Caemac Investments Limited

Caemac Investments Limited is a domiciliary care agency providing personal care to people living in their own homes or flats. The service was supporting seven people at the time of this 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

People were starting to be assessed by the palliative care team but had not yet had their end of life wishes assessed or recorded in care plans. This was an area the provider had previously been asked to review and implement but had failed to do so.

People had been asked about their likes and dislikes and preferred approaches for staff to support them, but this was not always recorded in their care plans. There was a lack of provider oversight in care records to ensure quality was consistent.

People told us they felt safe because they had regular teams of staff supporting them, had not experienced any missed care visits and were happy with the care provided.

People were supported by a staff team who had received all relevant training and understood how to keep people safe and escalate any concerns.

People and their relatives felt able to raise any concerns with the provider and were satisfied that these were acted on immediately and resolved.

Staff were trained in how to work safely within COVID-19 restrictions. People told us they were reassured that staff always wore the correct safety equipment such as gloves, masks and aprons and washed their hands regularly.

People said that staff were caring, thoughtful and helpful if anything changed.

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 they were regularly asked for their views about the care and were supported by staff to access other healthcare professionals when they needed this.

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 23 December 2019). 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 in some areas and the provider was no longer in breach of some regulations. However, not enough improvement had been made in other areas and the provider was still in breach of the associated regulation.

The service remains requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the responsive and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caemac Investments Limited 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 monitor the service.

We have identified breaches in relation to the planning and recording of person-centred care and the registered managers oversight of some areas at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Caemac Investments Limited is a domiciliary care agency providing personal care to people living in their own homes or flats. The service provided care visits and offered support over night for some people. The service was supporting 33 older and younger adults at the time of this inspection.

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

People were at risk of receiving unsafe care as staff were often late or early for care visits. Staff members were not staying for the full duration of people’s care visits. Some people required these visits to be at specific times based on their care needs. There was no monitoring or investigation in to the reasons for this.

People had risk assessments in place depending on their care needs. However, these were not detailed and did not give enough information for staff to support people safely. People were at risk of medicines being administered at incorrect times as information about this was not detailed. Missed signatures for medication administration were not being investigated.

Staff recruitment was not always safe. Necessary checks to ensure that staff members were able to support people were not always completed. Staff members were not receiving recorded supervision or competency observations to ensure that they had the skills and competence to complete their job roles effectively.

People gave us mixed feedback about the care they received from staff members. People told us that staff did not always introduce themselves when they arrived for care visits. People told us that they would like to have more time to talk to staff. Some people told us that staff were kind, caring and knew them well.

People did not always receive personalised care which met their needs. People’s care plans contained limited information about their personal preferences, likes and dislikes. People’s care needs were identified, however detail was not given to staff members to guide them to support people in a person-centred way. We have made a recommendation to the service about supporting people with different communication needs.

People had access to a complaints policy and procedure and complaints were responded to by the provider. However, these were not monitored to look for trends and for areas of the service which could be improved. We have made a recommendation to the service about recording and monitoring complaints.

The registered manager was not completing quality monitoring or audits at the service. There was limited oversight of the service, which meant that issues which required improvement could not be identified. Actions were not taken to bring about continuous improvement at the service. Known issues from previous inspections by the CQC had not been actioned.

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 were supported with their dietary needs and the staff team worked well with health professionals to ensure that people lived healthy lives and achieved good outcomes in this area of their 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 requires improvement (report published 3 October 2018) and there were multiple breaches of regulation. The provider completed and action plan after the last inspection to show us what they would do and by when to improve. At this inspection enough, improvement had not been made and the provider was still in breach of regulations. We also found breaches of two additional regulations. The service remains rated requires improvement and has deteriorated to inadequate in well-led. This is the second inspection where we rated the provider requires improvement.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified breaches in relation to safe care, staffing and recruitment, person centred care and good governance.

Please see the action we have told the provider to take at the end of this report.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Caemac Investments Limited is a domiciliary care agency. It provides personal care to people living in their own homes and flats in the community. It provides a service to older adults, younger disabled adults and bespoke packages to people returning to their own home following discharge from hospital.

Not everyone using Caemac Investments Limited 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 take into account any wider social care provided.

The service has a registered manager who is also the provider. 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.

Staff were not recruited safely. The necessary pre-employment recruitment checks been completed but the provider had failed to evidence their decision to appoint members of staff with convictions recorded on their Disclosure and Barring Service (DBS) checks or robustly assess the potential risk these staff members may present to people who used the service.

Risks to people’s health, safety and well-being had been identified and assessed but it was not clear if the assessments completed were up to date or reflective of people’s current needs.

There were sufficient staff deployed to cover the scheduled care calls; however, the call monitoring service was not consistently used or checked to ensure that care was being provided as planned. The provider did not complete an audit of the call monitoring service.

People told us they thought that staff were well trained and staff confirmed they received regular training which supported them in their roles. However, training records were inconsistent and there were no clear systems for recording the training completed or required for the staff team. Staff did not receive formal, recorded supervision.

Assessments were completed prior to the service providing care and support to people and people felt involved in deciding the care they were to receive. Care plans provided detail as to the care and support needs of people but it was not clear if they had been reviewed and were reflective of people’s current needs.

Quality monitoring systems had not been established at the service. Due to the lack of monitoring in all areas the provider did not have an overview of quality or safety. The provider was open and transparent and was aware of some of the shortfalls identified during the inspection but had not recorded the issues they had identified, nor had they completed any action plan to evidence how they planned on addressing the issues. The provider had also not use any system or process to gather people’s views on the service to ensure that their feedback was included in any service planning or development.

People told us they felt safe receiving care and support. Staff were aware of safeguarding procedures and had received training. Staff confirmed the action they would take if they identified any safeguarding concerns including reporting to local authorities or the CQC.

Medicines were managed safely. People's medicines administration records had the detail required to record what medicines had been administered.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice. The service worked within the principles of the Mental Capacity Act 2005 (MCA).

People's needs in relation to eating and drinking were recorded with guidance for staff on how to provide care and support. People were supported to maintain their health and well-being. We saw that relevant health professionals were involved in the planning and delivery of the care and support people received.

People told us they were happy with their care workers. They described staff as being friendly, courteous and polite. People confirmed that they were treated with respect and that staff maintained their dignity throughout their support.

People and their relatives knew who they could raise complaints with. No formal complaints had been received at the service however an up to date policy and procedure was in place.

People, relatives and staff told us they felt the provider was approachable and made positive comments about the service. Staff were aware that some areas required improvement and were confident the service would improve. Changes within the service management and the recruitment of additional members of senior staff had had a positive impact

During our inspection we found breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.