Background to this inspection
Updated
11 November 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 2 inspectors and an Expert by Experience. The Expert by Experience completed telephone calls to people and their relatives. 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.
Registered Manager
The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours' notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 28 September 2023 and ended on 5 October 2023. We visited the office on 3 October 2023.
What we did before the inspection
We reviewed information we had received about the service. 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 (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 9 relatives and people about their experience of the care provided. We spoke with 7 members of staff, the registered manager and the care manager.
We reviewed a range of records. This included 5 care records and plans. We looked at 5 staff files in relation to recruitment and staff supervision and a variety of records relating to the management of the service.
Updated
11 November 2023
About the service
Caremark (Harlow and Epping Forest) is a domiciliary care service providing personal care to adults who live in their own houses and flats. At the time of our inspection, 31 people were receiving personal care.
Not everyone who uses domiciliary care services receives 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
People's medicines were not always managed safely and the provider's processes for checking the accuracy of people's medicines records were not always robust. People's risk assessments were not updated or reviewed regularly.
Suitable arrangements were not in place to ensure all staff employed received appropriate training, a robust induction or regular supervision.
The registered managers governance arrangements did not always provide assurance the service was well led. Quality assurance systems were not robust and had not identified the shortfalls we found during our inspection.
The registered managers had been raising safeguarding alerts with the local authority however, there had been occasions whereby statutory notifications had not been sent to CQC as required. Providers must inform CQC of all incidents that affect the health, safety and welfare of people who use services.
There was limited information in the support plans we reviewed relating to people's end of life wishes. We have made a recommendation about end of life wishes.
People did not always feel the service supported them to make complaints. We have made a recommendation about supporting people to make complaints.
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. Staff had a good understanding of people's preference of care, staff promoted people's independence.
People and their relatives were involved in the planning and review of their care.
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 7 March 2018).
Why we inspected
We undertook this inspection as part of a random selection of services rated good and outstanding.
The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.
You can see what action we have asked the provider to take at the end of this full report
Enforcement and recommendations
We have identified breaches in relation to safe care and treatment, staffing and recruitment, training and supervision, good governance, and the notification of incidents. We have a made a recommendation about end of life wishes and complaints.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.