Caremark (Mid Surrey)

Caremark (Mid Surrey) is a domiciliary care agency providing personal care to people living in their own homes. The service provides support to people with a variety of health needs. At the time of our inspection there were 52 people using the service. Not everyone who received a 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. There were 11 people being supported by staff with personal care.

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

We have made a recommendation that the provider improve the planning for end of life care, people are better supported when they may lack the mental capacity to make decisions independently and they can be assured staff are recruited safely.

People’s needs, choices and preferences were not assessed or recorded accurately, timely or in a person-centred way. There was a risk that staff who were new to supporting people would not know what their needs were and therefore not provide adequate care.

Risks to people were not always assessed and staff lacked guidance on how to manage specific risks. Staff lacked practical training, training specific to the needs of the people they were supporting and some training was significantly outdated. People and relatives were not always confident that staff had been supported to have the knowledge required to provide the care required.

The manager lacked the support and infrastructure in the senior management team to manage a robust oversight of the service and to focus on improvements. Where they had the opportunity to make changes, such as with rotas and staff morale, we saw evidence of positive impact. The manager had a plan to address the concerns identified and would benefit from more support to action these promptly.

There were sufficient staff to enable consistent workers who could establish relationships with people and become familiar with their needs. A system of shadowing and communicating between staff equipped staff with some knowledge of individual needs.

Staff provided a thoughtful, kind and considerate service to people. Staff had made efforts with people to improve their mood and quality of life. They worked efficiently in partnership with other professionals and relatives to coordinate care effectively for people.

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.

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 this service was good (published 26 July 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staff training. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of 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 see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caremark (Mid Surrey) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, safe care and treatment, staffing 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

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It is located in the Leatherhead area and covers mid surrey.

This was the first inspection since the service was registered.

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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were satisfied with the care and support provided by the agency and were happy with the way staff performed their duties.

The agency kept up to date records that covered all aspects of the care and support people received, the support choices they had made and identified that they were being met. The records were clearly recorded, fully completed, and contained regularly reviewed information that enabled staff to perform their duties.

Staff were aware of their responsibilities regarding the people they supported, the tasks they performed and were aware of how people liked to receive support. Staff had appropriate skills and provided care and support in a professional, friendly and kind way.

Staff knew that they must treat people equally and respect their diversity and human rights. People said they felt fairly treated.

Staff received appropriate training and were accessible to people. They told us the organisation was good place to work for; they enjoyed working there and had access to good training and support.

The registered manager and staff encouraged people and their relatives to discuss health and other needs and passed on agreed information to community based health professionals, as required.

Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s likes, dislikes and preferences were met.

The agency was aware of the Mental Capacity Act (MCA) and their responsibilities regarding it.

The registered manager was approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

The health care professionals that we contacted were happy with the support that the agency provided for people.