Background to this inspection
Updated
18 January 2022
The inspection
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.
Inspection team
This inspection was completed by one inspector.
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 Care Quality Commission. This meant the provider was legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 19/01/2021 and ended on 09/02/2021. We visited the office location from where the regulated activity personal care was carried on from (which was not the registered location) on 19/01/2021, 02/02/2021 and 09/02/21.
What we did before the inspection
The provider was not asked to complete a provider information return prior to 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 carried out an assessment of the location through our transitional monitoring approach prior to our decision to inspect the service. This is where we review all the information that we have about the service and subsequently have a conversation with the registered person either online or by telephone. This is not an inspection and we do not rate services following this approach. Concerns identified during this review meant we decided to complete a focussed inspection.
We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and five relatives about their experience of the care provided. We spoke with twelve members of staff including the provider, acting manager , care coordinators, field care supervisors and care workers. We spoke with a National Operations manager from the Caremark Franchise during the inspection. We also spoke with commissioners from the relevant local authorities who commissioned care packages provided by the provider and one social worker.
We reviewed a range of records. This included 10 people’s care records and multiple medication records. We looked at four staff 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 seek clarification from the acting manager and provider to validate evidence found.
Updated
18 January 2022
About the service
Caremark (Walsall and Wolverhampton) is a domiciliary care service that was providing personal care to 51 people on the first day of our inspection. The service supports adults with dementia, learning disabilities or autistic spectrum disorder, physical disability and sensory impairments.
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.
When we inspected the service, we found they were not providing the service from the location registered with CQC, we have discussed this within the report.
People’s experience of using this service and what we found
Systems or processes were not operated effectively as the provider had failed to ensure there was consistent and effective leadership of the service. This meant the provider had little oversight of the service which placed people at risk of harm through not receiving consistent safe care.
People were not safeguarded from potential abuse and neglect as there had been occasions where adult abuse was not recognised and reported to local safeguarding teams.
People’s risk assessments were not always accurate and up to date with information about their needs. This placed people at risk of not receiving care in line with their needs as staff did not always have guidance in place to meet these.
People’s medicines records contained gaps that could not be explained and there was no oversight or audits of systems to manage people’s medicines. This meant there was limited assurance that people had their medicines as prescribed.
People were not protected from the risk of COVID-19 as the provider had no systems in place to monitor and mitigate risks relating to COVID-19. The provider had also failed to ensure staff had training in relation to COVID-19. People did tell us staff used facemasks, gloves and aprons when providing care.
People were not supported by staff who had been recruited safely as not all staff were subject to the full range of checks needed to ensure they were safe to work with vulnerable people before they commenced worked.
People were unhappy with the number of staff that visited them as opposed to a consistent group of staff. Despite this people did say they got on well with the staff visiting them.
People had raised complaints through the provider’s telephone monitoring calls, and these had not been investigated by the provider. This meant people were not be reassured their views would be considered and used to improve the service.
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 the service at their previous location was Good (published 27 February 2019).
Why we inspected
We received concerns in relation to staffing, people’s safety, management of medicines and management. As a result, we undertook a focused inspection to review the key questions of Safe and Well - led only.
We reviewed the information we held about the service. We have not reviewed the rating for effective, caring and responsive. This is because we only looked at the key questions we had specific concerns about. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caremark (Walsall and Wolverhampton) on our website at www.cqc.org.uk.
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 have identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed and good governance at this inspection.
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
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.