Gentle Hands Care Agency Ltd was rated Good overall at its January 2020 inspection, with all five key questions rated Good, representing an improvement in well-led from the previous Requires Improvement rating. Minor issues were identified around recording of incident learning outcomes, a missed CQC safeguarding notification, complaints trend oversight, and incomplete end-of-life care training, but none constituted regulatory breaches.
Concerns (4)
moderate
Safeguarding
: “We found one recent safeguarding concern that had not been notified to CQC, this was an oversight by the registered manager.”
minorIncident learning: “the outcome and learning were not always recorded from events, although the registered manager could tell us of the learning that had taken place.”
minorComplaints handling: “the final outcome was not always recorded in an accessible way, and there was no management oversight of trends.”
minorEnd-of-life care: “Staff had access to end of life care training but had not completed the training at the time of the inspection.”
Strengths
· Consistent staffing with long-serving care workers providing continuity of care for people
· Comprehensive, up-to-date and personalised care plans with one-page profiles
· Safe recruitment practices with all relevant checks and references obtained prior to start
· Medicines stored and administered safely with monthly stock checks and annual competency assessments
· Staff received regular supervision, spot checks, induction and refresher training including Care Certificate
Gentle Hands Care Agency Ltd was rated Good overall at its June 2017 inspection, having remediated four regulatory breaches identified in 2016 relating to risk assessments, person-centred care, training and governance. Well-led was rated Requires Improvement due to quality assurance systems still being embedded and a delay in prioritising remedial action on medication administration recording errors.
Concerns (5)
moderateMedication management: “staff had not signed to say medicines had been given, but had put the number of tablets given in the signature box. This meant that you could not always see who had given the medicines”
moderateGovernance: “the spread-sheets had not been updated to reflect this... the quality system was not entirely effective”
minorSupervision / appraisal: “when we looked at the team spread-sheet and randomly asked to see supervision records these had not always taken place”
minorRecord keeping: “care records were not always easy to access as the most recent information was not always the first documents you read and not all care records were accurately indexed”
minorComplaints handling: “Two family members told us they had not felt happy with the outcome of the complaint... the date at which the complaint was resolved was not always recorded”
Strengths
· All necessary employment checks were in place before staff started working with the service
· Risk assessments were in place, up to date and covered the majority of risks identified
· Staff understood safeguarding of vulnerable adults and children and knew how to whistle blow
· Supervision and training took place on a regular basis including practical courses for moving and handling and seizure management
· Staff were routinely rostered to work with the same people, promoting consistency and person-centred care
Gentle Hands Care Agency Ltd was rated Requires Improvement overall at its first inspection in June 2016, with four regulatory breaches identified covering risk assessments, care planning, staff training, and governance. The service demonstrated caring practice and responsive management relationships with families, but systemic failures in record-keeping, epilepsy training, and quality assurance processes placed people at risk of harm.
Concerns (7)
criticalSafeguarding: “one of the staff members we spoke with was unable to answer any questions we asked regarding the signs of abuse or what they would do about them in their role as carer”
criticalCare planning: “two out of six care plans that had not been updated since 2013...no guidance for staff in the care plan as to what duties to carry out”
criticalRecord keeping: “risk assessments did not include essential information on people's health and how to mitigate risks which meant people were at risk of harm”
criticalStaff training: “three out of 38 staff had been trained in dealing with epilepsy...the action they told us they would take if a person was having a seizure would be considered very unsafe”
moderateStaff competency: “no training to promote people's knowledge and awareness in working with someone with a learning disability...used language to describe a disability that was outdated and demeaning”
moderateGovernance: “the registered manager and deputy manager were not able at the time of the inspection to provide us with a list of outstanding work”
moderatePerson-centred care: “inspectors were also not confident that all staff understood how to facilitate meaningful activities with adults with a learning disability”
Strengths
· Relatives reported staff treated people with dignity and respect, closing doors during personal care and ensuring appropriate clothing choices
· Staff were aware of people's cultural and religious needs and were matched with service users from similar backgrounds where possible
· DBS checks and references were in place prior to staff starting work
· Staff received regular supervision and appraisals were conducted for those employed over 12 months
· All five complaints recorded had been dealt with appropriately
Quality-Statement breakdown (14)
safe: Safeguarding adults from abuseRequires improvement
safe: Risk assessments and safe care and treatment (Regulation 12)Requires improvement