15, 29-30 April 2014
During a routine inspection
Caremark (Calderdale) is based in Halifax and provides personal care and support to people living in their own homes in Calderdale, Huddersfield, Brighouse and surrounding areas. At the time of our inspection the agency was providing a service to 107 people.
The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission.
The service has undergone a number of changes since November 2013 when enforcement action was taken due to breaches in regulations which related to the care and welfare of people, safeguarding and the management of complaints. As a result of the enforcement action the local authority suspended placements with this agency and the suspension was in place when we visited. We spoke with the local authority before the inspection and they confirmed the agency was working with them to make improvements to the service.
People told us they experienced late and missed calls which meant they did not receive the care and support they needed at the time agreed. The registered manager and senior staff did not always recognise when abuse had occurred and had not made appropriate referrals to the safeguarding authority. Communication between staff was poor which resulted in incidents not being reported and acted upon.
We saw disciplinary procedures had been followed for two staff, but the issues had not been referred to safeguarding. Both staff no longer worked at the service but had not been referred to the Disclosure and Barring Service by the provider. The Disclosure and Barring Service decides whether a person should be placed on a barred list which means the person would be prevented from working with vulnerable groups of people.
The registered manager told us all staff had received safeguarding refresher training since the last inspection, however they were not able to provide evidence to confirm this.
There was no evidence to show staff had received training in the Mental Capacity Act (MCA) 2005. MCA is law protecting people who are unable to make decisions for themselves.
Consent and capacity forms had not been completed for people with dementia, although their care records had been signed by relatives on their behalf. This meant it was not clear if the person had the mental capacity to consent to these decisions for themselves or if they had agreed their relative could be consulted.
We found risks to people were not always managed appropriately and risk assessments were not always in place to inform staff how risks should be managed safely.
Staffing arrangements were inconsistent. Some people told us their staff arrived on time and they had seen improvements in the service, however others said they experienced late and missed calls. People told us there were problems with staff at the weekends and new staff often did not know their needs which meant they had to tell them what to do.
Staff recruitment processes were thorough and this ensured appropriate checks were carried out before people started working at the service.
People told us they had been involved in decisions about their care, however we found care records were not up to date and did not reflect people’s care and support needs.
People’s health care needs were recorded and there were systems in place for people to access health care services when needed. Information about medicines was sometimes contradictory and not recorded well which may lead to people not receiving their medicines safely.
We saw evidence which showed some staff had received induction and ongoing training, although records could not be provided to confirm this training had been received by all staff. Some people told us new staff were accompanied by more experienced staff before working alone, others said they were not.
Staff received supervision and arrangements were in place to develop a training development plan for staff.
People and their relatives gave mixed feedback about the staff. Those who had regular care staff spoke positively about the care that was provided and said staff were kind, caring and helpful. Others who did not have regular care staff were less positive.
People were involved in reviews of their care and staff showed a good understanding of people’s needs and the support they required.
Complaints were not dealt with consistently. Some people were satisfied their concerns had been addressed, others felt their concerns had not been listened to.
The service was not well led and leadership of the service required improvement. We found systems in place to monitor the quality of the service were ineffective.
Satisfaction surveys received back from people who use the service and their relatives had not been reviewed. Many of the surveys raised issues about how the service was run which the manager was not aware of until we brought this to their attention. This placed people at risk as issues raised had not been acted upon.
Quality monitoring systems were not effective or reliable. There was no evidence to show that complaints, safeguarding and incidents were analysed or that the learning from them was shared with staff and used to improve the service for people.
We are taking further action and will report on this when completed.