About the service GAIN care is a domiciliary care agency. It provides personal care to adults living in their own homes, some of whom required end of life care. At the time of the inspection, the service was supporting 11 people.
People’s experience of using this service and what we found
People told us staff asked for their consent before supporting with care tasks. Some people could not give informed consent for some areas of their care, including for restrictions in place. People were supported to have maximum choice and control of their lives and we did not find evidence that these restrictions were not in people's best interests, however mental capacity assessments and best interest decisions were not always decision specific or did not always detail all relevant decisions. The policies and procedures in place were not being followed.
During this inspection, we reported safeguarding concerns to the local authority in relation to restrictions placed on people as part of their care because these were not clearly documented and assessed.
Recruitment was not always carried out in line with requirements and guidance.
Improvements were required in relation to how people’s medicines were recorded and staff’s competencies checks were evidenced. We have made a recommendation in relation to management of medication.
Quality assurance systems in place were proportional to the current size of the service however, some had a limited cover and these had not always been effective in identifying and driving the necessary improvements. We have made a recommendation about the implementation of effective audits.
The provider ensured staff followed safe infection control practices and had enough personal protective equipment (PPE).
Staff felt well supported by management. There was a system in place to ensure staff were inducted and shadowed other experienced members of staff. Staff received varied training; however, the specific training, meet the needs of people who might display behaviours that challenge others had not been completed.
People were supported by staff who were caring and respected their dignity and privacy.
There was a complaints system in place. People and relatives told us they were confident that if there was any concerns, they could contact the registered manager and they would act on their concerns.
Relatives and people knew the registered manager and told us they were approachable. The registered manager told us about their plans to develop 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
This service was registered with us on 21 October 2019 and this is the first inspection.
Why we inspected
This was a planned inspection.
We have found evidence that the provider needs to make improvement. 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.
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.
We have identified breaches in relation to consent and fit and proper persons employed at this inspection.
We made two recommendations for the provider to review good practice guidance in relation to the management of medicines and in relation to the implementation of effective quality assurance processes.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.