Caremark (Wokingham and Bracknell)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.
 

This service scored 59 (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 had systems in place for accidents, incidents and complaints to be recorded.

Staff were encouraged to raise concerns when things went wrong. We saw incidents were recorded, reviewed and used to promote learning across the service. Learning from incidents informed reviews of care plans and risk assessments, and staff were provided with guidance to support appropriate responses to identified risks and escalation requirements.Learning was shared through team meetings, training and governance processes, with actions monitored to support continuous improvement.

People and relatives told us they knew how to raise concerns and were confident these would be dealt with appropriately.Staff told us team meetings were used to share learning outcomes.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager explained the referral process to us during this assessment. They told us once a referral was received and accepted, they would ensure the care plan was created before any staff completed a care call. The registered manager told us they also ensured the supervisor was in attendance with the carer on the first visit. The service completed telephone monitoring calls to the person receiving care a week after to ensure they were happy with the care provided. This approach helped to ensure people received care that was planned, safe and appropriate to their individual needs before care was delivered.
 

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

We found 2 incidents where someone with history of self-harm injured themselves. The person’s Positive Behaviour Support plan stated staff should still contact the crisis team, even if the person did not want them to. However, the person’s care record did not demonstrate staff did this. This did not ensure the person was always safeguarded from avoidable risk of harm to themselves.

Staff completed safeguarding training. A staff member told us, “If I think there is anything happening wrong, I will straight away call the line manager. If in danger I will call 999.” People and their relatives told us they felt care was safe and did not raise any safeguarding concerns. The provider confirmed there were no ongoing safeguarding incidents at the time of the assessment
 

The provider did not always work well with people to understand and manage risks.

We found people’s risks were assessed and care plans were in place to guide staff in supporting people safely. However, we found some aspects of the risk management documentation lacked sufficient detail about the specific actions staff should take to manage and mitigate identified risks. These inconsistencies, and in some cases a lack of information, increased the risk of people receiving unsafe or inappropriate care.

We reviewed several care plans and risk assessments. We found these contained detailed information and guidance for staff to follow. However, we found 1 person’s care record did not contain important information about their high-risk condition. This meant staff did not have adequate guidance and knowledge about recognising signs of a crisis and when to escalate for emergency support. We shared these concerns with the provider, and they took immediate action to update the person’s care plan. However, this demonstrated the provider’s own systems and processes had not identified this.

Another person required transferring with hoists. We found more than 1 occasion where staff identified a person was being transferred unsafely. However, we did not see supporting evidence this was identified and actioned without delay to mitigate the risk of avoidable harm.
 

The provider had systems in place to support safe moving and handling, including staff training, workplace observations and equipment monitoring records.

Care plans included guidance regarding the use of equipment and two-person transfers. During our assessment we reviewed records which raised questions regarding the consistency of transfer arrangements for some people; however, additional evidence provided demonstrates that, in one example reviewed, a trained family member was authorised within the care plan to participate in transfers alongside care staff. However, the provider’s own systems and processes had not identified the concerns we found. If staff felt the moving and handling procedure they were completing was unsafe, this did not demonstrate they were able to apply their learning and competency without potential risk of harm.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective development.

Staff completed relevant training and demonstrated an understanding of how to support people with a range of needs. Following receipt of additional evidence during the factual accuracy process, we noted records showing most staff had completed self-harm training relevant to the needs of a person they supported. We also saw care planning documentation which provided guidance for staff in managing identified risks.However, we continued to identify gaps in evidence relating to training and competency records for some delegated healthcare tasks, including blood pressure monitoring. We also found 1 incident in which a staff member supported a person who self-harmed without training.

Supervisions and spot checks were carried out regularly to support staff with their training and wellbeing needs. Systems for robust recruitment practices were in place
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us staff wore appropriate personal protective equipment (PPE) when providing care. Staff told us they had access to PPE and used this when providing care. The registered manager told us they completed spot checks every 3 months to ensure infection prevention and control practices were followed. Where any concerns were identified, the manager told us they reissued training and spot checks for staff. This helped to minimise the risk of infection and cross-contamination and supported people and staff to remain safe.
 

The provider did not always make sure that medicines were recorded accurately and they maintained oversight of people’s records.

We reviewed people’s medicine administration records (MAR) and found people’s medicines were not accurately recorded when administered. The provider had identified some concerns around this in their own audits and discussed this in staff meetings. However, there was a risk people’s medicines were not being administered safely due to the incorrect entries and records. There were also concerns that records did not always accurately reflect the time medicines were actually administered and which medicines were administered. This meant people were at risk of incorrect monitoring. For example, 1 person’s record demonstrated they were administered pain relieving medicine with 2 to 3 hour gaps between doses. The recommended spacing is 4 to 6 hours. This was not in line with the prescribing guidance.

Another person was prescribed a medicine to be taken twice a day, with 12-hour spacing. We found their medicine record demonstrated this was administered at 8-hour intervals. One person also required antibiotics to be administered twice a day, yet the MAR chart showed this was only administered once a day. This did not demonstrate medicines were always monitored and managed safely to ensure the desired therapeutic effectiveness was maintained.

The provider did not demonstrate they always maintained effective oversight and monitoring of this and took immediate action to ensure accurate records were maintained.

Staff told us how they supported people with their medicines. One staff said, “It depends on the person’s needs. If it’s supposed to be administered, we do it from original boxes or Nomads. If [we] have to pick up from the pharmacy, we do it as well. It is all in the care plans