Caremark (Harlow & Epping Forest)

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate.

The service was still in breach of legal regulations in relation to the management and oversight of the service provided. Systems in place continued to not robustly assess, monitor and improve the quality and safety of the services being provided to people. Audits completed were not effectively operated, systems and processes did not support learning and improvement, and the provider was not open and transparent with staff, people supported or their relatives.

The service was still in breach of the legal regulations in relation to a lack of continued governance at the service and continuing to not report required incidents to the Care Quality Commission.

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 have a clear shared vision, strategy and culture which was based on transparency, inclusion, and engagement.

The provider did not have a vision or set of values driving the day-to-day care or management that were known by staff working in the service. We asked staff to describe the values of Caremark Harlow Epping Forest. All staff spoken with gave a different view. One staff member said, “I think we try and put clients at the centre and accommodate them. It is a very individual care plan.” A second staff member said, “For me those values are Respect, dignity, consent.” Leaders were caring and wanted to provide people’s care in a person-centred way. However, we found this did not translate into a consistent vision to deliver a shared approach that was aligned to the provider’s values. This meant leaders had not embedded a person-centred culture in the service.
 

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, the provider acknowledged the leadership team had not received training at a sufficient level to support their role. Leaders furthermore did not always do so with integrity, openness and honesty.
There was a manager registered with CQC as required at the time of our assessment. Staff told us they were approachable and supportive. The feedback we received from people was that the registered manager did not contact them and was not visible in their homes to offer support or review care. One person said, “I don’t know who the top manager is, I did not [Care manager] but I think they left a while ago, I don’t know why, but at the moment if anything needs to be done, I see [Field care supervisor].”
Caremark Harlow and Epping Forest had prior to this assessment an audit completed where they were found to require improvement, alongside additional actions to manage those risks. The provider had not shared this outcome among the staff team or with the people they support. The provider acknowledged this was not acting in an open way and would take action to share this information with those people and seek their feedback.
 

The provider fostered a culture where people felt they could speak up and their voice would be heard.

Staff told us that the provider was approachable and listened to their concerns as a team, or where individual staff had concerns, they wished to share. One staff member told us about a particular example where they raised concerns which were listened to and acted upon. They said the outcome of this helped them feel valued and heard by the provider. However, they also said the provider did not keep them aware of the ongoing developments which caused them some level of anxiety. The provider acknowledged their communication back to staff could have been better and took steps to improve this.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The provider valued diversity in their workforce. No concerns were identified in this area during the assessment. Staff told us that they felt supported and treated fairly by the provider. We have reflected elsewhere in this report where opportunities for staff to progress were limited, however, the provider has undertaken improvements to ensure their approach to staff to develop is more inclusive.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.
In November 2023 the provider submitted an action plan to detail to CQC how they would improve training, recording in care records, staffing levels, safe care and management oversight. We found at this assessment that little progress has been made against this action plan. The provider had systems to assess and monitor the safety of the service; however, the operation of these had continued to fail to implement these effectively. This meant the provider continued to fail to assess, monitor and make improvements to the service and had not identified all the shortfalls we found during our assessment.
During our assessment we found the systems and processes in place to assess, monitor and improve the quality and safety of the service in relation to areas such as care planning, supervision, training, and oversight were not effective and the provider had failed to identify the improvements we identified during this assessment.
We found reportable concerns that had not been identified or shared with the local authority or CQC, even after the local authority raised similar issues. These concerns were not reviewed within a reasonable timeframe. When care reviews did occur, the incident was not assessed robustly and did not then provide sufficient guidance to staff, on managing those known risks. Daily and monthly oversight and audits of care records did not identify system failures that placed people at risk of avoidable harm.
The provider did not use a service improvement plan [SIP], only developing this during this assessment. A SIP is a strategic document that systematically identifies and addresses issues to enhance service quality and safety. This lack of oversight contributed to people experiencing less than good outcomes with their care delivery.
 

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.
The provider and leadership team were not part of wider management forums or development groups. There were several local organisations who could offer support to care organisations to help develop understanding of changes in the sector and signposting to training and additional resources.
Care staff did not always work in partnership with health professionals and review peoples care with them or share information to support people’s health needs. The provider acknowledged this and sought to discuss the pathways with the local GP surgeries and district nursing clinics.
The local authority had increased monitoring of the care provided by the service as they were not assured by the provider’s response to identified concerns.
 

The provider did not have a robust system in place to review risks in the service and subsequently share lessons from those risks with staff. Learning and improvement was not embedded as part of the daily culture and as a result, the necessary systems and processes to support a culture of learning and improvement had not yet been fully embedded. For example, a quarterly lesson learned analysis and meeting was held with staff. This reviewed the previous 3 months incidents, accidents, concerns, safeguarding and looked for themes. Although these identified trends, such as falls, quarterly only reviews of lessons learned, or emerging risks did not support improvements as part of a day-to-day culture of improving staff practise.
The provider was asking staff to make changes to their daily practise and telling staff where they must improve performance. However, they had not shared the feedback from the local authority review and actions arising from that assessment. People spoken with were not aware of the departure of the care manager or the outcome of external assessments. People’s feedback was not sought in relation to these assessments, and where feedback was sought this was sporadic and lacked depth. Overall, the culture in the service was not open and transparent and people experienced substandard support as communication with them to learn and adapt was not open and transparent.