Caremark Kensington

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation 12 in relation to people’s safe care and treatment, because of concerns with staff deployment and the ways people’s medicines were managed.

This service scored 59 (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 have a proactive and positive culture of safety. Not all staff recognised and reported concerns about safety and lessons were not always learnt to continually identify and embed good practice.

The provider had systems and processes, which could help enable learning from incidents where people may have been at risk. However, these were not always effective. This was because action to make improvements was not always taken in a timely manner and improvements were not always sustained. For example, notes from staff meetings and staff memos frequently highlighted issues that staff needed to address, such as timekeeping and accurate recording of care records, but we saw continual recurrences of the same issues.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, the provider did not always identify and share concerns quickly and appropriately. For example, they did not recognise that repeated omissions of people’s prescribed medicines and alleged instances of missed or short visits could constitute abuse and neglect.

People and their representatives told us they had no concerns about their safety and had confidence in the management to take appropriate action, if they did need to raise any concerns. A person using the service said they trusted their carers and felt safe. They told us, “I’ve got the best carers and when I see good practice I like to acknowledge it.”

Staff demonstrated their understanding of the importance of reporting any concerns about people. A member of staff told us they ensured people were safe and gave them opportunities to voice any concerns. Staff told us they had completed training for safeguarding and also had refresher courses. They confirmed that they understood and followed the appropriate reporting procedures for any concerns regarding people’s safety. A member of staff told us, “If I have concerns, I call the company and the manager. I write it in the book and, if appropriate, talk to the family.”

The safeguarding policies and procedures followed current and relevant legislation. The provider had mostly effective systems and processes to help ensure people were protected from abuse and neglect.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, the provider did not always identify and share concerns quickly and appropriately. For example, they did not recognise that repeated omissions of people’s prescribed medicines and alleged instances of missed or short visits could constitute abuse and neglect.

People and their representatives told us they had no concerns about their safety and had confidence in the management to take appropriate action, if they did need to raise any concerns. A person using the service said they trusted their carers and felt safe. They told us, “I’ve got the best carers and when I see good practice I like to acknowledge it.”

Staff demonstrated their understanding of the importance of reporting any concerns about people. A member of staff told us they ensured people were safe and gave them opportunities to voice any concerns. Staff told us they had completed training for safeguarding and also had refresher courses. They confirmed that they understood and followed the appropriate reporting procedures for any concerns regarding people’s safety. A member of staff told us, “If I have concerns, I call the company and the manager. I write it in the book and, if appropriate, talk to the family.”

The safeguarding policies and procedures followed current and relevant legislation. The provider had mostly effective systems and processes to help ensure people were protected from abuse and neglect.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

A person’s representative told us risks had been properly assessed and they were confident their loved one was safe when they went out in the community with staff. Another person’s representative told us their loved one’s care plan and risk assessments were reviewed with them annually. These included moving and handling and the use of the ceiling track hoist.

Staff told us that each person had a care plan and risk assessments. They said these gave them guidance for using equipment, such as hoists, as well as eating and drinking, allergies, mobility, pressure sores, medicines and people’s home environments.

The provider had systems and processes to assess and minimise risks that were identified for people using the service. Most of these were effective and we saw that risk assessments were person centred. Risks to people were assessed and plans were created collaboratively with people and their representatives to help manage those risks in the least restrictive way possible.

The provider had effective systems and processes to identify risks and hazards in people’s home environments. Environmental risk assessments were completed with people using the service and risk management plans were compiled to help mitigate identified risks as much as possible.

People said they had completed needs assessments and risk assessments when they began using the service. These assessments also included health and safety for themselves, as well as staff, within their individual home environments.

We were not assured there were sufficient staff to make sure people received the agreed level of care and support, in accordance with their individual care plans. This was because the provider had not identified numerous discrepancies and irregularities in the Electronic Call Monitoring (ECM) logs. This included incomplete visits, unlogged visits and visits cut shorter than the times they were contracted for. In 30% of calls, travel time had not been factored in-between visits. This meant the provider was unable to determine whether people had received the care they required.

Most people told us they had the same care staff on a regular basis, which was good for continuity. They also said they did not have concerns about the punctuality and reliability of their care staff, although there were some remarks about staff being late from time to time. A person using the service told us, “The carers always ring me if they are running late. I know when they are due, and they have access to my key safe to let themselves in.”

However, a person and their representative told us the care staff ‘rushed in and out and were not punctual.’ They also said that 2 care staff never completed the full time for their visit. They said the care staff only stayed for 15 minutes, when it should be for either 30 or 45 minutes.

Although we found no evidence people had been harmed, the poor management and oversight of staff deployment and the consistent lack of sufficient time for staff to travel between home visits placed people at risk of discomfort, harm and neglect. This is a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider made sure staff received effective support, supervision and development. Staff told us they had a good standard of induction which included training and shadowing. There was also a thorough recruitment process, which included completing an application form, interviews, references, verifying identity and police checks.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People using the service and their representatives told us the care staff followed good hygiene and infection control practices. They confirmed that staff used personal protective equipment (PPE) appropriately, such as gloves and aprons, and frequently washed their hands.

Staff told us they had completed training for infection control and had enough supplies of PPE. A member of staff said, “We use PPE. Gloves, shoe covers, masks if needed and even hair nets if hair might get in the way.” Senior staff told us their spot checks that always included making sure infection control procedures were followed during a visit and before staff moved on to the next person.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People did not always receive their medicines in accordance with the instructions from the prescriber, nor in line with their risk management plans.

One person was prescribed ‘time sensitive’ medicine for a health condition. Care records identified the person did not always receive their medicine when they required it. The person’s risk assessment stated one of the risks as being that missed or delayed [timing sensitive medicine] could lead to increased symptoms or mobility issues.

There were also discrepancies and variations on the Medicines Administration Records (MARs). Some staff recorded ‘prompted’ whilst others recorded ‘administered’. Some staff also recorded ‘NR’ to indicate that the medicines were not required or had already been provided but then wrote in the comments box that they had administered the person’s medicine.

The registered manager had sent reminders and memos to staff to accurately record on MARs, but errors and omissions continued to occur.

Although we found no evidence that people had been harmed, the poor management and oversight of people’s medicines placed them at risk of harm and neglect. This is a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.