Golden Keys Care Agency Ltd received an overall rating of Requires Improvement following a focused December 2023 inspection of the Safe and Well-led domains, with previous breaches of Regulations 12 and 17 now remedied but ongoing concerns around undated risk assessments, basic care plans, and inconsistent communication with people and families. The provider demonstrated a receptive attitude to improvement and had strengthened recruitment, medicines monitoring, and governance processes since the last inspection.
Concerns (5)
moderateRecord keeping: “some had no date of completion so it was difficult to see when they were completed and how often they would be reviewed.”
moderateCare planning: “People's care plans contained basic information on how to provide care and support to people.”
moderateCommunication with families: “There's no communication with carers unless it's [name of staff]”
minorGovernance: “only 48 surveys were sent and of those sent 30 replies were received missing an opportunity to capture all feedback from people”
minorMissed or late visits: “Staff do not always arrive on time and carers are not always consistent. We have had some issues with timings.”
Strengths
· Recruitment processes improved; no longer in breach of Regulation 19 (Fit and Proper Persons employed).
· Regular monthly medicines auditing in place with follow-up action on identified MAR gaps.
· Staff completed safeguarding training and could describe abuse types and escalation procedures.
· Staff reported sufficient travel time between visits and adequate PPE supply.
· Provider worked in partnership with GPs and district nurses to support people's needs.
Quality-Statement breakdown (11)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsGood
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: Continuous learning and improving careRequires improvement
Golden Keys Care Agency Ltd was rated Requires Improvement overall following a focused inspection of Safe and Well-led, representing a decline from its previous Good rating. Breaches of Regulations 12, 17, and 19 were identified, including unsafe medicines management, ineffective risk assessment, gaps in recruitment processes, and governance failures in statutory notifications and audit effectiveness.
Concerns (10)
criticalMedication management: “staff had either incorrectly used the codes provided at the bottom of the MAR chart or not used them at all, missing signatures and on 1 audited MAR chart we looked at, we found a person had not received their anticoagulant medicine for 5 days”
criticalCare planning: “risks associated with people's catheter care, diabetes and people who were prescribed anticoagulant (blood thinning) medicines. Staff did not have up to date information about these risks and how to mitigate them”
criticalGovernance: “we identified 6 occasions where the registered manager had notified the local authority of incidents but had failed to notify CQC and 1 occasion whereby the local authority had not been notified of an incident relating to a medicine error.”
criticalSafeguarding: “incidents we were informed of were not always identified or reported to the appropriate authorities.”
moderateRecord keeping: “Accidents and incident forms were in place; however, these were not always completed in full. For example, time and dates were missing, and information regarding the action taken and outcome for people was not always recorded.”
moderateStaffing levels: “7% of calls made were short calls, which means less than half the planned time is delivered. Out of 9244 calls made in February 2023 4986 of those had no travel time”
moderateMissed or late visits: “I have had 3 late calls recently, 1 day the carer did not come until 11pm. I ring the office up a lot”
moderateIncident learning: “accident/ incident overview log, however this failed to capture all of the accidents and incidents we reviewed on the day of the inspection from the services paper data.”
moderateStaff competency: “1 file contained only 1 reference, 1 file had no interview notes and there were gaps in staff employment history which had not been identified and explored throughout their recruitment process.”
minorLeadership: “People we spoke to were not aware who the registered manager was and most referred to the care coordinators when asked. People and relatives told us, 'No, I don't know who it is'”
Strengths
· Staff knew how to keep people safe from harm and people told us they felt safe when staff were providing care.
· Staff had received training in infection prevention and control and consistently used PPE correctly.
· Staff received supervisions and appraisals on a regular schedule (every 3 months).
· Staff involved in medicine administration had received appropriate training and competency checks.
· The provider worked in partnership with healthcare professionals such as District Nurses and GPs.
Quality-Statement breakdown (7)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersGood
Golden Keys Care Agency Ltd received a Good rating across all five key questions at its first CQC inspection in May–June 2018, with 49 people receiving personalised, safe and effective domiciliary care. The sole area of concern was occasional late care worker visits, though this did not affect the overall rating.
Concerns (1)
moderateMissed or late visits: “One person said, "My care worker didn't come until 10pm yesterday and I don't know whether to take my pills or not."”
Strengths
· People consistently felt safe with care workers and described them as trustworthy, professional and flexible
· Robust recruitment process including DBS checks, references and thorough induction with shadowing
· Medication management was well handled, with trained staff and good MAR records; registered manager is a qualified nurse
· Care workers received regular supervision, spot checks and a range of training to meet people's needs
· People and relatives were fully involved in care planning, assessments and decision-making