Caremark (Harlow & Epping Forest)

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 requires improvement. At this assessment the rating has remained 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 still in breach of legal regulations in relation to people’s safe care and treatment and a lack of training and support for all staff. However, the provider had made improvements to ensure staff were safely recruited.

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 act on incidents or accidents in a timely way to ensure lessons were learned and risks were reduced.
Staff knew how to report incidents and accidents, referring to the electronic reporting tool used. However, they did not always follow the providers policy. Staff explained the process, but also said they were not always made aware of the outcomes. We saw there had not been a consistent approach to sharing learning from incidents. While we saw that when incidents had been reported to managers there was a lack of evidence to show they had been shared with staff to improve their learning and experiences. An analysis tool was used on a quarterly basis and shared among staff, but this did not ensure learning was embedded within the day-to-day culture. Analysis was not shared on incidents that occurred on a day by day or week by week basis to improve learning within a reasonable time frame. Further improvements were required to develop a lesson learned framework to embed regularly within meetings and other similar activities. Lessons learned did not flow into looking at remedial actions, for example following a fall or tissue viability incident, staff did not then receive training to improve awareness and minimise risks.
 

The provider did not always work well with people to establish and maintain safe systems of care. They did not effectively manage or monitor people’s safety because they did not ensure those systems of care were reflective of people’s current needs.
We found improvements were needed to ensure people’s care plans contained updated information around areas such as choking risks, diabetes care, skin care and support with dementia. Risks to people’s health in some examples had not been assessed therefore mitigations had not always been put in place to reduce harm.
 

People felt safe with the care and support provided by staff. Staff were aware of safeguarding and how to report concerns although incidents were not always reported. Care staff at times documented incidents in the daily log. Incidents at times were found to have delays to being investigated when reported. We found instances where a safeguarding had not been raised even though the incident suggested the threshold was met. For example, unexplained falls or bruising. Additional improvement was required to ensure incidents were reported following the provider policy and that they were investigated in a timely way, by staff who were trained to do so.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff knew people well, although we found some improvements were needed to update people’s individual risk assessments and care plans. Comprehensive guidance was not recorded within people’s risk assessment to direct staff to support them with their diabetes care, dementia support, risks of choking or risk of falls as examples.

Risk assessments when completed attributed an incorrect risk level to people. For example, one person had recently experienced a fall, lived with sensory impairments that affected their mobility, and used a walking aid to mobilise. Given the risk factors, and with no actions to lower the risk considered, staff assessed this risk of falling a low. Other people had an assessment of low for other conditions which when reviewed would be considered as high risk. The incorrect assessment meant people would receive only 1 review as a low risk per year as opposed to the providers policy of 4.

Improvements continued to be required so that following an incident this triggered a review of the care plan within a reasonable timeframe. Improvements were also needed to people’s daily notes that recorded the care provided. These were not always accurate reflections of the care needs people required support with, or how care had been provided to people. We raised this with the registered manager who acknowledged daily recording needed improvement and immediately organised a training workshop to address this.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

On initial assessment, staff completed an environmental risk assessment within people’s homes to check whether it was safe for staff to carry out the necessary tasks. This included areas such as fire safety, environment checks for defects and repairs, trip hazards and whether there was sufficient space to operate equipment such as hoists or specialised beds. During spot checks the registered manager said these would be monitored and if actions were needed then these would be discussed with the person at that time. Staff reported through discussions with senior staff when there were any environmental risks. However, we have noted that reviews of people’s care were not as frequent as required, therefore monitoring of the environment would be an area that the registered manager would continue to improve.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. Staff had not completed training that was relevant to their role to support people. For example, staff had not completed training related to skin integrity, even though people were supported with wounds or frail skin. Other examples where people were supported without appropriate training were around areas such as dementia, diabetes and risks associated with choking. The provider had not ensured that staff delivering care to these people had the right level of skills and knowledge to do so in a safe and protective manner.
The senior team had not been supported to develop the skills and knowledge to effectively lead their teams. Those staff had not received training around areas such as supervision, coaching skills, higher level risk assessment, mental capacity assessment, incident investigation and safeguarding for managers. This lack of higher-level training for those staff led to improvements being identified in areas of incident management, lessons learned, risk reviews and overall monitoring and compliance.
The provider did not always make sure staff received effective support, supervision and development. Staff had not received observations of their competency because there was one staff member responsible and they did not have the time to complete these regularly. We found that this had an impact of the quality-of-care people received.
This assessment was triggered due to concerns raised that staff arrived late to people’s homes. During this assessment, this had been improved by the provider, but these processes were yet to be embedded. People told us staffing timeliness had improved. One person said, “Things have got a lot better over the past few weeks. In fact, not only are they now on time mostly, but I also have the same group of carers mostly, so I am happy with how things are now.”
Staff were recruited safely with required checks including criminal records checks carried out before they started working with people. Staff underwent an induction and shadowed existing staff until they were comfortable to work unsupervised. Staff completing induction had their competency assessed, however we found ongoing competency assessments for staff were not regularly completed. One staff member said, “When I was first training, I was able to choose when I was confident to go alone and had staff with me until I did. I did all my mandatory training before I went alone, I was signed off by my supervisor.”
 

People and relatives told us staff had personal protective equipment available when they assisted them with their personal care needs. One person said, “They have their aprons and things when they arrive and will wash their hands before they help me. I don’t have any worries that they will put me at risk of getting things like COVID because they are very clean when they work.”
The provider ensured staff had completed training around Infection Prevention and Control and people and their relatives told us that staff kept the environment clean. One person said, “They are very good. When they have finished helping me, they pack up all their bits and put them in this little bag and then it goes into the bin. They will then even stay longer and do little cleaning jobs for me.”

The provider made sure that medicines and treatments met people’s needs, capacities and preferences. Medicines that were prescribed at specific times were administered at those times. However, staff had not all received regular checks and direct observation of their practice as frequently as the provider told us they should happen. We also identified an example where one person’s medicine for their memory had run out and they experienced a delay in then having this administered in line with the prescriber’s instruction.

Where people were administered over the counter medicines for pain control there was no guidance for staff about how to safely administer these. Staff also had no information to identify when people who may find it difficult to communicate may be in pain and require a medicine to safely relieve that pain.