Archived: Caremark Swindon

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this registered service. This key question has been rated inadequate.: This meant the effectiveness of people’s care, treatment and support did not achieve good outcomes or was inconsistent.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and leaders told us people’s needs were assessed before they started using the service. People had care needs assessments in place, and these were detailed. However, information resulting from these was not always transferred to people’s care and support plans, such as information about people’s social, religious and cultural preferences, and people’s medical history. We raised this with the nominated individual, who explained this information was recorded within the care needs assessments. However, this information was not easily accessible by staff and staff were not always aware of information recorded within these assessments, such as people’s social, cultural or religious needs.

People and their relatives told us they were involved in the planning of people’s care. Widely recognised tools were used in some cases to assess people’s risks, such as relating to pressure damage and malnutrition. However, these were not used consistently or effectively for some people. For example, ‘Waterlow’ is a tool to assess whether people are at risk of skin integrity issues. We found one person who’s calculated ‘Waterlow’ score was 10, meaning the person was at risk of skin integrity issues, but there was no information within this person’s care plan to guide staff how to manage this risk.

We received mixed feedback from staff about teamwork within the service. One staff member told us, “We leave notes for each other”. However, another staff member told us, “I wouldn't say the teamwork is great. Some staff leave tasks for the next carer to do or do not tidy up after themselves. Certain members of the team I feel I can go to and get support and advice.” Although team meetings took place, there was no process to share the contents of these to staff who could not attend, meaning that some staff may have missed some information. There was evidence of the service working with other healthcare professionals such as the district nurse team, however, advice was not always correctly communicated to staff, such as the example with the incorrect required food textures in a person’s care plan.

Although people’s care plans contained reference to supporting people to live healthier lives, we found this information was generic and was not personalised to people. For example, 3 people’s care plans stated, “Having a healthy balanced diet and plenty of fluids is an important area in supporting my physical and mental wellbeing.” There was no information about what this meant for each person. However, people and their relatives felt staff supported people to live healthy lives and raised no concerns. Staff told us how they supported people to live healthy lives, such as by encouraging good nutrition and ensuring people have access to any facilities or equipment they require. The staff member told us, “If there are any problems health-wise we would contact the GP and district nurse.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes for people were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. We found people’s care and support plans did not always contain information to enable staff to monitor outcomes. For example, people did not have their medical history recorded within their care plans. This meant there was a risk that staff would not know the signs to look out for to proactively manage any previous conditions. Additionally, information from people’s risk assessments was not always transferred to people’s care plans, meaning staff may not be aware of how to monitor any risks. We asked staff if they could provide any examples of where a person had improved since being supported by the service. One staff member told us, “To be completely honest, I don't think any of my customers have improved.” Although, this staff member explained, “This one person I [support] does get up out of bed now and gets showered and dressed, but I believe this is because she's moved in with her daughter. So, she has something to get up for.” The NI provided an example where an additional call was put in place to support a person to improve their mobility, and we saw evidence these calls had been implemented.

Processes to assess whether people had capacity to make specific decisions and to make best interest decisions on their behalf were not always in line with legislation and national guidelines. For example, one person had a mental capacity assessment which had been completed in October 2023 which had not been reviewed in line with best practice guidelines. This meant the assessment may not have remained relevant, proportionate and appropriate. Additionally, this person did not have decision-specific mental capacity assessments in place. For example, the person did not have an assessment to determine whether they had capacity to consent to the administration of medicines from staff. We found the service did not follow the Mental Capacity Act in a decision around a person’s eating and drinking habits. The NI told us a person’s family had requested staff to leave foods which contradicted guidance provided by a speech and language therapist in relation to safe eating and drinking. The provider had not followed the mental capacity process to determine if the person had the capacity to make this decision themselves, or if the request by the person’s family was in the person’s best interest. Staff had some understanding of the Mental Capacity Act and gave examples of how they applied this within their roles, however, one staff member told us this training had only recently been made available to staff.