2 December 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
The inspection was completed by three inspectors. Two inspectors visited the location offices and a third inspector supported by making telephone calls to people using the service, their relatives and staff to ask for their feedback about the service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the CQC. A registered manager along with the provider are legally responsible for how the service is run and for the quality and safety of the care provided. A manager had been recruited and we were told they would be applying to become the registered manager.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 11 May 2021 and ended on 6 June 2021. We visited the office location on 11 May 2021.
What we did before the inspection
We reviewed information we had received about the service and sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a provider information return before this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
We spoke with six people who used the service, four people’s relatives and two health and social care professionals about their experience of the care provided. We spoke with the nominated individual, care coordinator, care supervisor and four members of care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four staff’s files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
After the inspection
We continued to review information from the inspection and to seek clarification from the provider to validate evidence found.
2 December 2021
About the service
Caremark (Harrogate) is a domiciliary care agency providing personal care to people living in their own homes. The service was supporting 15 people at the time of our inspection.
Not everyone who used the service received personal care. The Care Quality Commission (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.
People’s experience of using this service and what we found
People received inconsistent and at times unsafe care. COVID-19 risks had not been adequately assessed and managed, increasing the risk to people who may be vulnerable.
Robust systems were not in place to safely manage people’s medicines. Audits had not been completed to monitor, identify and address the concerns we found.
Whilst some people praised the kind and caring staff, there were inconsistencies in the quality of the care provided. This impacted on people’s experience of using the service and meant they were not always supported to achieve good outcomes. The provider had not operated a robust system to monitor and make sure staff were suitably trained and competent.
The service was not well-led. The provider had not taken adequate steps to monitor the service and to make sustained improvements.
Audits had not been used effectively to monitor quality and safety issues. Problems with staffing levels, and failures in the provider’s management, recording and monitoring of concerns, incidents and safeguarding issues put people at increased risk of harm.
The provider had begun responding to concerns and had acted to make sure enough staff were deployed. They sent us information following our site visit about the actions taken to start testing staff for COVID-19, to provide additional training and set up a system to help monitor and make sure spot checks and competency assessments had been completed. Whilst some feedback recognised recent changes, further sustained improvements were needed.
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 Requires Improvement (published 21 October 2020). At this inspection, not enough improvements had been made and the service remains rated Requires Improvement.
This service has been rated Requires Improvement or Inadequate for the last five consecutive inspections.
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels, staff’s training and the organisation and leadership of the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
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 identified breaches in relation to the safety of the service and the provider’s oversight and governance arrangements. Please see the action we told the provider to take at the end of this report.
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.