Archived: Caremark (Redbridge & Waltham Forest)

Caremark (Redbridge and Waltham Forest) is a domiciliary care agency providing personal care to adults and children. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection there were 56 people using the service who received personal care.

People’s experience of using this service and what we found

People were safeguarded from the risk of harm and abuse. Staff were recruited safely. People were protected from the risks associated from the spread of infection. Medicines were managed safely. People had risk assessments to protect them from the risks they may face. We have made a recommendation about risk assessments.

People’s needs were assessed before they began to use the service. The provider worked jointly with healthcare professionals to ensure people’s needs could be met. People were supported with nutrition and hydration. Staff were supported with training and supervision. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff obtained people’s consent before delivering care.

Staff demonstrated they knew the people they supported well and understood how they preferred to receive their care. People and relatives were able to express their views about the care that was provided. Staff knew how to respect people’s differences. People’s privacy, dignity and independence was promoted.

Staff understood how to provide a personalised care service. People’s choices were respected. Care records were personalised, contained people’s preferred method of communication. People and relatives knew how to complain and the provider had a system to record concerns. The provider understood how to provide end of life care in accordance with people’s wishes.

People, relatives and staff spoke positively about the management of the service. Staff and management understood their roles and responsibilities. The provider had a system to obtain feedback from people and to audit the quality of the service in order to make improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 02/02/2022). We identified breaches at the last inspection in relation to safeguarding people from abuse, person-centred care, staffing, recruitment, receiving and acting on complaints, dignity and respect, safe care and treatment and good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made but the provider remained in breach of the regulations.

At our last inspection we made two recommendations around communication and obtaining consent to care. At this inspection we found improvements had been made in these areas.

This service has been in Special Measures since 2 February 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the provider operating from an unregistered location. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the well-led section of this full report.

We have made a recommendation about reviewing risk assessments.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Caremark (Redbridge & Waltham Forest) is a domiciliary care agency providing personal care to 70 people in

their own homes in North East London.

People’s experience of using this service and what we found

People were not kept safe from the risk of abuse. The provider’s safeguarding system was not effective, and not all staff had been trained about how to safeguard people from abuse. Medicines were not always managed safely.

People and their relatives told us staff did not always wear personal protective equipment such as masks and gloves when staff were supporting them.

The provider’s recruitment process was not robust enough to ensure staff were of suitable character to work with adults at risk which put people at risk of harm.

People and relatives told us the provider did not have enough staff to keep people safe and meet their needs. People’s care visits were regularly missed or started late.

People and their relatives told us staff did not always have the right knowledge and experience to effectively support people in line with their needs and preferences. Staff had not received training about providing care with dignity in a person-centred way. People told us they were not supported by a consistent staff team but their more-regular carers were polite and friendly.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The provider did not have a system to monitor the quality of the care provided. The provider did not manage complaints well. People and their relatives told us they did not feel listened to. The service’s culture was not open and empowering. People and their relatives were not routinely asked to feedback about their experiences of the care provided. People told us communication with the office was difficult. There was a new management team in post at the service and people told us some improvements had begun to be made but there was a lot more progress that needed to be made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 January 2020).

Why we inspected

We received concerns about people being at risk of abuse. As a result, we undertook a focused inspection to review the key question well-led and key line of enquiries from other key questions. During the inspection we found other concerns and broadened the inspection to look at all five key questions.

We reviewed the information we held about the service. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caremark (Redbridge & Waltham Forest) on our website at www.cqc.org.uk.

Enforcement

For enforcement decisions taken during the period that the ‘COVID-19 – Enforcement principles and decision-making framework’ applies, add the following paragraph: We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from abuse, person-centred care, staffing, recruitment, receiving and acting on complaints, dignity and respect, safe care and treatment and good governance at this inspection.

We have made a recommendation about meeting communication needs.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Caremark (Redbridge & Waltham Forest) is a domiciliary care agency providing personal care to 85 people in their own homes in North East London.

People’s experience of using this service and what we found

People told us they felt safe at the service. Staff knew to report any allegations of abuse to the registered manager but were not always aware of the procedure to follow if they needed to 'blow the whistle' on poor practice. There were no instances of poor practice found during the inspection and the registered manager took immediate steps to increase staff knowledge.

People told us staff were caring and friendly. Their dignity and privacy were promoted, and their diversity was championed. People felt confident they could contact the office if they needed to make a complaint.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff received training to help them carry out their roles. Staff supported people to eat and drink enough and to have access to healthcare.

The provider created a personalised electronic care plan for each person and updated them regularly. Risks to people’s health and wellbeing were assessed and managed effectively.

People told us the service was well run. There was an open and inclusive culture at the service and the provider had effective systems in place to assess the quality of the service and make any improvements necessary improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 10 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is a domiciliary care service that provides personal care to people living in their own homes. At the time of our inspection there were 112 people using the service. The service is required to have a registered manager. The service had two registered managers in post. 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.

Systems were in place to minimise risk and to ensure that people were supported as safely as possible. Staff were aware of their responsibilities to ensure people were safe and what to do if they suspected any abuse or had other concerns. They were confident that the registered manager would address any these.

Risk assessments were undertaken and staff knew what actions they needed to take to keep people safe and minimise any potential risk of accident and injury. People were protected by the provider’s recruitment process which ensured staff were suitable to work with people who need support.

Adequate staffing levels ensured that people received a consistent service from staff who they were familiar with, knew of people's individual circumstances and could meet their needs. Appropriate systems were in place regarding medicines management so that people were supported to take their medicines as appropriate.

Staff received induction training and the support they needed when they started work. This ensured that they did their job safely and they provided support to people in the way they preferred. Staff told us that they had received training that was required to meet people’s needs and to keep them safe.

People and their families were involved in making decisions about their care and how it was delivered. People were supported and encouraged to make choices about all aspects of their care and support. Staff supported people, where required, to have drinks and meals that they enjoyed.

People were cared for and supported by staff who were kind and caring. Staff supported people to be as independent as possible. People were encouraged and supported to undertake daily tasks. The service had a system in place for receiving and responding to complaints. People who used the service and their relatives were aware of the complaints procedure and knew who to speak with if they had concerns.

Systems were in place to evaluate and monitor the quality of the service in order to make continuous improvements to the service.

People, relatives and staff had confidence in the management team and the service. People we spoke with told us that the quality of service was good and that the management were approachable and helpful. The provider had quality assurance processes in place to improve the service.