About the service Gold Care Services is a supported living service providing personal care to 13 people aged 18 and over at the time of the inspection. The people receiving support had a learning disability and/or Autism. The service supported people in three supported living homes in South London and Surrey.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Risks to people were not always assessed and managed correctly. Accidents and incidents were not analysed to ensure trends and themes were identified.
People were not consistently supported with medicines in a safe way. Infection control measures had not always been implemented effectively and government guidance in response to the COVID-19 pandemic was not always followed.
Staff had not always been trained in relevant areas to make them effective in their roles. Some staff told us they did not always feel supported by the registered manager.
Management of the service was unclear as to who was responsible for oversight of each of the supported living homes. This had impacted the effectiveness of quality audits and made areas for improvement difficult to identify.
CQC and the local authority had not been made aware of significant incidents and allegations that had been made within the service. Safeguarding protocols had not always been followed correctly and staff had inconsistent knowledge on how to report concerns.
Some people had restrictions in place that did not have clear documentation to confirm how lawful consent was obtained and how decisions were made in people’s best interests. People were not always supported to have maximum choice and control of their lives. Staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right Support:
People’s support needs were not always consistently recorded and risks to them were not always appropriately identified and assessed.
Right Care:
Care practises upheld and respected people’s dignity. We saw examples of caring interactions between staff and people that were being supported.
Right Culture:
The culture in the service was having a negative impact on the support that was being provided to people. Due to a breakdown in communication within the management team, appropriate oversight to ensure effective care was not evident.
The provider and the management team have acknowledged there was improvement to be made in the service and were working with the local authority to address concerns as quickly as possible. This was to ensure improvement were made to the quality of support people received.
People told us they felt supported and felt included and involved in the running of the service.
The registered manager followed safe recruitment processes and attempts had been made to continue staff appraisals and supervisions throughout the pandemic.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 1 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.
Why we inspected
We undertook this focused inspection to check they had followed their action plan to make improvements and to confirm if they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gold Care Services on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, safeguarding, consent to care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.