Archived: Williams CM Ltd

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.

Williams CM Ltd is a domiciliary care service providing personal care to 16 people at the time of the 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.

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

People were placed at risk of harm because the provider had failed to address the concerns identified at the last inspection. People received support from staff who had not always received appropriate training and had not been safely recruited. Where people received support with their mobility needs, staff had not always been suitably trained to carry out this support. There was poor oversight of medicines administration and we found errors the provider had not identified. Infection control practices remained poor and staff did not always follow government guidance around the use of Personal Protective Equipment (PPE). This place people at risk of harm.

The provider had failed to establish effective systems to monitor the quality of care people received and drive improvement. Records relating to the care people received with their personal care and medicines were not reviewed to ensure people received a safe standard of care. Recruitment processes had not been established which meant some staff may not be safe to work with people. Feedback from people and staff reflected some concerns with the provider and staff did not always feel listened to. The provider had not worked in partnership with others when making decisions about some people’s care.

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 1 April 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been in Special Measures since 31 March 2021. At this inspection enough improvement had not been made and the provider was still in breach of regulations and therefore remains in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service between 19 January and 9 February 2021. Breaches of legal requirements were found. We identified breaches in relation to safe care and treatment, staffing, fit and proper persons employed and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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 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 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 Williams CM Ltd 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 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 safe care and treatment, staff training, recruitment processes and 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

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 (Walsall & Wolverhampton) is a Domiciliary care agency that provides personal care to people with a variety of needs over the time of the inspection. This included people aged over and under 65 who may be living with dementia, have a learning disability/autistic spectrum disorder, physical disability or sensory impairment. At the time of our inspection the service supported 83 people with personal care.

People’s experience of using this service:

People and relatives told us they felt safe with care staff and staff were able to demonstrate a good awareness of each person's safety and how to minimise identified risks to their safety. People and care staff told us they were able to attend people’s care calls in a timely way and stop for the duration of their planned care call.

People were supported by care staff that were caring, showed compassion and expressed genuine interest about the people they cared for. People received person centred care and support based on their individual needs and preferences. Staff were knowledgeable about people, their needs and preferences and used this to develop a good relationship with the people they visited.

People were supported by care staff who had the skills and knowledge to meet their needs. Staff understood, felt confident and well supported in their role. People's health was supported as staff worked with other health care providers when needed to support people’s healthcare needs.

People were supported to have maximum choice and control of their lives and staff understood that they should support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's care plans reflected people’s needs and preferences and the staff were able to explain recent changes to people’s care. Where there was changes that were highlighted by people to us, they agreed this was shared with the provider. We saw the service was responsive to this information.

People knew how to complain and that any concerns would be listened and responded to by the provider. The registered manager saw complaints as useful feedback from which to develop and improve the service.

People, relatives, staff and professionals gave us a positive picture as to the quality of care people received, and also said they were able to share their views with staff.

Quality monitoring systems included audits, spot checks on staff practice and regular checks on people’s satisfaction with the service they received, by surveys, phone calls or visits from the service’s management. The provider has systems in place to ensure they kept up to date with developments in the sector and changes in the law.

People and relatives told us the registered manager and staff were approachable, organised, listened and responded to them and acted on feedback when they shared this with them.

Rating at last inspection: The rating for the service at our last inspection was ‘requires improvement’ with our last report published on 11 November 2017.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets.

Enforcement:

No enforcement action was required.

Follow up:

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

Caremark (Walsall and Wolverhampton) is a domiciliary care agency that is registered to provide personal care. The service supports people with a range of needs; including older people and people living with a disability or health needs. At the time of the inspection the service was providing support to 116 people who were living in their own homes.

The provider had recruited a new manager who was in post at the time of the inspection. They were not yet registered with CQC as the registered manager. 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 found improvements were being made to risk assessments and the recording of accidents and incidents to ensure people were sufficiently protected from harm. People had not always received their care visits at their preferred time or delivered by a consistent team of care staff. The manager was in the process of recruiting additional care staff to address this concern. We found poor records around people’s medicines meant assurances could not be given that medicines were administered as prescribed.

People were supported by a care staff team who understood how to protect them from potential abuse. Pre-employment checks were completed prior to new staff members starting work.

People’s rights were upheld by care staff who understood how to make decisions in the best interests of those who lacked capacity. Decisions made in people’s best interests were not recorded. People were cared for by care staff who were supported in their roles. The skills of care staff were to be developed through newly enhanced training and development programmes.

People were supported to have sufficient quantities of food and drink that met their dietary needs. People’s day to day health needs were met.

People were supported by a staff team who were kind and caring in their approach. People were supported to make choices about their care. People’s privacy, dignity and independence were upheld and promoted.

People’s needs and preferences were understood by care staff. People felt involved in making decisions about their care and were aware of their care plan. People felt involved in reviewing their care needs. People were able to raise a complaint when required and received an appropriate response.

People were cared for by a service with a new management team who were committed to making the required improvements. Improvement plans were in place across the service to address areas in which the required standards were not being met. The manager was developing an open and transparent culture within the service and welcomed feedback provided during the inspection.

Caremark (Walsall & Wolverhampton) is a domiciliary care agency that is registered to provide personal care. At the time of the inspection the service was providing support to 89 people living in their own homes, most of whom were older people. There was a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

People were protected by a staff team who could describe the signs of potential abuse and knew how to report concerns. However, we found concerns were not always consistently reported by staff. Staff could describe how to manage risks to people while delivering care. Accidents and incidents were recorded and reported. However, the management team were not always completing effective reviews of the actions taken by staff to ensure people were kept safe.

People told us there were sufficient numbers of staff but they did not always receive their care visits at the time they needed them. Pre-employment checks were completed before care staff started work to ensure they were suitable to work with vulnerable adults. People were happy with the support they received with their medicines. We found the registered manager was not always able to confirm people had received their medicines as prescribed. This was due to issues such as gaps in medicines records not being investigated and resolved.

People were not always fully enabled to consent to the care they received. Where people lacked mental capacity decisions had not always been made on their behalf using the principles of the Mental Capacity Act 2005. People were happy with the skills and experience of their care staff. They told us they were also happy with the support they received with their food and drink.

People told us they were supported by a care staff team who were kind and caring towards them. People were treated with dignity and respect. People were encouraged to make choices about the day to day care they received and their independence was promoted.

People told us they had raised concerns with office staff and did not feel their concerns had been listened to or appropriately responded to. We did however see that where the management team were made aware of formal complaints these were investigated and responded to. Relatives told us they were fully involved in developing care plans however people were not always aware of their own care plan. We found care plans were in place that reflected people’s preferences and these were regularly reviewed. Care plans did not always clearly outline all actions required by care staff to meet people’s needs.

People told us they were happy with the service they received from care staff and most people knew who the manager was. They told us improvements were needed in communication with the office team. People were cared for by a staff team who were motivated in their roles and felt supported by the management team.

We found quality assurance systems were in place but these were not always effective in identifying the areas of improvement required in the service. Where some issues and concerns were identified these were not investigated and resolved in a timely way in order to reduce risks to people and ensure they were receiving the care they required.

We found the provider was not meeting the regulations relating to the submission of statutory notifications to CQC and the effective management of the service. You can see what action we told the provider to take at the back of the full version of the report.