Caremark Tunbridge Wells, Tonbridge and Malling

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure people’s needs were thoroughly assessed and reviewed. Assessment processes were in place; however, care plans and risk assessments were not consistently detailed, accurate or reflective of people’s current needs, increasing the risk of ineffective care.
The provider recognised historical weaknesses in care planning and assessment processes, with evidence that care plans had been incomplete, generic or not sufficiently person-centred.

The provider confirmed that many risk assessments and reviews were overdue or missing, requiring a prioritised programme of review and audit to bring records up to date.

Although improvements were underway, this process was still ongoing at the time of inspection, meaning that not all people had an accurate and complete assessment of need in place.

This was corroborated by feedback from people and relatives, who reported they had not always seen care plans or been involved in their development, and in some cases care plans had not been reviewed for extended periods.

Inconsistent and incomplete assessments meant staff did not always have clear, up-to-date guidance to support effective care delivery.

The provider generally delivered care based on training and recognised practice; however, this was not always applied consistently, particularly where staff experience varied or care needs were complex.

Staff received induction, mandatory training and role-specific training, including moving and handling, medication and specialist care such as stoma or catheter management.

Staff described using training, care plans and previous notes to guide their practice, and demonstrated an understanding of how to support people with complex health needs, including monitoring for deterioration and escalating concerns appropriately.

There were examples of effective care delivery, including staff identifying signs of infection or deterioration and taking appropriate action, such as increasing fluids or contacting the office.

However, people’s feedback indicated that care was not always delivered consistently in line with best practice. For example, some people reported that staff did not always have the skills or experience to meet their needs, particularly in relation to specialist care such as stoma management.

Staff we spoke to did know how to support people with a stoma and they could articulate risks to look for to ensure infection and skin integrity risks were managed.

This demonstrated that while systems for evidence-based care were in place, there was variability in how consistently these were applied.

The provider generally delivered care based on training and recognised practice; however, this was not always applied consistently, particularly where staff experience varied or care needs were complex.

Staff received induction, mandatory training and role-specific training, including moving and handling, medication and specialist care such as stoma or catheter management.

Staff described using training, care plans and previous notes to guide their practice, and demonstrated an understanding of how to support people with complex health needs, including monitoring for deterioration and escalating concerns appropriately.

There were examples of effective care delivery, including staff identifying signs of infection or deterioration and taking appropriate action, such as increasing fluids or contacting the office.

However, people’s feedback indicated that care was not always delivered consistently in line with best practice. For example, some people reported that staff did not always have the skills or experience to meet their needs, particularly in relation to specialist care such as stoma management.

Staff we spoke to did know how to support people with a stoma and they could articulate risks to look for to ensure infection and skin integrity risks were managed.

This demonstrated that while systems for evidence-based care were in place, there was variability in how consistently these were applied.

The provider generally supported people to maintain their health and wellbeing; however, this was not always delivered consistently in line with people’s needs.

Staff described supporting people with nutritional needs, hydration, mobility and general wellbeing, and adapting support where required based on people’s conditions and preferences.

Staff demonstrated awareness of how to monitor health conditions and respond to changes, including escalating concerns where people’s health deteriorated.

However, people’s experiences highlighted inconsistencies in this area. For example, some people reported that meals were not always prepared appropriately. Nutritional needs were not always consistently met and care tasks were sometimes task-focused rather than holistic. One person told us, “I have lunch sometimes at 4pm. It’s a ready meal or something they have made is burnt to a crisp or under cooked so I don’t eat it.”

This indicated that although staff understood their role in supporting health and wellbeing, delivery was not consistently effective across the service.

The provider did not always effectively monitor or improve outcomes for people. Systems for audit, review and oversight were in place but were not consistently embedded or effective in driving sustained improvement.

The provider had introduced systems to monitor quality, including audits, compliance tracking and review processes.

Improvements were being implemented to address historical gaps, including updating care plans, improving risk assessments and introducing tracking systems to monitor compliance.

However, these systems were still being embedded, and there was limited evidence that monitoring processes were consistently leading to improved outcomes.

This was reflected in people’s feedback, where recurring concerns were identified in relation to care delivery and staff competence, along with communication and responsiveness.

These concerns demonstrated that monitoring systems were not yet fully effective at identifying issues and ensuring sustained improvement.

The provider generally ensured staff understood and applied principles of consent, although this was not always formally recorded or consistently evidenced within care planning.
Staff demonstrated a good understanding of consent in practice, including seeking people’s agreement before providing care and respecting their choices where they declined support.

Care processes included recording whether consent was given or declined during visits, with systems in place to document this electronically.

However, while consent was applied in practice, care planning and documentation did not always clearly demonstrate how consent and decision-making were considered, particularly where capacity may fluctuate.

This indicated that consent processes were understood and applied at a practical level but were not always consistently embedded within formal documentation and governance systems.

Staff were aware of people's right to make choices, and of the principles of the Mental Capacity Act (MCA). One staff member said, “I work with each person level and include them with their care as much as possible.” Another staff member said, “I want people to have as much control over what the can or can’t do.”