We carried out a review of the data available to us about Caremark Poole & East Dorset on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Caremark Poole & East Dorset, you can give feedback on this service.
¿ The registered manager had implemented several new processes which had resulted in safer practice.
¿ Medication Administration Records were being monitored on a weekly basis to ensure any gaps or errors were identified and action taken.
¿ The majority of people felt safe and well cared for by staff. We informed the registered manager of comments which suggested certain staff conduct was not as the person expected. The registered manager took immediate action to investigate.
¿ All care plans had been reviewed to unsure they reflected the person’s needs.
¿ A system for assessing people’s risk in an event which effects the service from running had been introduced.
¿ People and their relatives were fully involved in assessing and planning the care and support they received. People were referred to health care professionals as required.
¿ People's privacy was protected and they were treated with dignity and respect.
¿ New staff had been recruited and there was a clear management structure in place.
¿ Staff received regular training and felt supported by their line manager.
¿ People and relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns.
¿ People and staff expressed confidence in the management team and felt the service was well led.
Rating at last inspection:
Requires Improvement (The date last report published was 3 March 2018).
About the service: Caremark Poole & East Dorset is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using Caremark Poole and East Dorset receives a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we, also take into account, any wider social care provided.
Why we inspected: This was a planned inspection based on the rating at the last inspection. The service has improved and was rated Good in all areas, therefore rated Good overall..
Going forward we will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good.
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 older adults and younger disabled adults.
Not everyone using Caremark Poole and East Dorset receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we, also take into account any wider social care provided.
At the time of the inspection Caremark Poole and East Dorset was supporting around 60 people living in Poole and Bournemouth and providing 470 hours of care per week.
Caremark Poole and East Dorset 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.’
The last inspection of Caremark Poole and East Dorset was carried out in July 2015. There were no breaches of regulation found at that inspection but we did suggest that some improvements were made in the management and administration of medicines.
The registered manager had joined Caremark Poole and East Dorset in June 2017. Prior to this, the service had been without a registered manager for more than six months. In addition to the registered manager, the usual staffing for the service included a care coordinator who was responsible for planning all visits to people receiving care and scheduling the staff to make the visits, and two field care supervisors who were responsible for day to day supervision and support of staff and maintenance of care records. At the time of the inspection, the service had been without a care coordinator for a number of weeks, one of the field care supervisors was on long term leave and the other had resigned. This meant that the registered manager was trying to cover these roles and provide on call/out of hours support themselves with the help of administration staff and care staff who were also stepping into roles to help out, for which they had not been trained.
People told us their care and support needs were mostly met and that staff were kind, caring and respectful. People also said they felt safe and had confidence in the staff.
There were systems in place for the management and administration of medicines but we found that these had not always been followed. This meant that people may not always receive their medicines as they were prescribed.
The service did not always assess the risks to the health and safety of the people they provided care to. Where risk assessments had been completed, some identified hazards but no action had been taken to reduce or manage the hazard and some were in need of review because situations had changed.
People were supported to access healthcare as necessary and to eat and drink where this was part of their support needs.
Staff knew people well and understood their needs. However, care plans were not always sufficiently detailed and up to date to provide information for staff if they did not already know the person they were supporting.
The provider had implemented satisfactory systems to recruit and train staff in a way that ensured that relevant checks and references were carried out and staff were competent to undertake the tasks required of them.
Staff understood how to protect people from possible abuse and how to whistleblow.
There were systems in place to monitor and assess the quality and safety of the service provided. These systems had not been fully implemented and the audits that had been completed were not always effective at identifying shortfalls in the service. However, the registered manager was aware of these weaknesses and had developed an action plan to address these.
Records were not always up to date and some contained inaccuracies or inconsistencies or lacked detail. Other records were not dated, timed or signed.
You can see what action we told the provider to take at the back of the full version of the report.
The inspection was announced and took place on 7 and 8 July 2015. We told the registered manager one day before our visit that we would be coming. This was to make sure staff we needed to speak with were available.
Caremark Poole & East Dorset employs care workers to provide personal care for adults of all ages in their own homes. At the time of the inspection the service was providing personal care to 46 people. In addition to this they provided two people with a sitting service. The service was not providing any personal care to people who needed two staff at the same time or any live-in care services as they previously had done.
