Date of Inspection:22 January 2025 to 25 February 2025. The service is a domiciliary care and supported living service providing the regulated activity of personal care. This inspection was in response to CQC receiving information of concern. The inspection was prompted in part by information of an incident following which a service user was at risk of financial abuse. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. Systems in place to report and investigate safeguarding concerns were not always effective. Concerns relating to abuse were not always reported. Systems were in place to identify and manage risks to people. However, these systems were not always effective, and interventions did not always result in positive outcomes. There was a range of checks and audits to monitor the quality and safety of the service and to help drive improvements. These included checks on risks to people, care plan reviews, spot checks and medicines. However, these systems were not always effective. Audits failed to identify our concerns relating to safeguarding, notifications and risks to people’s care and support. The provider did not always notify CQC of reportable events. A notification is information about important events which the provider is required to send us by law . These are breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17 Good governance and the Care Quality Commission (Registration) Regulations 2009: Regulation 18 Medicines were managed well, and people received their medicine as prescribed. Staff were suitably employed and trained and had access to further training when required. Staff spoke positively about the management at the service and told us they felt supported.
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Gain Healthcare Ltd improved from Requires Improvement to Good overall, demonstrating progress in safe medication management, recruitment, and personalised care. However, the Well-Led domain remains Requires Improvement due to a failure to identify and act on unlawful deprivation of liberty without Court of Protection authorisation.
Concerns (3)
criticalConsent / capacity: “People had been deprived of their liberty without the appropriate legal authorisations being sought from the Court of Protection.”
moderateGovernance: “Whilst this was not the immediate responsibility of the provider, they had not through their own systems, identified or taken action in response to this shortfall.”
minorCommunication with families: “The service did not always receive positive feedback from professionals in relation to partnership working and communication.”
Strengths
· Safe recruitment practices in place including DBS checks, documented interview notes and satisfactory evidence of staff conduct.
· Personalised support plans with up-to-date assessments, including use of IDDSI framework for swallowing difficulties.
· Electronic medicines administration records (eMAR) with real-time alerts ensured medicines were administered safely.
· Staff received appropriate induction, supervision and ongoing training including MCA and safeguarding.
· Positive behaviour support (PBS) plans and least restrictive practice embedded in the model of care.
Gain Healthcare Ltd was rated Requires Improvement overall, with breaches of Regulations 12, 17 and 19 due to inadequate risk assessment, unsafe medicines management, inaccurate records, poor recruitment checks and weak governance. CQC served warning notices on Regulations 12 and 17, although staff were found to be kind, caring and respectful of people's dignity.
Concerns (14)
criticalMissed or late visits: “Staff are often late, and visits can be rushed. [Person's] visits should be 45 minutes long, however, very often staff will rush off after 10 to 15 minutes”
criticalMedication management: “Medicines were not consistently managed safely... I do [person's] medicines now, because the carers don't always come on time to do this.”
criticalCare planning: “Records held conflicting information and did not always reflect current best practice of care planning. This meant people were at risk of not receiving the care and support they required.”
criticalRecord keeping: “The provider had failed to ensure there were accurate and complete records in respect of each person, to evidence the care and treatment provided to them was in line with their assessed needs.”
criticalGovernance: “The provider's systems and processes had not been effective in assessing, monitoring and mitigating risks to the health, safety and welfare of people using the service.”
criticalSafeguarding: “we were not assured that the registered manager understood what concerns should be shared with the appropriate bodies... The registered manager stated they had not considered this.”
criticalOther: “Recruitment procedures were not always operated effectively to ensure staff employed were of good character or suitable for the role.”
moderateStaff competency: “concerns had been raised by a health professional about a member of care staff administering medicines they had not been deemed competent to do so safely.”
moderateInfection control: “staff told us that at times they were short of gloves for personal care tasks... one relative that staff did not always use the correct personal protective equipment (PPE).”
moderateEnd-of-life care: “The service supported people during the end of their lives, however, people did not have end of life plans in place which considered their wishes and preferences.”
moderateComplaints handling: “Two relatives said they experienced late calls and raised a complaint about this, although there was no record of this on the complaints log we were provided with.”
moderatePerson-centred care: “Care plans were not personalised. We looked at five care plans and found the wording was the same in certain sections of care plans.”
minorCommunication with families: “Some relatives felt that their family members sometimes struggled to understand care staff accents and felt this caused a barrier with having to explain certain things.”
minorConsent / capacity: “We did not see that people, or their legal representatives, had always signed to consent they agreed with how support and care would be provided to them.”
Strengths
· Relatives told us they felt their family members were provided with safe care and that staff were kind, caring and patient.
· Staff showed a good awareness of people's needs and how to support them with kindness, treating people as individuals.
· Privacy and dignity was respected; staff close curtains/doors during personal care.
· Staff supported and encouraged people's independence.
· Staff had completed the Care Certificate and MCA training and demonstrated understanding of their duties.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experience
Requires improvement
effective: Staff working with other agencies; supporting people to live healthier lives, access healthcare services and supportRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their care; respecting and promoting privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferences; End of life care and supportRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Working in partnership with othersNot rated