Caremark (Wokingham and Bracknell)

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service was in breach of legal regulation in relation to good governance.
 

This service scored 57 (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 a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff were involved in regular team meetings, and the registered manager told us meeting minutes were sent to staff who could not attend. We reviewed these meeting minutes and found there were regular discussions about shared culture and values. We found staff were updated in meetings and supervisions about any changes in their organisation, including any actions being taken in the office.Staff were able to tell us the values of the service. One staff said, “Care values is empathy patience and dedication reliability and advocacy.”

People and relatives felt the service worked well together. One person said, “All the staff in this organisation seem well trained, organised and good at their various roles. I would recommend them.”
 

Not all leaders understood the context in which the provider delivered care, treatment and support. They embodied the culture and values of their workforce and organisation.

During our assessment we identified some inconsistencies in record-keeping, medicines management and statutory notification processes. We found leaders had established governance systems which included incident reviews, care plan audits, staff meetings, training and learning reviews. Evidence showed leaders acted on concerns by updating care plans, reviewing risks and sharing learning with staff.

However, the issues identified during the assessment demonstrated that governance systems had not always identified and addressed concerns at the earliest opportunity and required further strengthening to ensure consistent oversight.

Staff told us how they worked with the registered manager to identify any development and learning needs. One staff said, “We have a meeting with the manager and [are] going through a lot of questions asking if I have any problems, asking what I am supposed to know, any concerns I want to speak about. It is important to be heard and not to feel alone when providing a care at home service."
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they felt able to speak up. One staff said, “If I speak for anyone, they listen carefully and act quickly.” The provider had a freedom to speak up policy in place at the time of the assessment. We reviewed incident reports and found the provider encouraged staff to speak up if concerned about safety incidents.

The registered manager told us, “We try to encourage people to be open and honest with us. We will sit and have a chat and eventually they do talk and open up, it’s about giving them time to know you are there to support them.”
 

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they were supported to request and access additional training opportunities if needed. Staff also told us, “I [have] a health problem and if something is needed, I can ask for a day off, they never say we cannot do that for you. I feel support and everything from the office.”

At the time of this assessment there was an equality and dignity at work policy in place. Staff received training in equality, diversity and inclusion. The registered manager told us they completed annual appraisals and regular supervisions. The registered manager also said, “We have an open-door policy, staff can come and see me if they have any issues. We do health and wellbeing in their spot checks to make sure their workload is ok.”
 

The provider did not always have clear responsibilities, roles, systems of accountability and good governance. They did not always act on the best information about risk, performance and outcomes, or always share this securely with others when appropriate.

At the time of this assessment, we identified concerns relating to people’s risk management, oversight of medicines and regulatory requirements to submit statutory notifications. This meant risks to people's health, safety and welfare were not always recognised, monitored or mitigated. This also meant staff and leaders could not always access complete and accurate information about people's needs, risks and care, limiting the provider's ability to monitor the quality and safety of care being delivered.

Although there were systems and processes in place to monitor and improve the service, these systems had not always been effective in identifying concerns we found including some medicines being administered incorrectly and medicine administration records not containing all medicines being administered. The provider did not demonstrate how they always maintained effective oversight of people’s needs to ensure positive clinical outcomes.

As a result, the provider could not always demonstrate effective oversight of the service or assure themselves that people were receiving consistently safe and effective care. This increased the risk that concerns would remain unidentified and people could be exposed to avoidable harm
 

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners and collaborate for improvement.

The registered manager told us they worked closely with the local authority to drive improvement. People’s care records contained information about external services who also supported people’s care and treatment, such as mental health teams and district nurses. However, information was not always shared between the provider and professional partners. This did not demonstrate the provider clearly understood their duty to collaborate. For example, CQC were not notified about certain incidents which were a statutory requirement for the provider to complete.

The provider shared contact information with CQC for the professional partnership services they worked with
 

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

We were not always assured that learning and improvement were consistently embedded within the service. We found systems and processes were in place, including care plan audits, however these had not always been effective in identifying the gaps and discrepancies relating to people’s care planning, risk management, and record keeping. This meant opportunities for learning and improvement were not always recognised or acted upon.

We found the provider remained in breach of Regulation 17 identified at the previous assessment. The provider did not demonstrate they had implemented sustainable changes from identified learning to ensure there was continuous improvement in the service.