We last inspected Caremark Poole & East Dorset on 5 August 2014. This was to follow up on a warning notice and compliance action issued at the previous inspection in May 2014. These were in relation to safeguarding people and assessing and monitoring the safety and quality of the service provision. Improvements were noted in the systems for safeguarding people but not all of the regulation was being met. We found the assessing and monitoring the safety and quality of the service provision met the regulations. At the May 2014 inspection we also identified shortfalls in the care and welfare of people. At this inspection we found improvements had been made and all of the previous shortfalls had been met.
There manager was registered in August 2014. 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.
There were systems in place to safely manage and administer medicines for people. Staff had been trained in the safe administration of medicines. However, one person’s medicines had not been administered as prescribed and this was an arear for improvement.
People and relatives said the staff were kind and respectful. They took the time to make sure people had everything they needed before they left them.
People received care and support in a personalised way. Staff knew people well and understood their needs. There were care plans in place so that staff knew what care and support to provide people. We found that people received the health, personal and social care support they needed.
People told us they felt safe and relatives said their family members were safe with staff and they had confidence in staff. Any risks to people’s safety were assessed and managed to minimise risks.
Staff were caring and treated people with dignity and respect. People and staff had good relationships. People told us they liked all of their care workers.
Staff received an induction and core training so they had the skills and knowledge to meet people’s needs. There were enough staff employed and staff were safely recruited.
People and their relatives knew how to raise concerns or complaints. People and relatives were regularly consulted by the managers.
The culture within the service was personalised and open. There was a clear management structure and staff, relatives and people felt comfortable talking to the managers about any issues and were sure that any concerns would be addressed. There were systems in place to monitor the safety and quality of the service provided.
Below is a summary of what we found in the areas we looked at. The summary describes what proprietor, manager and two members of staff told us and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
We looked at the provider's accident book and saw that since our last inspection one accident had been recorded, and appropriate action was taken by the member of staff to ensure to person's safety and welfare. The manager explained that they would be completing regular audits of accidents to check for any trends or triggers.
People who use the service were not always protected from the risk of abuse because the provider did not always take appropriate steps to identify the possibility of abuse and prevent abuse from happening.
Is the service effective and caring?
At our inspection on 21 and 29 May 2014 we identified that people's care and treatment was not always planned and delivered in a way that ensured people's safety and welfare. We did not specifically assess these areas at this inspection. This was because the provider had submitted an action plan detailing how they would address these shortfalls to be met by the 22 August 2014.
Is the service responsive?
People were able to comment on the service provided. The manager explained that an annual survey had been completed in April 2014. We saw that the results had been collated and analysed and an action plan was in place to address lower scoring areas. For example, feedback was received that people did not know who the management staff were. As a result of this feedback the provider sent a letter to people with the contact details of the management staff.
Is the service well led?
The provider undertook audits to check the quality of the service. For example, we looked at audit reports relating to care plans and medicines.
Staff told us that they received regular training and development; we examined four staff files that reflected this. The provider may find it useful to note that two staff files we examined showed that their training had expired by approximately two months. We discussed this with the manager who told us that they were aware of this and were in the process of arranging further refresher training.
The inspection was undertaken by one inspector over the course of two different days. Time was spent in the office, visiting people in their homes and talking with staff. In total we visited three people in their homes. We also spoke with one member of staff whilst they were on duty and two members of staff by telephone.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service caring?
' Is the service responsive?
' Is the service effective?
' Is the service well led?
This is a summary of what we found-
' Is the service safe?
Care was not always planned to meet people's needs. One person's moving and handling risk assessment stated that they required support from two carers. However when we visited this person in their home, we found that the person had been reassessed by an occupational therapist (OT) and was able to transfer with the support of one member of staff. This meant that the person was at risk of inappropriate or unsafe care.
We found that where people required assistance with taking their medicines, some care plans were inaccurate. For example, one person was recorded to require 'prompting' to take their medicine by care staff. However their medicine risk assessment stated that staff were required to 'administer' the medicine. This meant that there was contradictory guidance for staff regarding whether they needed to prompt, or administer this persons' medication. We looked at another person's medicine administration chart; we noted that they were prescribed medicines to be taken in the morning. However, when we examined their care plan, this was not reflected. This meant that care and treatment was not planned in a way that was intended to ensure people's safety and welfare.
People who used the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
' Is the service caring?
Throughout our inspection we received positive feedback from people who use the service and their relatives. One person commented that staff acted in a kind and caring manner. One person told us "Generally all of the staff are good. We did have one person who we didn't click with. They weren't doing anything wrong and we made that clear when we spoke to the office. They did listen to us and we haven't had that member of staff come back."
