Caremark (Cheshire North East)

Caremark (Cheshire North East) is a domiciliary care agency providing personal care and support to people living in their own homes.

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. At the time of the inspection, 56 people were receiving support with personal care.

People’s experience of the service and what we found:

The provider undertook some quality assurance audits and checks, however they had not identified all the issues we found during the inspection. Records were not always sufficiently robust. This related to aspects of risk management, medicines records and to demonstrate full compliance with the MCA. Systems to improve the provider's oversight of training and staff supervisions were being further developed.

Where necessary staff reported safeguarding concerns to the local authority. However, whilst the provider was aware of the need to notify CQC about certain incidents and events, they had not fully understood all aspects of this requirement. We have made a recommendation about this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, staff had not always followed the systems/policies in place. This related to records for capacity assessments and best interest decisions. We have made a recommendation about this.

The provider ensured there were sufficient numbers of suitably trained staff, who had been recruited safely. Overall, people were supported to receive their medicines safely and risks were managed. However, the electronic recording system in relation to medicines needed to be further adapted and some records needed to be more in-depth about actions being taken. The provider was addressing this.

People told us they felt safe and were complimentary about the care provision. People’s needs were met in a person centred way and the care was flexible. Systems were in place to protect people from abuse or avoidable harm.

People’s needs were assessed and care and support was delivered in line with current standards to achieve effective outcomes. People had been included in discussions about their care. Staff worked well with other agencies and acted on any changes in people’s needs.

There was a positive and open culture at the service, with good communication. The provider had already devised a development plan to drive ongoing improvements in the quality of the care. The provider worked in partnership with others and people’s views and feedback were sought.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 9 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. During the inspection we found there was a concern in relation to consent and mental capacity, so we widened the scope of the inspection to include effective.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection by selecting the 'All inspection reports and timeline’ link for Caremark (Cheshire North East) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach of regulation in relation to the provider's overall governance. We have made 2 recommendations in relation to consent to care and regulatory requirements.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

There were enough staff to meet people’s needs and recruitment was ongoing to fill any shortfalls in staffing. A new rostering system was to be introduced to ensure staff had enough time to complete and travel between calls. There were systems in place to ensure staff were knowledgeable, competent and supported in their roles.

The service had plenty of personal protective equipment available and staff were engaged in the Covid-19 testing and vaccination programme. Training and updates were provided to staff regularly.

A new manager was in place and, together with the management team, they were committed to driving improvements at the service and ensuring people received good quality care and support. An action plan was in place and work was ongoing in this area. People were generally happy with the support they were receiving.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 May 2018).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about staffing, staff training, infection prevention and control and how the service was being managed. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in June 2017 we found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. These breaches related to the service not following the principles of the Mental Capacity Act 2005 to assess if people did have capacity to consent to their care and the service not notifying The Care Quality Commission (CQC) about significant events that they are required to notify of by law.

Following that inspection we asked the provider to complete an action plan to identify what they would do and by when to improve the key questions- Is the service effective and well-led.

At this inspection, we found that all the required improvements had been made.

The action plan submitted identified the service had followed the principles of the Mental Capacity Act 2005. Mental capacity assessments were being carried out if it was felt that some people did not have capacity, or had fluctuating capacity. The registered manager had systems in place to ensure they notified CQC about significant events that they are required to notify by law.

Caremark (Cheshire North East) is a domiciliary care agency based in the Handforth area of Cheshire. It provides personal care to people living in the community. The services provided include care and support provision for older people, people with a physical or learning disability, people living with dementia, children and end of life care. At the time of our inspection, the service offered care and support to 42 people who lived in the area.

There was a manager in post who had submitted his application to CQC to become registered as a manager of the service. A registered manager is a person who has registered with the CQC 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.

Systems were in place to check the quality and safety of the service. The manager also sought feedback from people informally on a regular basis and on a formal basis annually. All the feedback we viewed was positive. Spot checks and observations were carried out with staff to ensure that the standards of care were maintained.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and knew how to respond to and report any concerns they may have.

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 supported this practice.

Care records had been updated and contained personalised information about people's needs which helped ensure that staff had access to up-to-date and accurate information around people's individual needs and choices. This helped ensure that people received the correct level of support.

Medication administration records (MAR) sheets held details of types of medication and the times they were to be given.

There were clear lines of responsibility within the service and the manager and managing director worked positively with the local authority and other professional services in order to develop and drive improvement.

The manager had the ratings displayed in the office from the last CQC inspection.

There was a Registered Manager in post at the time of our inspection. 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.

At this inspection we identified breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one of the Care Quality Commission (Registration) Regulations 2009. You can see what action we asked the provider to take at the back of this report.

The principles of the Mental Capacity Act 2005 were not always being followed. Mental capacity assessments were not being carried out if it was felt that some people did not have capacity or had fluctuating capacity. Evidence had not always been sought to verify that representatives had Lasting Power of Attorney or that people had given permission for their relative to sign consent on their behalf.

The registered manager had not always notified CQC about significant events that they are required to notify us of by law.

Reviews of care plans had not always identified that some lacked personal detail and information was not consistent throughout the care file. The registered manager told us they would review files to ensure they contained more personalised information.

People told us they felt safe and we saw risk assessments and plans had been put in place to keep people safe. When an incident had occurred, action had been taken to protect the person and to reduce the likelihood of another incident occurring.

Medicines were managed safely. People told us they received their medicines and there was clear guidance available for staff to follow.

There were appropriate amounts of staff to care for people and people told us staff were generally on time. Staff were aware of their responsibilities to safeguard people from abuse and referrals had been made if there had been an incident.

Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.

Staff had sufficient training to support people effectively and staff were able to refresh this training when required.

People had access to other health professionals in order to maintain their health and wellbeing.

Most people we spoke to could prepare their own food or were supported by relatives to make their meals throughout the day. Of those who were supported by staff, they felt staff did this appropriately.

People felt staff were caring and that they were treated with dignity and respect and people were encouraged to maintain as much independence as possible.

People felt they were supported appropriately by staff and had regular staff they were able to get to know. We recommend that plans are reviewed to ensure that they are all person-specific and details of life histories so staff can continue to get to know people.

People and relatives were able to complain if they needed to and it was recorded that this feedback was acted upon. We saw that complaints were recorded, investigated and responded to.

People were asked for their opinion about their care and staff were able to have team meetings. Staff felt supported in their role and had confidence in the registered manager.

We looked at the care records for a nine of the people who used the service and could see that arrangements made for their care and support were centred on their individual needs.

All the staff we spoke with were enthusiastic and positive about the service. They told us that they were proud to be associated with the service and the high quality of care provided. They praised the manager, supervisors and other senior staff for their guidance, support and leadership. Records showed that staff were well supervised and had benefited from training in range relevant subjects. This showed us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that there were areas where improvements were needed. These included gaining consent to care and records the people who use the service are protected from unsafe or inappropriate care and support.

People who used the service told us that they found the staff respectful and they were treated with dignity and their privacy was maintained. One person told us: 'They turn up on time' and said: 'In general now I have the same staff visit me, which is important to me.' They also told us that they felt that the staff: 'Seem to be well trained and know what they are doing.' Another person told us: 'I have no complaints; I think it's a very good service.'

One relative told us: "The staff are kind and it's kindness we look for in the staff." They also said they were happy with the service provided and would recommend it to others.

We looked at staff recruitment files and saw that the agency had thorough recruitment and selection procedures in place.

We saw that the agency forwarded quality questionnaires/surveys to people who used the service and saw the comments people made, which were very positive. People who used the service told us that their views were listened to and any queries or concerns were responded to appropriately.