people with complex needs, such as catheter care, diabetes, pressure relief and choking risks, were not always accurate or up to date and did not consistently show that assessed needs were being met.

People and relatives gave mixed feedback about whether staff consistently supported them in the way that suited them best; many valued regular carers who knew them well, but said other staff did not always follow routines that mattered to them. One relative told us some carers were “amazing” while others did not provide care as expected.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider aimed to provide continuous care, but staffing arrangements and rota planning still meant people did not reliably receive care in line with agreed visit times and planned staffing requirements. Electronic call monitoring showed most visits were delivered, but some people had frequent late calls, shortened visits and limited overlap between two carers where this was required for safe moving and handling.

Several people and relatives told us staff were often early or late and did not always stay for the full time, which affected personal care and medication.

Professionals and relatives said care could be well‑coordinated when regular carers attended and communication with district nurses and GPs was generally appropriate. Since the last assessment, there is some early evidence that rota management is starting to improve under the new manager.

The provider did not always give people and relatives clear, timely information about their care, visit times or how to raise concerns.

Some people told us they did not know exactly when staff would arrive, could not use or access the care app, and were not always informed when visits were changed. A relative told us, it was sometimes “murder trying to get through” to the office and that they were left unsure who would be coming. Some relatives told us information and communication had now improved over the last few weeks with the new manager in post, but this was not yet the experience of everyone using the service.

The management team told us, they could offer information in accessible formats to meet people’s communication needs if needed. Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says people should get the support they need in relation to communication.

The provider did not always listen to people and act on their feedback, although engagement has now started to improve.

People and relatives said they could raise concerns, but many felt these were not taken seriously or did not lead to change. One family told us they had reported worries about staff behaviour and visit timing “since last October,” but felt “no action” had been taken. Some people said they had not been asked recently for structured feedback.

We saw records of complaints and specific actions identified to address the complaint, however there was not always evidence action had been taken.

Staff told us they could now share concerns more openly in team meetings.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

The provider aimed to give people fair access to visits and support, but inconsistent rota planning and on‑call arrangements meant this was not always achieved in practice. Electronic data showed most visits were delivered within 15 minutes of the planned time, but a small number of people, often those needing two carers, experienced very late calls and a high number of short visits. Some people told us staff came “hours earlier” than planned or very late at night, which affected their daily routines.

The provider did not always make sure people had consistent experiences and outcomes, particularly where there were many different carers or complex health needs. Some people told us, staff knew them well and supported them to stay at home safely. Others described carers who arrived late, left early, or did not follow care plans, meaning medication, catheter care or repositioning was missed or not recorded.

Families of people with higher support needs told us they could not always plan their day because visit times changed or they did not know which staff would attend, and office communication had not always recognised the impact on them.

Care records and audits did not consistently show that the provider monitored outcomes for different groups of people, such as those who are cared for in bed, have a learning disability or are part of the LGBTQ+ community, to check they were experiencing equally good care.

People were supported to plan some important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw examples where treatment escalation plans and advance decisions had been discussed, and at the time of the assessment the service was not providing end of life care.

Some care plans recorded people’s wishes about resuscitation, staying at home and who they wanted involved in decisions, which helped guide staff and families. However, current records still varied in how clearly they set out longer‑term goals and contingency plans if family carers could no longer support. The new manager has begun to review care plans and introduce service improvement plans, but these actions are still at an early stage and need to be fully implemented and sustained.