People confirmed that staff always took care to protect their privacy when providing personal care and encouraged them to do as much for themselves as possible even if this took longer.
' Is the service responsive?
Where a need was identified, there was not always a clear plan in place setting out how staff would meet this person's needs to meet this need.
There were arrangements in place to deal with foreseeable emergencies. One relative told us "My husband had a fall. The carer was very good and called the emergency services and then called me to let me know what was happening."
' Is the service effective?
We found that people's needs had been assessed before the package of care was started to ensure that they could meet their needs. However we also found that some care plans lacked the detail, or contradicted some of the delivery of care that the social services assessments had specified. For example, one person's assessment stated that staff must ensure that the person had a personal alarm on their person in case of emergencies. However the providers' care plan did not reflect this. We also saw that the person was assessed by social services as requiring a soft diet and liked cold drinks. However the providers care plan stated that the person enjoyed hot drinks and there was no record of dietary needs.
People told us that they were happy with the care they received and felt their needs were met. Staff spoken with understood people's needs and knew them well. One relative told us "We get our rota the week before. Generally we get the same staff visiting which is good."
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
' Is the service well led?
We found that the home had some systems for reviewing and monitoring the quality of service provided to people. However, these had not been implemented effectively to ensure that people were not at risk of unsafe or inappropriate care, or in a way that protected people from being at risk of harm.
We found that people's individual needs were assessed and that care was planned and delivered to meet their needs. A person told us "Staff make sure I am washed properly, have clean clothes and I am safe". Another person said "If you want anything you can ask them - it's quite alright as far as I am concerned".
We found that staff had completed training in safeguarding people from abuse and knew how to act if they had concerns.
People told us that they were satisfied with the standard of care they received from the provider's staff. One person said "they respect my dignity and they are careful". A person's relative said "on the whole they are quite good". We found that the provider had arrangements in place to ensure staff were supported and trained to deliver care to recognised standards.
We visited three people in their homes, spoke with one relative and the acting manager and observed three care workers supporting people.
One relative said 'we are very happy with everything' and another person said 'the carers are great'.
We found that people were treated with dignity and respect. They received the care they were assessed as needing. Care workers observed were respectful and knew people's care needs.
People received their medication and creams and prescribed. Records were completed and care workers were trained in medication administration.
Staff were safely recruited and checks were made to ensure they were suitable to work with vulnerable people.
There were systems in place for the monitoring assessing the quality of the service.
We visited the office where the service operates from. One visit was made on 27 June 2012 and a second visit on 2 July 2012. We examined records which related to staff recruitment, care plans and rosters for care workers. We also looked at the quality assurance system the provider had in place.
We spoke with the provider and visited one person who received a service at their home. We were able to speak with one care worker.
The provider informed us that they were providing care to 12 people.
The person we visited was happy with the care provided, but had a concerns about items being removed from their home whilst they were in hospital.
We tried to contact three other people who received a service by telephone, but were unsuccessful.
We found that people's had not always been involved in drawing up their plan of care. People's care plans and daily records did not fully evidence the assistance people needed to make sure their needs were met. Risk assessments had not been fully completed and did not fully identify all risks and actions needed to minimise these risks.
We looked at staff files and found that none of the files had all the information required in the regulations.
The provider had failed to implement a quality assurance system that complied with the regulations. This was a compliance action from the previous inspection. CQC has issued a Warning Notice which requires the provider to take action by 24 August 2012 to
meet the regulatory requirements. If this is not achieved further enforcement action
may be taken.
People told us that care workers from the agency were polite and respectful. They also told us that they had been involved in decisions about their care and how the agency would meet their needs.
Comments we received from people included;
"All the girls are very good and they always speak to me if they have concerns about my wife."
"The carers go beyond (the basics), and make sure the little things like hair and makeup are done too"
"On the whole, the carers are very good"
People told us that they felt safe with their carers and that they had confidence in the staff.
The people we spoke to told us that their care workers took sensible precautions to maintain hygiene and prevent the spread of infection. They told us that staff wash their hands, change gloves and wear aprons.
People using the service and/or their relatives told us that the agency provides the necessary care and support to meet their needs. They also said that the staff were kind and had got to know them so that they felt that the carers understood their needs and how to meet them.
We received comments such as 'They are lovely and they arrive on time' and 'They have all been very nice but there have been quite a few changes'
We were also told that people feel safe with the carers and have confidence in them.
Some people told us that they receive a schedule once a week advising them of which carers will be visiting. They said that this often changes at the last minute but they do not always get told about this.