Gloriavd Health Care Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This key question has been rated requires improvement. We reviewed 4 quality statements for this key question. We found medicines were mostly managed safely and people received their medicines as prescribed, however, medication records were not always robust. We found risks to people were mostly managed safely however, we did identify 1 person’s moving and handling practices were not safe, and this was addressed immediately. People and relatives told us they felt safe how their care was provided. Recruitment procedures for staff were robust and staff we spoke to said they had received the relevant training.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were safeguarded from abuse and neglect. People told us they felt safe. Comments from people and their relatives included, "Yes, I feel safe” and, "Yes, [person] is safe with the carers. They walk behind [person]. Has had no falls or incidents since the stroke. They have a frame if support is needed" and, "Safe, yes. Things are as they should be."

Staff and the registered manager demonstrated a good knowledge of types of abuse, safeguarding procedures and who to inform if they had any concerns. Staff knew how to report abuse and had received training in safeguarding adults. Their comments included, "Abuse can happen in any form. I look out for this, but I have not come across it yet thankfully" and "I go to the manager first and tell them my concerns."

The registered manager was clear on their responsibilities and duties to identify and report any safeguarding concerns. Statutory notifications had been submitted as appropriate. During this inspection, we reviewed evidence confirming actions were taken and lessons learnt following incidents, some included safeguarding concerns. For example, a new system was put in place to monitor and record the application of transdermal patches following an incident. Staff and leaders followed their policies and procedures in relation to safeguarding adults and whistleblowing concerns.

People and relatives told us they felt safe how their care was provided. One person said, "I couldn’t be safer." Relatives told us, "Yes [name] is safe when having care. Staff always check on the broken hip side. Staff never leave [name] on their own. Staff are never complacent and are always mindful of what can happen."

Staff knew how to act to manage and prevent risks linked to people's care and seek advice and support in case of an emergency. Their comments included, "If someone had a fall, we would call 111 to make sure the person is breathing, get advice and go through questions with 111. We would call the office to report to manager and inform family." The registered manager was involved in delivering people's care and showed a good understanding of how risks to people's care were managed. However, during this inspection we found one concern in relation to how one person's moving and handling needs were being managed. We shared our concerns with the registered manager, and they took immediate action to address this.

During this inspection, we found most risks to people's care were well managed, but we found concerns in relation to one person's moving and handling requirements. Evidence reviewed during our site visit and in our conversations with the registered manager and deputy manager, we were not assured that this person's moving and handling manoeuvres were being completed by 2 fully trained and qualified people because the manoeuvre was being done by 1 trained carer and this person's relative. We shared our concerns with the registered manager. After our inspection, we reviewed evidence confirming appropriate actions had been taken to ensure this person was safe while receiving the care they required.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were mostly positive about the service and received consistent care from the same staff teams. Comments included "It is more or less the same group of staff. They’ve been before and know what to do” and, "A tight team. They know [relative name’s] needs." People and relatives told us they received their care visits mainly on time. Comments included, “Carers are usually on time but not every time. They’re really good at calling us if they’re going to be late. One morning there was an emergency which took their time. No missed calls” and, "I can choose staff time of arrival. I prefer 7.30 to 8am and before 6pm if possible. They’re usually here at 5.45 which is good” and, “Late only once. They phone us. We’re ok with that as long as we know." People and relatives told us they believe staff have had the appropriate training to support their needs. Comments included “Yes, staff are sufficiently trained. If I’m upset, they’re very good at calming me down" and “Carers know my [relative’s] needs.”

The registered manager told us systems were in place to ensure safe staffing, such as electronic call monitoring. They told us how the system alerted them if a staff member was later than expected so this could be investigated. The registered manager completed monthly audits for call durations, late and missed visits. Staff told us they had enough time to spend with people and enough time to travel between care visits. One staff member commented, "Yes we have enough time and take our time to care for our clients also." Staff were well trained, and we received good feedback regarding the training from staff. Their comments included "Yes I have medication training and feel confident. We also have checks in the service user’s homes from the office management which are regular and unannounced. They watch all our work including medication" another comment was "I had an induction in the office and did training. I then went on shadowing for around 2 weeks, so I felt confident in my work."

The service had systems to recruit staff safely. This included gathering references and undertaking a Disclosure and Barring Service (DBS) check. The DBS check identifies any convictions a person has or whether they are barred from working with vulnerable adults. Staff had received the appropriate training to do their jobs safely, with refreshers completed every year.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received positive feedback from people and relatives in relation to support received with medication. Comments included, "My skin is intact. Staff apply cream twice a day. They soak my feet first, spot things and correct them" and "I’m confident from my [relative’s] feedback that medicines are done safely.”

During this inspection, we found medication records were not always an accurate reflection of the care provided. We found gaps in medication administration records and medication audits had not been effective in ensuring this issue was addressed. In our review of the evidence, we did not find evidence that people had missed their medication because care records (handover records) showed medication had been administered. The registered manager told us about the systems in place to ensure staff were trained to support people with their medication and how medication administration was monitored. In our review of staff's files, we found medication training certificates and medication competency assessments. There was a medication policy in place, but we found examples of this not being followed because records of medication administered were not always complete or contemporaneous. For example, two people’s medication records showed gaps in recording. In our review of evidence gathered as part of this inspection, we were assured people had received the medication they required; however, records were not always kept accurate. This showed the medicine records were not always complete and forms part of the continued breach in regulation 17 (good governance). Systems in place did not show how records of medication were an accurate reflection of what had been administered. We found examples where appropriate codes were not being used when people had been in hospital or medication had been administered by relatives. We found gaps had been identified in the provider's medication audits completed 2 months before our inspection visit, but we continued to find concerns in relation to the records not being complete or accurate. This showed the medicine records were not always complete and the quality assurances processes in place had not been fully effective to drive the necessary improvements. This constitutes a continued breach in regulation 17 (good governance).