Date of assessment 08 January to 15 January 2025.Generations Care Ltd is a domiciliary care agency which provides personal care to people in their own homes. The service provides support to older people and younger adults with a range of needs. This includes people with physical disabilities. At the time of our inspection the service was providing the regulated activity personal care to approximately 160 people. The last rating for this service was requires improvement (published 25 November 2022), with a breach of regulation. The provider was required to send us an action plan telling us how they would improve and by when. We undertook this assessment to check they had followed their action plan and to confirm they now met legal requirements. At this assessment not enough improvement had been made and the provider remained in breach of regulation 17 (Good Governance). The provider did not always operate effective quality assurance systems and processes to provide effective oversight of the quality and safety of the service. More robust systems needed to be implemented and improved oversight maintained when audits and checks were delegated to staff within the service. The overall rating for the service has remained requires improvement. The service has now been rated requires improvement for the last 4 consecutive inspections. However, some improvements had been made. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.
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Generations Care Ltd received an overall rating of Requires Improvement at this focused inspection, remaining in breach of Regulation 17 (Good Governance) for the third consecutive inspection due to ineffective oversight systems failing to identify care record deficiencies and safety risks. Responsive care improved to Good, with personalised care delivery and complaint handling strengthened since the previous inspection.
Concerns (6)
criticalGovernance: “The provider remained in breach of regulation 17. The provider had failed to fully meet the warning notice we issued at the last inspection.”
criticalRecord keeping: “A person's allergy was still not documented on their medication risk assessment despite this being raised at our last inspection.”
criticalCare planning: “Checks of care records had failed to identify staff were not always measuring and recording urine output as instructed within people's catheter risk assessments.”
moderateMedication management: “Some care records did not clearly record when non-prescribed topical creams had been applied or contained guidance for staff to ensure they knew when and how often to apply the creams.”
moderateIncident learning: “The management team had completed audits and looked at incidents, however there was no evidence that learning, or themes were taken from this to improve the quality of care provided.”
moderateCare planning: “Risk assessments were not being reviewed regularly. A medication risk assessment had not been reviewed for over 25 months.”
Strengths
· People received their medicine as prescribed and staff completed training and competency assessments to administer medicines safely.
· Complaints were managed in line with provider policy with improved responsiveness since the last inspection.
· People received personalised care with choices and preferences respected, including gender preference for carers.
· Staff were recruited safely with references and DBS checks completed.
· Staff received safeguarding training and understood their responsibilities to report concerns.
Quality-Statement breakdown (7)
safe: Assessing risk, safety monitoring and management; Using medicines safely; Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
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: Engaging and involving people using the service, the public and staff; Promoting a positive cultureGood
Generations Care Ltd was rated Requires Improvement following a focused inspection that identified breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance), resulting in warning notices. Key concerns included unsafe medicines management, inadequate risk assessments, missed call monitoring, ineffective audits, and poor complaints handling.
Concerns (12)
criticalMedication management: “one person did not receive their prescribed, Morphine Sulphate for two consecutive days”
criticalMedication management: “person's medication risk assessment failed to include their allergy to penicillin, placing them at risk of potential harm”
criticalRecord keeping: “one person's records stated the wrong name of their medical condition and did not include the symptoms staff needed to respond to in a medical emergency”
criticalGovernance: “Systems were not established or operated effectively to assess, monitor and improve the quality and safety of the service.”
moderateCare planning: “Some care plans and risk assessments lacked detailed guidance to inform staff how to support people safely.”
moderateInfection control: “provider had not completed risk assessments for people or staff that were more susceptible to the risk of infection during COVID-19”
moderateMissed or late visits: “provider did not have a robust system in place to monitor the time staff arrived and left people's homes, or to ensure people had received their planned care”
moderateIncident learning: “Lessons had not always been learnt and opportunities to make improvements had been missed.”
moderateComplaints handling: “complaints were not always managed, in line with the provider's policy. As, not all complainants received a written response”
moderatePerson-centred care: “Some people told us, they did not receive care at the time, they wished or by a staff member, of their preferred gender.”
moderateCommunication with families: “some people told us, they didn't feel listened to, as nothing changed in relation to their call times, consistency of staff and tasks not completed”
minorEnd-of-life care: “One person did not have a personalised end of life care plan in place, or guidance for staff to follow, as their health deteriorated.”
Strengths
· People felt safe with staff and reported positive relationships with carers
· Staff were recruited safely with pre-employment checks completed
· Staff had received safeguarding training and understood their reporting responsibilities
· Staff felt supported by the management team through individual and team meetings
· Service worked closely with GPs and district nurses for end of life care
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and management; Using medicines safely; Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportRequires improvement
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responsive:
Good
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: Engaging and involving people using the service, the public and staff; Promoting a positive culture; Duty of candourRequires improvement