We carried out a review of the data available to us about Caremark (Harrogate) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Caremark (Harrogate), you can give feedback on this service.
Caremark (Harrogate) is a domiciliary care agency providing personal care to people living in their own homes in and around the Harrogate area. The service was supporting 30 people at the time of our inspection.
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.
People’s experience of using this service and what we found
Significant improvements had been made to the service since the last inspection. People told us they now received their calls at regular times and had consistency in their staff team.
Safe recruitment processes were in place and followed. New staff completed a thorough induction and all staff had received regular and appropriate training.
Improvements had been made with regards to medicine management and people told us they received their medicines as prescribed. Directions in relation to topical medicines, such as creams was not always thoroughly recorded. The registered manager took action to address this.
Staff had received safeguarding training and were aware of when to report any concerns. Accidents and incidents were recorded, and audits were in place and used to identify any themes or trends.
People told us staff were kind, caring and made them feel safe. Consent to care and support was recorded and people were encouraged and supported to make their own decisions.
Staff worked in partnership with other professionals to ensure people received the care and support they needed. Professionals reported an improvement in communication and engagement since the last inspection.
The provider had developed thorough systems and processes to monitor and improve the service. These had only been completed for the month of December and required further embedding into the service.
People, relatives and staff spoke positively of the registered manager and provider and the open, positive culture that had been created. The management team regularly engaged with people and listened and took action to address any feedback or concerns shared.
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 requires improvement (published 2 December 2021). 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 and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 11 May 2021. Breaches of legal requirements were found, and we placed conditions on the providers registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.
We undertook this focused inspection to check they had followed their action plan, complied with the conditions placed on their registration and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. 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 (Harrogate) on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
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.
Enforcement
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.
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.
Caremark (Harrogate) is a service providing personal care in people’s own homes. Older and younger adults were supported, some of whom had a learning disability and or autism, mental health needs or were living with dementia.
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. They supported 14 people with personal care when we inspected.
People’s experience of using this service and what we found
People gave positive feedback about using the service and explained they felt confident raising concerns with the managers if needed. They enjoyed the care and support they received from members of staff.
The risk assessment process had improved. A new policy had been introduced, which placed responsibility on the registered manager to identify all hazards. We recommended the provider research evidence-based assessments and implement best practice around risk management. This included working with healthcare professionals for high-risk care tasks. This will reduce the likelihood that hazards will be missed and reduce the risk of avoidable harm to people.
Care worker induction had improved. More work had been carried out to ensure staff felt confident and competent before working alone. The care plan system was now available remotely for staff to view electronically. Not all specific details they needed to care for people was available, for example, instructions on when to give ‘as and when’ prescribed medicines and detailed moving and handling plans. The registered manager was keen to understand any feedback and make improvements in this area.
People told us they felt staff were well trained. All staff had received induction training, and the provider had recognised a more robust set of training topics was required. Not all training contained the minimum amount of knowledge required for staff and the new training package would rectify this. This was due to be implemented at the time of the inspection and had been delayed due to the on-going pandemic.
People now received a more responsive and timely service because the rota system was more organised. There was still room for improvement and the electronic data was now available to support the registered manager and provider to monitor performance more closely.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. We recommended the provider ensures care and support provided is linked to best practice guidance to enhance the outcomes people achieved.
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. Records to evidence consent and decision made in a person’s best interests were not always clear.
The registered manager had led the team well during the current pandemic and alongside making changes and improvements had ensured staff had all the equipment and knowledge of infection control to work safely.
The provider and registered manager worked well together and this had meant improvements had been made and increased the likelihood they will be sustained. The staff team and people they supported were diverse and work to ensure people were treated as individuals and equals was apparent.
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 requires improvement (published 24 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, improvements had been made and the provider was no longer in breach of regulations.
Although improvements continue to be made this service has been rated requires improvement or inadequate for the last four consecutive inspections.
Why we inspected
We carried out an announced comprehensive inspection of this service in May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing levels and induction and governance of the service.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. 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 (Harrogate) on our website at www.cqc.org.uk.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
Caremark (Harrogate) is registered to provide personal care and support to people of all ages.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This means tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, there were 17 older people who were receiving a service, 10 of whom received personal care calls.
