Guardian Home Care is a domiciliary care agency, at the time of our assessment they were supporting approximately 122 people with a regulated activity of personal care. The assessment took place from the 25 April to 13 May 2024. The assessment was completed to follow up on the last inspection to see if improvements had been made. We found improvements had been made to the management of medicines and governance arrangements and the service was no longer in breach of the regulations.
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Guardian Homecare (Basildon) was rated Requires Improvement overall following a March 2023 inspection, with breaches of Regulation 12 (medicines management) and Regulation 17 (good governance) identified. Key failures included unsafe medicines storage and administration, ineffective call monitoring audits, and 25% of care visits lasting less than half their agreed duration.
Concerns (8)
criticalMedication management: “Medicines were not stored securely. Medicines were kept unlocked, in a kitchen cupboard.”
criticalMedication management: “A PRN medication had been administered frequently. This was not in line with the prescriber's instructions, placing the person at potential risk of harm.”
criticalGovernance: “Call time audits did not identify the shortfalls we identified at this inspection. The current system was unable to identify the shortfalls identified at this inspection.”
moderateMedication management: “gaps were identified on the MAR chart and staff were unable to clarify why there were gaps.”
moderateMissed or late visits: “Our analysis identified 25% of people's care visits lasted less than half the agreed duration. There were 186 pairs of calls where staff had logged in at 2 locations simultaneously.”
moderateRecord keeping: “People's medicines records were not always collected regularly from people's homes and this meant the management team were not able to review them.”
moderateCommunication with families: “Not all people or those acting on their behalf felt the service's communication arrangements were effective. One person told us, 'I would give them a 5/10.'”
minorRecord keeping: “a daily catheter care record for one person was not in place.”
Strengths
· Staff understood how to protect people from poor care and abuse and knew how to recognise and report concerns.
· Staff supported people to make decisions and communicated with people in ways that met their needs.
· Risk assessments were reviewed and remained up to date to meet people's needs and reduce risks.
· The service managed incidents well; lessons learned were shared at team meetings and used to improve care.
· Safe and effective recruitment procedures were followed with all relevant pre-employment checks completed.
Quality-Statement breakdown (9)
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement
well-led: How the provider understands and acts on the duty of candour; Promoting a positive cultureGood
well-led: Continuous learning and improving care; Working in partnership with othersGood