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Inspection Summary


Overall summary & rating

Good

Updated 18 August 2018

The inspection took place on 18 July 2018 and was unannounced. The last comprehensive inspection of this service took place on 7 August 2017 when we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to fit and

proper persons employed and good governance. On 4 October 2017, we carried out a focused inspection to check if the provider had made the necessary improvements and found that they had met the requirements.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to a range of people, including older adults, some of whom were living with the experience of dementia, younger adults with a learning disability and children. At the time of the inspection the service was supporting 28 people, including one child who were all receiving personal care support. Not everyone using Caremark (Hillingdon) received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, support with medicines and eating. Where they do we also take into account any wider social care provided.

The previous registered manager left their role in May 2018 and the provider was currently managing the day to day running of the service. They had recruited to the post of manager and this person was applying to become the registered manager. 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.

Risk assessments for people’s home environment and individual risks had generally been carried out and plans put in place to minimise the risks occurring. However, risk assessments had not always been updated in a timely manner and we identified one occasion where a risk assessment had not been completed about one person’s particular needs. This was addressed by the provider both during and shortly after this inspection.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). The provider was aware of what to do and who to contact if they had concerns that people lacked capacity to make certain decisions. The provider needed to be sure if a person had a deprivation of liberty order placed on them so that they were satisfied people were not being restricted unlawfully.

There were quality assurance systems in place to monitor the quality of the service provided. This included understanding the experiences of people who used the service and identifying any concerns. The audits did not always identify when records were incomplete or out of date.

People and relatives said people were being cared for safely by the care workers. Policies and procedures were in place for safeguarding people from the risk of abuse.

The care workers told us they felt supported. They took part in individual and group meetings to discuss their roles, the service and good practice was praised and rewarded. The provider had not been providing an annual appraisal of the care worker’s performance and confirmed they would introduce this.

There were sufficient numbers of care workers employed to meet people's needs.

Care records provided staff with information about the care and support each person required. At the time of our inspection there was no-one receiving end of life care support.

People were supported to manage their medicines in a safe way. Staff responded quickly to changes in people's health and worked with other health and social care professionals to meet their needs.

The provider had arrangements to help protect people from the risk of the spread of infection as the care workers wore protective equipment, such as gloves and aprons, w

Inspection areas

Safe

Good

Updated 18 August 2018

The service was safe.

The provider mostly had suitable arrangements to assess risks so risks were identified, recorded and mitigated. We however found some cases where the risk assessments were not up to date or identified a potential risk to a person. The provider took action to address this promptly.

Policies and procedures were in place for safeguarding people from the risk of abuse and staff knew the processes to follow to report any concerns.

There were sufficient numbers of suitably qualified staff deployed to care for people.

People received their medicines in a safe way and as prescribed.

There were systems to help learning and make improvements when things went wrong.

People were protected from the risks associated with the spread of infection because the provider had appropriate systems for the prevention and control of infection.

Effective

Good

Updated 18 August 2018

The service was effective.

Staff respected people’s right to make decisions about their care and treatment and knew to report any deterioration in a person’s ability to do so. The provider had not ensured that they had accurate information, if people had any agreed and lawful restrictions on their liberty.

People were cared for by care workers who had the skills, knowledge and support to deliver effective care.

People were helped to access healthcare services as and when needed.

People received support to maintain a balanced diet and care workers ensured people had enough to drink so they stayed hydrated.

Caring

Good

Updated 18 August 2018

The service was caring.

Care workers ensured that people received care in a person centred way.

Care workers were compassionate, thoughtful and built up trusting relationships with people.

People were able to express their views and these were respected and valued.

Care workers respected people’s privacy and dignity and ensured people were happy with the care and support they needed.

Responsive

Good

Updated 18 August 2018

The service was responsive.

Care records provided staff with information about the care and support each person required.

Care workers provided stimulation and occupation for those people who benefited and enjoyed engaging in activities.

The complaints procedure was made available to people and people and relatives said they would raise any issues they might have so they could be addressed.

Well-led

Requires improvement

Updated 18 August 2018

The service was not always well-led.

The provider had systems for monitoring and improving the quality of the service, however these did not always identify when records were incomplete or out of date.

People and their relatives said it was easy to contact the office staff and that they were approachable and supportive. Their views were sought through review meetings, phone calls and satisfaction surveys.

Policies and procedures were in place and the provider was a member of several organisations which they used to keep up to date with current legislation and good practice.