Gogomadu Cares Nottingham Office

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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.

This is the first assessment for this service. This key question has been rated requires improvement. This meant people’s needs were not always met.

The provider was in breach of the legal regulation relating to safe care and treatment, good governance and fit and proper persons employed.

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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We found care records did not always provide direction to staff regarding how people wanted their care to be provided, what made them feel reassured or what gave cause for concern. Whilst verbal feedback indicated the person was involved in their care and reviews, this was not consistent and not clearly recorded in records. The person told us they felt able to advocate for themselves and knew how their care should be given. However, this was also not recorded in care plans or daily records. This meant opportunities to involve people in how their care and support was provided may be missed.

Daily records lacked detail regarding people’s personalised care. This meant staff visiting on subsequent visits did not have updates regarding the person’s well-being.

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.

Information in relation to people’s specific health and social care needs was not always recorded, was incorrect or it was difficult to understand why they needed support. Where health concerns were recorded, this did not always provide staff with guidance regarding how to support the person or identify signs of a deterioration in their health or well-being.

Daily records did not always highlight that staff followed up on concerns. For example, where staff recorded the person did not feel well, the next staff team who worked with the person did not record how the person was or if there had been any improvement or deterioration in their health. Where actions took place to support the person, information added gave limited detail and context. Against one action it recorded the person needed some help with a task but gave no information on what that help was. This demonstrated a lack of continuity and monitoring of people’s general health and well-being.

However, feedback from the person was positive that they had the same set of staff caring for them on rotation.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s care plans contained limited information regarding their communication needs or how information should be shared, which was not in line with the Accessible Information Standards. People’s communication plans did not consistently state how they preferred to receive information or identify who could advocate on their behalf if needed. Where people were unable to provide written communication, there was no clear guidance on how decisions or documents should be signed or who would do so. Records did not clearly identify what assistive technology was available, how it should be used, or what actions staff should take if it was unavailable. Care plans also lacked clear guidance on how staff should support people to access written or electronic information. This increased the risk that people may not be able to understand, consent to, or be meaningfully involved in decisions about their care, potentially undermining their independence, dignity, and safety.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider had a complaints policy and process in place which highlighted how people could raise a concern. However, there was no mention of how to make this available in other formats, no names on the policy for who the registered manager or service manager was or a clear process of how to progress complaints. The provider was unable to supply a complaints log which recorded all stages of a complaint as mentioned in their policy, to be reviewed each month by the service manager. This meant the service did not follow their own policy on how they would review complaints to ensure sustained changes and improvements and reduce the need for future complaints.

Records showed that whilst issues raised were responded to, there was limited follow-up to check people, or their relatives were happy with the outcome or that action taken had been effective. The service recorded complaints, which appeared to have been verbally reported. Lessons learnt or complaint outcomes were recorded against each complaint but not centrally recorded. The complaint forms had been signed by the same person who had signed the staff member box, which provided no evidence that the person who raised the complaint had been involved in finding a solution to the problem or been consulted about the outcome.

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

The person, their relative and professionals told us there were opportunities to further develop how the person was supported to engage in activities that were meaningful to them, beyond more routine home-based options. Some planned activities and outings were taking place; however, these were limited in range and frequency. There was limited clear information in care records on the frequency needed of health appointments such as the dentist and opticians, how these could be arranged, professional's details and when the appointments last occurred.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider did not proactively seek or act on information about groups at higher risk of inequality. Shortfalls identified meant the service did not consistently gather or respond to feedback which would highlight early signs of unequal experiences.

Care records did not always reflect people’s needs relating to their protected characteristics under the Equality Act 2010. Although some care records reflected information regarding the person’s race, ethnicity, and preferred language, they failed to contain detail with key characteristics, including people’s sexual orientation, religion, and disabilities. For example, the information was not clearly produced or the word ‘none’ or ‘I have nothing to express,’ were recorded in the care plan rather than meaningful information. This meant there was a risk the person’s needs in these areas may not be supported and opportunities to improve people’s outcomes and experiences may be missed.

Where the person was unable to do certain activities, it was not recorded how staff could support them to have reasonable adjustments. For example, where the person was unable to use a computer mouse, there was limited information about how the person could be supported to access computers and systems with support or with assistive technology. We also saw no evidence of referrals or actions taken to address this. This meant the provider could not be assured people received equitable experiences or outcomes.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life but this was not appropriately recorded to ensure they would be supported as they wished at the end of their life.

Information relating to future care wishes was recorded in different sections of care plans, with varying levels of detail, and differing information, which made it difficult to identify a clear and shared understanding of the person’s preferences. This increased the risk that people may not receive care that fully reflected their needs and wishes at the most critical time.