Archived: Caremark (Welwyn & Hatfield)

The service did not have a registered manager and there was no 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.

During the inspection we identified significant concerns in relation to the safety of people using the service and the overall management and leadership in place. As a result we served a notice to restrict any further admissions to the service on 22 July 2016. The provider had informed us on 19 July 2016 that they were insolvent and due to appoint liquidators the following week, which meant that people had to be found alternative care providers by the local authority. The provider subsequently applied to cancel their registration of the service on 22 July 2016 which meant that no further care or support would be provided from this location.

People were exposed to a risk of avoidable harm as a result of inadequate management and a consistent failure to monitor their care and support needs. People did not receive their visits on time and these were frequently reported as having been missed or late. Despite the demonstrable impact upon people, the service had not developed effective systems to monitor this or identify ways in which it could be improved.

People’s medicines were not managed safely and they did not always receive them on time. Staff were trained to administer medicines, but people’s care plans did not contain sufficient information to support them to understand people’s needs. The medicine administration records kept to account for people’s medicines contained gaps, errors and were not audited efficiently to identify ways to improve upon this.

The service did not have a registered manager and there was no consistent, stable management or leadership in place. People and staff did not feel that they were listened to and did not have confidence in the management of the service to improve. The quality monitoring systems in place were inadequate for identifying improvements that needed to be made, and the lack of managerial oversight in the service meant that changes were not made as required. The service did not follow their own policies in relation to people’s care and support, and people were receiving inadequate care as a result.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We visited the offices unannounced on 19th January 2015 to see what improvements had been made. We met with the manager and the owners. We looked at three care logs over a three month period and looked at five care staff personnel files. We contacted ten people who received care and of these we spoke to seven people. All said they were receiving two carers each visit. Six people said the agency had improved since our last inspection.

The agency has not accepted any new clients since the last inspection to enable them to work on the areas that need improving. People were now receiving care from two carers where this was required. However we found further improvements were required to show that staff new to care were shadowed to ensure their competency was sufficient before starting work. Also there was a need for evidence to show that new staff did have any gaps in their employment explored and had planned dates for all their training.

The people we spoke with said that they were happy with the service they received. One person said 'The care staff were helpful and caring.' Another person said 'I have regular care staff who know how to support me. I do not have any concerns.' One person commented that they had problems with lateness sometimes and changes in staff but this seems to have improved along with communication with the office staff.

We found that people had been involved in their care planning and the way care had been provided for them. People's privacy and dignity had been respected. We noted from the care plans we had reviewed that each person had an assessment of needs carried out and care plan developed to ensure that their needs were being met appropriately. The staff had been supported and provided with relevant training for the work they did. There was a system for assessing and monitoring the quality of service.