Golden Keys Care Agency 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 Good. At this assessment the rating has changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.The service was in breach of legal regulation in relation people giving their consent to receive care and support.

This service scored 54 (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 ensure people's care and treatment was effective because assessments and care planning records were not consistently accurate or up to date. Assessment and care planning systems were not always robust enough to ensure information remained reflective of people's current circumstances. We found examples of contradictory information about people's levels of independence, support needs and current care arrangements. Records also contained inconsistent review dates, and changes in people's needs had not always been reflected across all relevant care planning documentation in a timely way. This increased the risk that staff may not always have access to accurate information about how people wished to be supported. Managers recognised improvements were needed and told us they were reviewing people's care plans.

Despite these concerns, leaders told us no one was accepted into the service without a pre-assessment. Assessments considered people's needs, risks, capacity and the skills required to support them safely. Managers described how people were matched with staff who had the appropriate skills and competencies to meet their individual needs. Care plans were reviewed at least every six months and when people's needs changed. For example, staffing levels were increased when a person's needs became more complex, and care plans were updated when people were no longer able to undertake aspects of their care independently. Care records generally contained information about people's health conditions, support needs and associated risks.

The provider did not always ensure care and treatment reflected recognised good practice and specialist advice. Care records did not consistently demonstrate that professional recommendations had been fully incorporated into care planning or care delivery. We found limited guidance for staff relating to swallowing difficulties, diabetes management and other complex health conditions. Clinical information was not always consistent across records, and some care plans lacked sufficiently detailed instructions for escalation, monitoring and risk management. This reduced assurance that staff always had access to accurate and up-to-date information to support people in line with current best practice and specialist guidance.

Despite these concerns, the service worked with a range of healthcare professionals, including GPs, district nurses, occupational therapists, speech and language therapists, and social workers. Managers told us policies and procedures were maintained through an external governance system and updated automatically. People and relatives described staff recognising changes in health needs and seeking appropriate support when required. One relative told us, "Staff identified a rash and escalated concerns promptly.” Another said their family member's health had improved, and hospital admissions had reduced since receiving support from the service.

The provider worked collaboratively with other professionals and services to support people's health and wellbeing.

Managers described positive working relationships with district nurses, GPs, occupational therapists, social workers and local authority teams. Staff sought advice and support when people's healthcare needs changed, or concerns were identified regarding their wellbeing. Examples included working with district nurses to manage skin integrity concerns, involving occupational therapists in moving and handling assessments and liaising with social workers where self-neglect or capacity concerns had been identified.

Care records demonstrated regular involvement from a range of health and social care professionals. However, records did not always consistently document the outcomes of professional reviews or clearly record how recommendations had been incorporated into care planning. Managers acknowledged further work was needed to strengthen record keeping and assured us they would be taking immediate action to address the shortfalls we had identified. Overall, there was evidence staff worked effectively with external professionals to support people's health, safety and wellbeing.

The provider did not always support people to maintain their health and wellbeing because healthcare needs and specialist advice were not consistently reflected in care planning. Records did not always show how professional recommendations had been implemented and contained limited guidance on managing swallowing difficulties, diabetes and other complex health needs. Monitoring requirements, signs of deterioration and when to seek professional support were not always clearly documented. Managers also acknowledged oral healthcare had not been sufficiently considered and were arranging additional training. These issues reduced assurance that people consistently received care in line with their healthcare needs.

Despite this, staff supported people to access healthcare services and responded appropriately to changes in their health. Staff attended appointments, liaised with healthcare professionals and escalated concerns when required. Leaders and staff described positive relationships with healthcare services and sought professional advice when needed.

Records evidenced support with nutrition, hydration, mobility, personal care and skin integrity. Staff understood the importance of recognising changes in people's health, and relatives gave positive examples of staff identifying concerns and acting promptly. One relative said their family member's health had improved, and hospital admissions had reduced since receiving support from the service.

The provider did not always effectively monitor people's care and treatment to improve outcomes. Records did not consistently demonstrate how outcomes were assessed, monitored or reviewed. Care plans often contained broad, non-measurable outcomes, and records did not clearly show whether people were achieving their goals or benefiting from the support provided. Daily notes were frequently task-focused and repetitive, recording care delivered rather than its impact on people's wellbeing, progress or quality of life. As a result, leaders could not always demonstrate that care was achieving positive outcomes or use information consistently to identify, monitor and drive improvement. These issues reduced assurance that people consistently received care that met their needs and reflected wider governance and oversight concerns.

Leaders gathered feedback through reviews, surveys and regular contact with people and their relatives. Managers completed audits, spot checks and other quality assurance activities and reviewed incidents, complaints and safeguarding concerns to identify learning opportunities. However, these systems were not always effective in evidencing outcomes or ensuring improvements were embedded in practice, meaning people's experiences and outcomes were not consistently monitored or improved.

The provider did not consistently ensure records relating to consent and decision-making were complete or maintained in accordance with legal requirements. Care records did not consistently demonstrate that consent had been obtained or that decisions had been made in line with the Mental Capacity Act 2005 (MCA). Multiple care plans contained blank mental capacity assessments, best interest decisions outcomes and consent sections, including for people living with dementia or cognitive impairment.

Of the records reviewed, none contained documented consent to care and there was limited evidence that decision-specific capacity assessments or best interest decisions had been completed where required. As a result, the provider could not demonstrate that valid consent had been obtained for care and treatment or that decisions had been made in accordance with the MCA where people may have lacked capacity. Leaders acknowledged improvements were needed, and governance systems had failed to identify these concerns.

Despite these shortcomings, staff and managers demonstrated an understanding of consent and the principles of the MCA. Leaders told us staff received training and understood people had the right to refuse care and make unwise decisions. Managers described supporting people to make their own decisions while managing associated risks and seeking input from social workers and advocates when required.

People and relatives told us staff sought consent before providing support. One person said, “Yes, they always ask my permission.” A relative also described hearing staff check with their family member before providing care.