Archived: CMCL Care

Updated 7 August 2019

Inspection team

The inspection team consisted of three inspectors, an assistant 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.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. A new managing director had also been appointed who was helping run the service on a daily basis and told us it was their intention to apply to become an additional registered manager for the service. We refer to them is this report as the managing director.

Notice of inspection

The first day of this inspection was unannounced.

Inspection activity started on 4 June 2019 and ended on 17 June 2019. On the 6 and 13 June we visited the provider’s offices to review documentation relating to people’s care and the management of the service. On the 16 June 2019 we visited people in their homes to ask them about their care and support, check how medicines were managed and review care related documentation. Between 4 and 17 June 2019 we made phone calls to people who used the service, their relatives and staff.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection. We used all of this information to plan our inspection.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

During the inspection we spoke with ten people who used the service and 17 relatives of people who used the service. We spoke to most people via the telephone but also undertook visits to five people’s homes. We also spoke with 14 care workers, the registered manager, managing director and operations manager. We reviewed 13 people’s care and medicines records. We also spoke with one professional who worked with the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found and asked for an immediate action plan to mitigate some of the risks identified.

Updated 7 August 2019

About the service

Caremark (Bradford) is a domiciliary care agency which provides personal care to people in their own homes. At the time of the inspection the service was providing personal care to 159 people.

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:

People provided mixed feedback about the overall quality of the service they received. Most people were happy with Caremark however there was a sizeable minority that was unhappy and said management had not been effective in addressing their issues or concerns.

Medicines were not managed in a safe or proper way. People did not always receive their medicines as prescribed and medicines administration records were not always clear or fully completed. Unsafe medicines management had been an issue at the last three inspections demonstrating the service had a poor track record in this area.

Some risks to people’s health and safety were assessed but this approach was inconsistent. We found a number of key risk assessments missing or lacking the required detailed.

Most people told us they felt safe using the service. However there had a been a high number of safeguarding incidents and we saw robust systems were not always operated to protect people from abuse or harm.

People said there were variations in the quality of staff and some unsuitable care workers that shouldn’t be working for the service. We saw robust recruitment procedures were not always operated.

Staff received a range of training and support which was relevant to their roles. Training was kept up-to-date. However, some people experienced a high number of different care workers in a given week or month which was a barrier to providing consistent, high quality care.

Most people received calls at the times that they needed them, however this was not consistently the case. A number of calls were significantly shorter than they should have been, and some people said staff rushed.

Most people said staff were kind and caring and treated them well. However, this view was not universal, and a number of people gave us examples of how they had not always been treated with dignity and respect by staff or the management team.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not always support this practice.

The service was not well led because the service continued to be in breach of regulation and had not deteriorated since the last inspection. Audit and checking procedures were not suitably robust in identifying errors and taking action to prevent them re-occurring.

We found seven breaches of regulation. We raised these issues with the service and requested an immediate action plan to state how they would mitigate the risks to people. We also made safeguarding alerts to the local authority about some of the more serious concerns.

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 14 August 2019) and there were two breaches of regulation. We issued two warning notices, for regulation 12 safe care and treatment and for regulation 17 good governance.

At this inspection the service had not improved or met the warning notices and was still in breach of these regulations.

Why we inspected

The inspection was prompted in part due to concerns received about overall care quality and due to a number of safeguarding incidents which had occurred in the service. A decision was made to bring the planned comprehensive inspection of this service forward to allow us to inspect and examine those risks.

This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caremark (Bradford) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, safe care and treatment (medicines and risk management), safeguarding, consent, recruitment, complaints and good governance.

Please see the action we have told the provider to take at the end of this report.

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 request updated action plans to understand what they will do to improve the standards of quality and safety. 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.

Special Measures

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.

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.