Archived: Caremark Limited

Caremark Limited is a domiciliary care agency (DCA) that provides personal care to children 0-18 years of age, people who misuse drugs and alcohol and older people living in their own homes some of who were living with dementia. At the time of the inspection 118 people were using the service. 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.

Caremark Limited had chosen to take part in a pilot where DCAs were inspected virtually without a site visit. During the initial inspection we identified shortfalls in relation to people’s risk assessments, the management of medicines and quality assurance processes. As a result, the virtual DCA pilot was stopped and a focused inspection including a site visit was completed. An action plan had already been developed following the initial feedback and changes had been made to improve the service people received.

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

General feedback from people was positive about the service they received. One person said, “I wouldn’t change the care staff, they are great.” Another person said, “The staff are very caring and understanding and know me well.”

People’s care records had been reviewed and updated, they were person centred and outlined what people’s specific health needs were. Risk assessments had been reviewed to include people’s specific choices, and, potential risks of becoming seriously ill if they contracted Covid-19.

People’s needs had been assessed in relation to their medicines support. Staff followed specific guidance and had been trained in the administration of medicines.

Quality assurance systems had been reviewed and additional training had been given to the management team that were completing the spot checks and carrying out the audits. Feedback from people had been sought and acted on to improve the quality of the service they received. Communication between the management team, people and staff had been improved.

Staff understood their role to keep people safe and understood how to report any concerns they had. Staff knew the potential signs of abuse and action had been taken when concerns had been identified. Accidents and incidents were monitored to identify potential patterns or trends. Action was then taken to reduce the risk of reoccurrence.

Staff had been recruited safely following checks to ensure they were safe to work with people who required care. People and relatives told us staff wore personal protective equipment (PPE) during the care calls. Staff understood how to reduce the risk of infection and reduce the potential spread of infection. Potential risks posed to staff within people’s own homes had been reduced where required.

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. People were given choices about all aspects of their care such as what they wanted to wear and eat.

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 (5 December 2017).

Why we inspected

This focused inspection was prompted in part due to concerns that had been identified during the DCA pilot, which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk considering the Covid-19 pandemic. We identified concerns in relation to the assessment of risks, medicines and quality assurance processes. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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.

Caremark Limited is a domiciliary care agency that provides personal care to people in their own homes in West Sussex. At the time of our visit the agency provided personal care to over 200 people and children. This included 95 people who resided in extra care accommodation at three different locations. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service only.

During our inspection the manager was present. They had been employed since November 2016 and had submitted an application to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

We previously inspected the service in May 2016 when it was rated ‘Requires Improvement’ overall and in all domains apart from the ‘Caring’ and ‘Well Led’ domains which were rated ‘Good.’ Two breaches of regulations were made for medicines and staff support. In response to this the provider sent us an action plan that detailed the steps that would be taken to achieve compliance. At this inspection we found that sufficient action had been taken and that the breaches of regulations were met.

Safe medicine procedures were now being followed and care workers were maintaining medicine records that reflected the support they gave to people. The manager had also reviewed the structure and organisation of the agency office. This had led to better communication between people who received a service and people employed by the agency. The level of support that staff received had also improved with staff now receiving regular supervision and training that enabled them to meet people’s individual needs.

People were happy with the service they received and complimented the care workers who supported them. They said that generally visits took place at times of their choosing and if care workers were going to be late they were notified of this in advance. People felt they were treated with kindness and said their privacy and dignity was respected. People's care plans contained information about what was important to them and how care should be delivered. People were involved in reviewing care plans with members of the management team. People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible.

Care workers knew how to keep people safe. They understood their responsibilities under safeguarding procedures and were confident the management team would act swiftly and deal with any issues appropriately. Recruitment procedures ensured care was provided by staff who were safe to support people in their own homes. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely. There were some gaps in risk management records that the manager was addressing.

People were happy with the support they received to eat and drink. Changes in people's health care needs and their support was reviewed when required. If people required input from other healthcare professionals, this was arranged. People who used the service felt able to make requests and express their opinions and views. A formal complaints process was in place that people were aware of.

