Caremark (Harlow & Epping Forest)

Caremark (Harlow and Epping Forest) is a domiciliary care service providing personal care to adults who live in their own houses and flats. At the time of our inspection, 31 people were receiving personal care.

Not everyone who uses domiciliary care services receives 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's medicines were not always managed safely and the provider's processes for checking the accuracy of people's medicines records were not always robust. People's risk assessments were not updated or reviewed regularly.

Suitable arrangements were not in place to ensure all staff employed received appropriate training, a robust induction or regular supervision.

The registered managers governance arrangements did not always provide assurance the service was well led. Quality assurance systems were not robust and had not identified the shortfalls we found during our inspection.

The registered managers had been raising safeguarding alerts with the local authority however, there had been occasions whereby statutory notifications had not been sent to CQC as required. Providers must inform CQC of all incidents that affect the health, safety and welfare of people who use services.

There was limited information in the support plans we reviewed relating to people's end of life wishes. We have made a recommendation about end of life wishes.

People did not always feel the service supported them to make complaints. We have made a recommendation about supporting people to make complaints.

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. Staff had a good understanding of people's preference of care, staff promoted people's independence.

People and their relatives were involved in the planning and review 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

The last rating for this service was good (published 7 March 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report

Enforcement and recommendations

We have identified breaches in relation to safe care and treatment, staffing and recruitment, training and supervision, good governance, and the notification of incidents. We have a made a recommendation about end of life wishes and complaints.

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

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.

Caremark (Harlow & Epping Forest) is a domiciliary care service providing personal care to people in their own home. At the time of our inspection, 11 people received personal care from the agency.

There was a registered manager in post at the time of the 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.

People receiving a service told us they felt safe and relatives believed their family members were kept safe. They said they had not had any missed calls, and usually received care from staff they knew well. The provider had systems to safeguard people from harm and abuse. Care workers completed safeguarding training and knew how to report any concerns. Risks to people had been assessed and reviewed regularly to ensure people's individual needs were being met safely.

Staffing levels were managed in a way to ensure staff were available to provide a consistent service to meet the needs of people who lived in their own homes. The provider had systems in place to ensure suitable staff were recruited for the role. Where people needed support with their medicines, the registered manager ensured they received these as prescribed and safely.

Staff were aware of the importance of seeking consent from people they supported and demonstrated an understanding of the Mental Capacity Act (MCA) 2005. Staff received appropriate induction and training to equip them to support people well. The registered manager carried out an assessment of needs before people started using the service. People were supported to eat and drink sufficient amounts for their wellbeing. The registered manager liaised with organisations such as the local authority and the NHS when needed. People were supported to access healthcare services when they needed it. Staff would provide people with meals of their choice.

People's feedback about their experience of the service was positive. People said staff treated them respectfully and asked them how they wanted their care and support to be provided. People told us they had their care visits as planned. Staff were described as kind and caring by people who used the service.

When people’s needs changed, staff would notify the registered manager and communicate with other health professionals in order to ensure people received the right care and treatment. People received care from staff they knew. The service provided appropriate information to people when they started using the service to ensure they were aware of the standard of support they should expect.

People told us they knew who to complain to, minor issues were recorded but not in a format that could identify patterns or trends to promote continuous improvement.

The registered manager was visible and approachable. Quality assurance systems needed to be more robust to help ensure the registered manager could identify and make improvements to the service. However, this was not currently impacting on the service provided to people.

We have made recommendations about the management of complaints and the introduction of a more robust quality assurance process.