Caremark (Wokingham and Bracknell)

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.At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We found 1 person’s care plan that instructed staff to measure the person’s blood pressure, but did not detail what staff should do if the person’s blood pressure was high or low. Records showed that staff took and recorded the person’s blood pressure but staff did not demonstrate they always escalated this and sought guidance and input from healthcare professionals. This meant people were at potential risk of avoidable harm.

The provider completed regular care plan reviews. The registered manager told us, “We do a 6-month review, unless they have gone to hospital and there are changes in their needs. We will message the carers once the care plan has been updated before they go to the person.”

Relatives told us they helped to create their family member’s care plan and completed reviews with the service
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Some people using the service required support with skin integrity. Although the provider did not use a formal pressure ulcer risk scoring tool, they demonstrated evidence-based skin integrity monitoring and escalation arrangements were in place.However, we reviewed the staff training matrix and found no supporting evidence that all staff completed training for pressure ulcers.

Care plans documented people’s support requirements in relation to nutrition and hydration needs. People with diabetes and epilepsy had risk assessments in place, which documented signs staff should look out for if people’s conditions required emergency treatment
 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us they worked well together to support people and their needs. One staff said, “Some of the clients we have to [support with eating]. If we need extra time we contact the office. They can be slow and need 45 minutes rather than 30, we tell the office and it is taken care of.”

When people were assessed by external services including occupational therapists (OT) and Speech and Language Therapists, we found this information was available on care records.
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The provider demonstrated how they supported people in line with their individual needs. For example, 1 person required support from staff to take their blood pressure. We found staff regularly supported the person to do this and worked with the family to provide the blood pressure readings.People and relatives told us they felt staff were sufficiently trained to support people to maintain their health. One relative told us, “[Family Member’s] care helps [person] to stay calm and feel safe at all times.”
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We found the provider did not always maintain oversight of monitoring to ensure positive outcomes. For example, one person with diabetes required fluid monitoring because they were at risk of dehydration. The person did not have a fluid monitoring chart in place to ensure oversight of hydration was maintained. The provider confirmed staff left drinks with the person. However, this did not demonstrate how they assured themselves the person received adequate hydration levels and if they were in line with their target.

Additionally, we found 1 person was administered a prescribed nutritional supplement; yet this was not recorded on their MAR chart to ensure the person was safely monitored. This special nutritional product contains energy (calories), protein, vitamins and minerals. They are designed for people who, because of illness or incapacity, are unable to eat enough food to meet their body's daily needs for energy and nutrients. The person’s care plan did not include the reasons for prescribing, how much to give, when to give and how often to monitor the person’s progress. We found there was no record maintained about the person’s treatment and care, such as monthly weight checks or fluid intake charts. This meant the person was not effectively monitored to ensure they always achieved positive clinical outcomes.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider completed mental capacity assessments and staff received training for this topic. Although capacity assessments were in place, we found these were not always carried out in line with the codes of practice and did not always clearly demonstrate people’s support was maximised to participate in these assessments. For example, when English was not the first spoken language, the provider did not demonstrate how they supported the person with a translation service to ensure they could participate in their assessment. Additionally, we found 1 capacity assessment was recorded with several decisions. This did not demonstrate the capacity assessments were always decision and time specific.

Information relating to lasting power of attorney was contained in people’s care record. The provider confirmed at the time of the assessment there was no one supported with a court of protection