The manager was committed to continuous improvement and feedback from people, whether positive or negative was used as an opportunity for improvement. Quality assurance systems were being used to drive improvements. Care workers were committed and said that the manager and the management team were approachable and supportive.

At our last inspection, in April 2015, we found breaches of the regulations in relation to medicines, staffing levels, staff training and support. At this inspection we found that there had been improvement in how the service was managed and delivered. New staff had been recruited and the breach in relation to staffing numbers was met. We found, however, that further work was needed to make and sustain progress in the areas of medicines management and staff training and support.

Caremark Limited is a domiciliary care service that provides support to people in West Sussex, including in Pulborough, Henfield and Horsham. At the time of our visit the service was supporting 112 people, including six children, with personal care.

The service had a 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.

People were at risk because guidance for staff on the support they required with their medicines was sometimes missing or inconsistent. Records of the medicines administered to people contained gaps where staff had not always signed to confirm that people had received their prescribed medicines.

Some people did not have a care plan in their home and other care plans did not reflect the person’s current needs. This meant that staff would not have accurate information to refer to and put people at risk of receiving inappropriate or unsafe care. People and staff told us that there had been an improvement in recent months and that reviews had been taking place.

Risks to people’s health and safety had been assessed and there was guidance for staff on how to minimise risk. We noted that there were no risk assessments in place for the use of bed rails and the registered manager took prompt action to address this.

Staff felt supported and said there had been improvement in the service. They spoke highly of the training they received. We found, however, that staff training had not always been updated and that supervisions and spot checks had not taken place at the frequency required by the provider. Further work was needed to ensure that staff understood individual needs and that people received effective care at all times.

Staff understood local safeguarding procedures and reported any concerns promptly. We found, however, that some staff who were supporting children had not completed child safeguarding training.

There were enough staff employed to meet people’s needs. People told us that the timing of their visits and the continuity of the staff who visited them had improved.

People spoke highly of the staff and told us that they treated them with dignity and respect. They told us that they had been involved in planning the care that they received. Staff understood how consent should be considered in line with the Mental Capacity Act 2005.

Staff supported people to prepare meals and to eat and drink if required. Where there were changes in people’s health staff responded promptly and made referrals to other healthcare professionals when additional support was required.

People had been asked for their feedback on the service and the registered manager was responding to their concerns. The majority of concerns shared with us related to new staff not understanding people’s needs and the fluency of English of some staff. The registered manager was monitoring the rotas to ensure that introductory visits were taking place so that staff were always introduced to a person and their needs before being required to provide support.

People felt able to contact the registered manager or staff if they had concerns and said that they received a good response. People told us that they understood how to complain.

The registered manager and provider had developed new systems to manage and monitor the service. These changes were delivering improvements. The registered manager had a clear action plan and was working to embed change and deliver continuity of service to people.

We found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

People and their relatives were satisfied with the service. One said, 'They're very kind and efficient'. Another told us, 'They're all really helpful and friendly' and, 'They're a good crowd'. One person during a telephone survey had responded, 'I look forward to my carers visits, they make me feel safe'. Relatives told us that the staff were diligent. One said, 'We've stabilised with a number of girls that X gets on well with'.

We spoke with six care workers, three supervisors, one office based care co-ordinator and the manager. They told us that they enjoyed their work and that they felt supported. One care worker said, 'I absolutely love the job'.

We found that people experienced safe and effective care delivered by regular staff who knew them well. Staff had received appropriate training. The interactions between care workers and people that we observed during home visits were positive. People were offered choices about the care that they received and support was provided in a kind and respectful manner. Everyone that we spoke with told us that they could approach the staff and manager if they were unhappy or had ideas to discuss.

Not everyone could remember if they had been given a copy of their care plan. But they told us that they had agreed to the care provided. They also told us that they had regular contact with the agency to review the care provided to ensure their needs had been met.

Everyone said that, usually, care staff arrived on time for visits. They said that, if care staff were going to be late, they were usually informed of this. They also told us that, when necessary, they could contact the office to change the times of calls so could attend hospital or doctors' appointments or if they chose to go out.

One person told us, 'The service I get is satisfactory. They are sometimes a bit late, but that can't be helped.' Another person said, 'I think they have been very good.'