Graceful Care received a Good rating across all five key questions at this March 2020 inspection, maintaining its previous rating from 2017. Minor gaps were identified in annual medicines competency testing, end-of-life care planning, and one instance of an unrecorded mental capacity assessment, all of which the provider acted to address.
Concerns (4)
moderate
Consent / capacity
: “The provider had not assessed the person's mental capacity or recorded they still considered the ongoing care plan was in the person's best interests.”
minorMedication management: “Medicines were generally managed safely but annual medicines competency testing was not in place.”
minorEnd-of-life care: “The provider did not have any records of people's end of life wishes. This meant people's wishes and preferences for care at the end of their lives were not always known.”
minorCare planning: “Protected characteristics under the Equalities Act 2010 were identified and recorded in people's care plans...the quality of the information varied from detailed information to, '[Person] had no cultural or religious needs.'”
Strengths
· Safeguarding systems and processes were robust, with up-to-date staff training and appropriate referrals to local authority and CQC.
· Staff provided consistent, person-centred care, with rotas ensuring continuity and people matched with carers who spoke their language.
· An in-house trainer was employed since the last inspection, reducing complaints and improving staff competency.
· The registered manager was described as hands-on, available and responsive by people, relatives and staff.
· Comprehensive audits and quality assurance systems including spot checks, MAR audits, and colour-coded training renewal monitoring were in place.
Graceful Care received an overall rating of Requires Improvement at its first CQC inspection, with four regulatory breaches identified covering safeguarding, safe care and treatment, consent, and good governance. Strengths were noted in caring and responsive practice, with staff praised for kindness and consistency, but significant failings in MCA compliance, individual risk assessment, incident investigation, and governance analysis undermined the safety and effectiveness of the service.
Concerns (8)
criticalSafeguarding: “The service did not inform the Care Quality Commission (CQC) of the safeguarding alert as they were required to do. This was a breach of Regulation 13.”
criticalCare planning: “There was a lack of individual risk assessments. One file indicated the person had particular needs which could be a potential risk to others...but there were no individual risk assessments.”
criticalConsent / capacity: “Family members had signed on behalf of their relatives but there was no clear indication of why the person who used the service was unable to sign the care plan.”
criticalGovernance: “The provider did not always record outcomes or analyse service information such as complaints or feedback from surveys. This was a breach of Regulation 17.”
moderateIncident learning: “Incident and action taken were described but there was no record of the follow up or analysis of trends recorded to improve future service delivery.”
moderateStaff competency: “The MCA was not included in training, which meant staff, including the registered manager, did not have a good understanding of the MCA.”
moderateRecord keeping: “Care records and staff files lacked audits to ensure files contained evidence that systems were being followed to improve service delivery and keep people safe.”
minorSupervision / appraisal: “We saw evidence of supervision taking place but not four times a year as indicated by the service's supervision policy.”
Strengths
· Care workers were described as kind, caring and consistent, with people and relatives expressing high satisfaction with the support received.
· Sufficient staffing levels with consistent care worker allocation, providing continuity of care and enabling people to build relationships with staff.
· Effective complaints procedure with 24-hour initial response, and evidence of complaints being recorded and investigated.
· Good working relationships with external healthcare professionals including GPs, district nurses, occupational therapists and social workers.
· Person-centred support including cultural and language matching of care workers to people using the service.
Quality-Statement breakdown (16)
safe: Safeguarding procedures and incident investigationRequires improvement
safe: Individual risk assessment and risk managementRequires improvement
Graceful Care achieved a Good rating across all five key questions following a previous inspection that identified regulatory breaches in safeguarding, consent, safe care and governance. The provider demonstrated sustained improvements in all areas, with well-embedded safeguarding, risk assessment, MCA compliance and governance systems, and strong person-centred practice.
Concerns (2)
minorMissed or late visits: “"The weekend one she has been an hour late", "Sometimes they might be a little late but nine out of ten times they're just right"”
minorComplaints handling: “some people did not always feel their concerns were adequately addressed”
Strengths
· Safeguarding policies and procedures updated since previous inspection; all care workers trained to identify abuse types and escalation routes.
· Comprehensive individual risk assessments in place covering falls, medicines, personal safety, environment and moving and handling.
· Safe recruitment procedures followed including references, identity checks, DBS checks and probation reviews.
· Care workers supported through induction, quarterly supervisions and annual appraisals; four staff undertaking Care Certificate.
· MCA principles embedded: consent forms, capacity assessments and best interests decisions documented in care files.
caring: Kindness, compassion and relationship qualityGood
caring: Privacy, dignity and involvement in careGood
responsive: Care planning and reviewGood
responsive: Complaints handlingGood
responsive: Cultural competency and language matchingGood
well-led: Quality monitoring and governance systemsRequires improvement
well-led: Leadership accessibility and staff supportGood
well-led: MCA understanding at leadership levelRequires improvement