Archived: Guardian Homecare-Bedford

Updated 20 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection was announced and was carried out on 6 and 7 March 2018 by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We gave the service 48 hours’ notice of the inspection, because they provide a domiciliary care service and we needed to be sure that the registered manager and other members of staff would be available.

Before the inspection we checked the information we held about the service and the provider, such as notifications. A notification is information about important events which the provider is required to send us by law.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also asked for feedback from the local authority who have a quality monitoring and commissioning role with the service. No concerns were raised.

During the inspection we used different methods to help us understand the experiences of people using the service, because some people had complex needs which meant they were not able to speak with us. The inspector visited the office location to speak with the registered manager and office staff; and to review care records and policies and procedures. The Expert by experience made telephone calls to a random selection of people using the service to gain their feedback about the service they received.

In total, we spoke with 14 people using the service, three relatives or close friends, the regional manager, the registered manager, a service coordinator, a field supervisor and one member of care staff. We also sent some questionnaires to another selection of people using this service. Eight people or their relatives responded.

We then looked at various records, including care records for four people, as well as other records relating to the running of the service. These included staff records, medicine records, audits and meeting minutes so that we could corroborate our findings and ensure the care and support being provided to people was appropriate for them.

Updated 20 April 2018

Guardian Homecare – Bedford is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to adults of all ages who have a variety of care and support needs including: dementia, physical disabilities, sensory impairments and mental health needs. At the time of this inspection there were 139 people using the service.

Not everyone using Guardian Homecare – Bedford receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

This was the first inspection of Guardian Homecare – Bedford since it registered with CQC in March 2017. This means the service has not previously been rated. During this inspection, which took place on 06 and 07 March 2018, we rated the service as Good.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we did identify some areas that needed improvements. However, we also saw evidence that the provider was aware of these and was already taking steps to address them. This included the timing of care calls to people. Overall, people told us that the service was reliable, but sometimes care staff did not arrive when they needed them to. The registered manager showed us that weekly analysis of call timings was underway, in order to provide an improved service to people.

The provider carried out checks on new staff to make sure they were suitable and safe to work at the service. However, we found some gaps with the recruitment checks carried out. These gaps were investigated and filled by the registered manager shortly after the inspection.

In addition, we found concerns with how staff recorded whether people had received topical medicines such as barrier creams. This is because staff had not always used the correct code (key) to record the reason for administering the cream. The management team showed us that training booklets had been prepared for staff to complete, to support them in their understanding of expected record keeping standards.

People were protected from abuse and avoidable harm. Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely and that they were protected by the prevention and control of infection.

There was evidence that the service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People received care and support that promoted a good quality of life and was delivered in line with current legislation and standards. Staff received training to ensure they had the right skills, knowledge and experience to meet people’s needs.

People were supported to have enough food and drink to maintain a balanced diet. Risks to people with complex eating and drinking needs were being managed appropriately.

Staff worked with other external teams and services to ensure people received effective care, support and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.

The service acted in line with legislation and guidance regarding seeking people’s consent.

People received personalised care from staff who were helpful, kind and compassionate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s privacy, dignity, and independence was respected and promoted.

Arrangements were in place for people to raise any concerns or complaints they might have about the service. These were responded to in a positive way, in order to improve the quality of service provided.

Systems were in place for people to be involved in making decisions about their end of life care needs, so if the need arose staff would be prepared and able to carry out those wishes.

There was strong leadership at the service which resulted in people receiving high quality and person centred care. The registered manager ensured that staff understood their legal responsibilities and accountability. This approach had created a positive culture that was open, inclusive and empowering for the people using the service.

Systems were in place to monitor the quality of the service provided and to drive continuous improvement. The registered manager and provider worked in partnership with key organisations and agencies for the benefit of people using the service.

Further information is in the detailed findings below.