People’s experience of using this service and what we found
People told us they felt safe and trusted staff who supported them. People felt that staff had good knowledge of how to protect people from the risk of harm and abuse. People and their relatives told us they were supported to access health care appointments when required.
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. People told us staff promoted their independence, choices and protected their dignity. Staff could describe people’s diverse needs and how they supported them.
Risk assessments were in place to guide staff on how to manage identified risks to people considering least restrictive options.
The provider had made improvements to their recruitment processes to ensure staff were recruited safely, and employment checks completed before they started working alone with vulnerable people.
Staff completed an induction but did not always have sufficient time shadowing other staff to ensure they were competent and confident before working alone. Staff received regular training, although the provider was unable to evidence PEG training had been completed for some staff. We identified that supervisions were not held in line with the provider’s policy and not all staff employed over 12 months had received an annual appraisal. The manager had not always completed checks to ensure staff were competent in their role.
On regular occasions the provider had been unable to staff some calls. There was some reliance on agency staff to ensure some calls were covered. Since the inspection the provider has been working with other agencies to improve the service delivery.
Medicines management was not always robust. The provider had failed to ensure recommendations made by the pharmacist in December 2018 were actioned. This was an area of focus and the local authority and other agencies are working with the provider to ensure improvements are made.
Staff knew how to support people to eat a healthy diet and maintain good hydration.
Care plans had been reviewed and people and/or their relatives had been involved in this process. These had a person-centred focus and described people’s preferences and routines. There was no-one receiving end of life care at the time of the inspection. However, the manager told us that any end of life care planning would be recorded when needed to ensure peoples’ choices were respected.
Communications had improved, and people told us they received satisfaction surveys or spoke with the manager to give feedback about the service. Complaints had been recorded and investigated in line with the provider’s policies.
The provider’s quality monitoring system required further improvements to be made. Regular audits had not always been completed as the manager was covering other tasks that had taken up their time. Where advice and recommendations had been by made health professionals, these had not always been fully implemented.
The current registered manager was supported by another manager whom shared responsibility for the day to day running of the service, we have referred to them as the manager throughout this report.
Feedback from staff, people and their relatives about the manager was positive. Staff said they could raise issues with them and found them supportive. People and their relatives found the manager approachable and effective in their management skills.
Both the registered manager and the supporting manager acknowledged further improvements were required. These were improvements in relation to the running and governance of this service which needed to be sustained and embedded over a longer period of time. The registered manager advised that they had plans to ensure the manager took over their responsibility of the registered manager’s role in the near future. This would enable both to focus on the oversight of the service and drive improvements to sustain a better quality of care for people.
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 4 December 2018) and there were multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, improvements had been made in some areas. However, further work was required to ensure improvements were sustained and the provider was still in breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This service has been in Special Measures since 2 December 2018. 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.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
This service is a domiciliary care agency. It provides personal care to predominantly older people living in their own houses and flats in the community.
Not everyone using Caremark Harrogate receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
The service had a registered manager who was also the sole director of Monark Limited and the provider's nominated individual. 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.
At the last inspection in July 2017, there was a breach of regulation regarding the governance of the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least 'Good'. We found the provider had failed to achieve this and identified a continuing breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At the commencement of our inspection the service supported 32 mainly older people. At the end of the inspection 20 people were supported. This was because people found alternative providers or their care needs had changed. The provider acknowledged they did not have the capacity to meet the needs of some people being supported due to staff leaving and asked the local authority to become responsible for supporting them.
People did not have personalised and detailed risk assessments with up to date care plans which had been reviewed. The service was not identifying all the risks which people faced to enable staff to respond and manage these risks.
Staff were not safely recruited. There were gaps in staff recruitment checks and we could not be assured if they were safe to work with vulnerable people. On the first day of our inspection the recently appointed care manager, had developed a matrix which showed where they had identified checks needing to be completed and the action taken already to address them.
