Background to this inspection
Updated
1 November 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This comprehensive inspection took place on 12 September 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because we needed to be sure the registered manager would be available.
Before the inspection, we reviewed information we held about the service, which included notifications they had sent us. A notification is information about important events, which the provider is required to send us by law. We also contacted Local Authority commissioners of adult social care services and Healthwatch and asked them for their views of the service provided.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information that we held about the service such as notifications, which are events which happened in the service that the provider is required to tell us about, and information that had been sent to us by other agencies. This included the local authority who commissioned services from the provider.
The inspection team consisted of an inspector, an assistant inspector and an expert by experience. The expert by experience had experience of caring for someone who has used this type of service. The expert by experience and the assistant inspector carried out telephone interviews with people prior to the office-based inspection. They attempted to speak with 26 people or relatives. They managed to speak with 10 people who used the service and six relatives. The inspector visited the office location to see the registered manager, office staff and to speak with care staff. The inspection report was partly informed by feedback from the telephone interviews.
During the inspection, we spoke with two members of the care staff, a care coordinator, a field care supervisor and the registered manager.
We looked at records relating to five people who used the service as well as three staff recruitment records. We looked at other information related to the running of and the quality of the service. This included quality assurance audits, training information for care staff, staff duty rotas, meeting minutes and arrangements for managing complaints.
We asked the registered manager to send us copies of various policies and procedures after the inspection. They did this within the requested timeframe.
Updated
1 November 2018
We carried out an announced inspection of the service on 12 September 2018. Caremark (Gedling & Rushcliffe) is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It currently provides a service to older adults. Not everyone using Caremark (Gedling & Rushcliffe) receives regulated activity; 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 consider any wider social care provided.
There was a registered manager in post at the time of our inspection. 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 time of the inspection, 33 people received some element of support with their personal care. This is the service’s second inspection under its current registration. At the previous inspection, the service was rated as ‘Requires Improvement’ overall. At this inspection, they have remained at this rating and we identified one continued breach of the Health and Social Care Act 2008 (Regulated Activities).
You can see what action we have told the provider to take at the end of this report.
The risks to people’s health and safety had been assessed but the recorded assessments were not personalised and did not always reflect people’s individual care needs. Most people were satisfied with the punctuality of the staff, however records showed there were times when calls were regularly late. There had been a high turnover of staff however this had now stabilised and staff retention had improved. Staff were recruited safely and people were supported appropriately with their medicines. Staff were aware of how to reduce the spread of inspection. The registered manager investigated accidents and incidents; however, their decisions were not analysed and reviewed by the provider.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service did not always support this practice. People had care records in place. These were not always developed in line with current legislation and best practice guidelines. Staff received an induction and training programme, however some staff required refresher training which had not yet been arranged. People felt staff understood how to support them in their preferred way. Where needed, people were supported with their meals, however nutritional assessments were generic and not personalised to people’s needs. Other health and social care agencies were involved where further support was needed for people.
People felt staff were kind and caring, treated them with respect and ensured their dignity was maintained. People liked the staff and their independence was encouraged. People were involved with decisions about their care. People’s personal data was protected in line with the current legislation.
People’s needs were assessed prior to commencing with the service. This enabled staff to have the information needed to support them effectively. People’s records were person centred and informed staff how to support people in their preferred way. People felt staff responded to their complaints effectively, records viewed confirmed this. People’s diverse needs were discussed with them during their initial assessment. End of life care was not currently provided by the service.
Some improvements had been made to the quality assurance processes since our last inspection. However, they were still not fully effective in identifying areas of risk within the service. The registered manager received limited input from the provider to ensure they were held accountable for their decisions and the effectiveness of how the service was managed. The registered manager now had administrative staff in place, which meant they could delegate some responsibilities and focus on managing the service. The registered manager carried out their role in line with their registration with the CQC. Notifiable incidents were reported to the CQC.