The provider lacked systems to ensure the safe management of medicines. People were not always supported by staff who were appropriately trained, competent and skilled. Staff were not provided with regular supervision to do their job effectively. People's care records were not always as per the requirements of Mental Capacity Act 2005 (MCA). Not all people's care plans were person centred. Care plans to guide staff where people needed support with eating and drinking were not detailed.
Some people had missed and late care visits and the provider did not have sufficient systems in place to manage and prevent this from happening again.
Confidentiality was not always maintained. We recommend the service address this through appropriate training.
Complaints were not being managed in line with the provider's complaints policy. We found complaints were not responded to or in a timely manner and they had not been monitored to identify any trends.
The registered manager was not completing regular quality monitoring checks to review the quality of the service and make plans to make improvements. People were not asked for their feedback about the quality of the service being provided.
People told us the staff who supported them regularly, were kind and caring and respected their privacy and dignity.
The registered manager voluntarily decided not to accept any new care packages and agreed to be supported by the local authority and Caremark’s regional development manager to make improvements. Prior to our inspection, a new care manager had been appointed. They had started to identify the shortfalls in the service and had developed plans to address these.
We found six breaches of regulations during the inspection. These were in relation to fit and proper persons employed, safeguarding service users from abuse and improper treatment, safe care and treatment, staffing, receiving and acting on complaints and good governance.
You can see what action we told the provider to take at the back of the full version of the report.
At this inspection we found standards had deteriorated. The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures.'
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying their terms of 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 questions it will no longer be in special measures.
We inspected this service on 21 and 28 July 2017. The inspection was announced. The provider was given 48 hours’ notice of our inspection, because the location provides a domiciliary care service and we needed to be sure someone would be in the location’s office when we visited. At the time of our inspection, there were 32 predominantly older people using the service. This was our first inspection of this location since the service moved offices in August 2015. The provider’s previous location was rated ‘Good’, when we inspected in May 2015.
The service had a registered manager who was also the sole director of Monark Limited and the provider’s nominated individual. 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. We have referred to the registered manager as ‘manager’ throughout this report.
During the inspection, we found people’s care plans and risk assessments had not been consistently updated as their needs changed. Whilst the manager was in the process of addressing these concerns, it showed us that effective systems had not been put in place to ensure people’s needs were regularly reviewed and their care plans updated.
We identified some issues with Medication Administration Records (MARs). The provider’s audits had not identified and addressed these concerns. People’s MARs and daily notes had not been returned to the office and audited in a timely manner to monitor and identify any issues or concerns with staff’s practice. Recruitment records did not consistently evidence when Disclosure and Baring Service checks had been completed.
We received mixed feedback about staff’s reliability and punctuality. We noted there had been some issues with missed visits and variation in the time that staff arrived to provide people’s care and support. We spoke with the manager about the need to more robustly monitor and analyse issues with staff’s punctuality and reliability in response to people’s feedback about staff arriving late. They agreed to look into these concerns.
We received mixed feedback about the management and organisation of the service. We concluded the issues and concerns we found showed us the service had not been consistently well-led. Whilst improvements were being made, more robust systems of quality assurance were needed to monitor and maintain consistency.
These concerns were a breach of regulation relating to the governance of the service. You can see what action we told the provider to take at the back of the full version of this report.
Despite these concerns, people who used the service told us they felt safe with the care and support staff provided. People were protected from the risk of abuse by staff who were trained to recognise and respond to safeguarding concerns.
Staff completed training and spot checks were completed to monitor their practice. Staff told us they felt supported by management and that additional advice and guidance was available if needed.
Staff sought consent before providing care. Consent to care was documented in people’s care plans and capacity assessments and best interest decisions were made where necessary. Staff provided effective care and support to ensure people ate and drank enough. When people were unwell, staff ensured they were supported to access healthcare services.
People told us staff were kind and caring. Feedback showed us people had developed positive caring relationships with the staff that supported them and clearly valued the meaningful interactions they shared. Staff supported people in a way which maintained their privacy and dignity.
People told us staff provided person-centred care. There were systems in place to enable people to raise issues and concerns and to provide feedback about the service.