The Care Quality Commission
  • Services in your home
  • Homecare service

Archived: Caremark (Oxford)

Overall: Good read more about inspection ratings

Unit 8, Isis Business Centre, Pony Road, Cowley, Oxford, Oxfordshire, OX4 2RD (01865) 777700

Provided and run by:
Jolly Care Limited

All Inspections

2 July 2015

During an inspection looking at part of the service

We undertook an announced inspection of Caremark (Oxford) Domiciliary Care Agency (DCA) on 2 July 2015. We told the provider two days before our visit that we would be coming. Caremark (Oxford) provides personal care services to people in their own homes. At the time of our inspection 29 people were receiving a personal care service.

At our last inspection on 12 January 2015 we asked the provider to take action to make improvements relating to records. At this inspection we found actions had been completed and improvements made.

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 2008 and associated Regulations about how the service is run.

People told us they benefitted from caring relationships with the staff. One person said “They are really nice and they look after me so well”. There were sufficient staff to meet people’s needs and people received their care when they expected.

People were safe. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. Records confirmed the service notified the appropriate authorities where concerns relating to suspected abuse were identified.

Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff had a good understanding of the Mental Capacity Act (MCA) and applied its principles in their work. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected.

People told us the service responded to their needs and wishes. Comments included; They are very good, they meet all my needs” and “It’s really reassuring to know they look after my needs”.

People told us they were confident they would be listened to and action would be taken. The service had systems to assess the quality of the service provided in the home. Learning was identified and action taken to make improvements which improved people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the registered manager. Staff supervision records were up to date and they received annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service.

People knew the registered manager and told us they were friendly, approachable and supportive. One person said “I know them well, they often visit me at home”.

12 January 2015

During a routine inspection

We inspected Caremark (Oxford) on 12 January 2015. Caremark (Oxford) is a domiciliary care agency providing care and support to people who live in their own homes. At the time of our inspection 25 people were being supported by the service.

The previous inspection of this service was carried out in June 2014. At that inspection the service was found in breach of multiple regulations: care and welfare, respecting and involving people, safeguarding, staffing, recruitment relating to workers, supporting workers, management and quality assurance of the service and records. We judged these concerns had a major impact on people and imposed a condition of the provider’s registration to prevent the service taking on any further care packages until action had been taken to bring the service up to the required standards. We met with the provider and received an action plan with what action was going to be taken to ensure standards were increased to the required level.

At this inspection in January 2015 we found the service had taken a significant number of actions to address the concerns identified at the last inspection. As a result we have removed the condition of registration preventing any new care packages. However, we did identify some areas that still required improvement.

People’s views were sought on the care they received in a variety of ways. However, it was not always clear from the records what action had been taken as a result of people’s feedback and how this information had been used to improve the service.

There were enough suitably qualified staff within the service to meet people’s needs. Recruitment records also showed all relevant checks were carried out before staff began work. Staff were receiving regular supervision and appraisal. However, it was not always clear what support was being received and whether there was a development plan in place for staff. People benefited from appropriate care and treatment as new staff had an induction period and went through a period of shadowing before working with people.

Staff described the actions they took to ensure people were cared for safely. Care plans identified risks to people's health and welfare. Risk assessments and support plans were in place to enable staff to deliver care safely. However, some risk assessments we reviewed did not always clearly detail how to manage these risks. Incidents and accidents were recorded, however it was not always clear through records what action had been taken to prevent further incidents.

Staff had a good understanding of safeguarding and were able to tell us what action they would take if they suspected abuse. The service had a clear record of incidents that had been reported as safeguarding with the actions they had taken to keep people safe.

People were asked for their consent before care was given. Staff also told us how they would ensure people were consenting. Not all staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

People spoke very highly of the care they received and were involved in their care planning. Relatives also felt the service was caring. Care staff demonstrated a caring approach when we spoke with them and clearly valued their relationships with people they supported. However, people did not always feel they received information regarding their care, such as details of which care worker would be providing their care.

Systems had been introduced to monitor the quality and safety of the service; it was too early to judge the effectiveness of these systems. Regional managers had conducted audits as part of the improvements plans. These audits identified actions which had since been completed to improve the quality of the service.

The provider and registered manager had a clear vision for the service that staff shared and were able to speak with us about. Improvements had been implemented across the service with support from regional managers and local authority monitoring. We asked for the provider to send us a strategy with how these improvements would be sustained when the additional support was no longer in place or not as regular. It was too early to judge the effectiveness of this strategy.

At this inspection in January 2015, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; you can see what action we’ve taken at the back of this report.

30 June 2014

During a routine inspection

Caremark were supporting 47 people at the time of our inspection. We spoke with 16 people and five people's relatives. We also looked at eight peoples care files. We spoke with 12 staff which included two office staff, the registered manager and the nominated individual. We looked at six staff files and reviewed information given to us by the service.

Two inspectors carried out this inspection and we considered our inspection findings to answer the questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was not always safe. People's needs were not always met safely due to there not being adequate guidelines in place or guidelines that took into account professional's recommendations. People were at risk of not having their needs met at the appropriate times due to visits not happening at the agreed time. This was due to staffing levels not being able to allow for sickness, absence and changes having to be made to the rota. The service had a no agency staff policy which meant shortfalls in staffing were not always covered.

Allegations of suspected abuse were not always responded to and followed up appropriately and records did not always have adequate detail or correct information to ensure people's well-being.

Is the service effective?

The service was not always effective. Most people we spoke with felt very happy with their care. One person told us, 'the carers are wonderful I look forward to them coming'. Another person told us, 'I have no complaints, lovely people'. However some people we spoke with did not always feel respected. One person we spoke with told us, 'they are always in such a rush, sometimes they don't even talk'. Another person's relative we spoke with told us, 'it's good and bad depends who you get, the more experienced carers are great, but some of the others make my wife very uncomfortable, they forget she's a person'.

We found that whilst some staff received supervision others did not and other staff we spoke with had not ever had an annual appraisal.

Is the service caring?

We found that the service was not always caring. People who used the service were not always supported within a respectful culture. We saw in some people's records that care staff had written in a manner that could cause offense. We saw that some of these entries had been crossed out for more appropriate words to be used. We also found that calls not being on time had become acceptable. Some people we spoke with were complimentary about the care they received. One person told us, 'they are very caring and friendly'. However another person told us, 'it depends who you get, some just don't seem interested'.

Is the service responsive?

We found that the service was not always responsive. There was not always evidence that learning from incidents and investigations took place and appropriate changes were implemented. We saw a number of incident reports relating to people that use the service. These were kept in people's individual files. Across all incidents we looked at we saw no evidence of lessons being learned and applied across the whole service.

Is the service well led?

We found the service was not well led. The provider did not have an effective system to regularly assess and monitor the quality of service that people received. We found that there were a number of complaints into poor practice. We also saw records that showed a number of care staff were regularly unreliable. We saw no evidence that this practice was investigated or that these care staff were managed to improve. People who used the service and their representatives were asked for their views about their care and treatment but their views were not always acted on.

15 April 2013

During a routine inspection

Caremark (Oxford) was a new service. At the time of inspection the service supported 13 people and employed six care staff. There were plans to expand the business.

We spoke with three relatives of people who used the service who said they and the people receiving care were involved in making decision about their care. Relatives said staff treated people with dignity and respect; 'They don't patronise. They really, really listen and have a conversation. There's constant dialogue'. We spoke with four staff who said 'we always ask people what they would like'.

We looked at four files and saw that peoples' needs had been assessed and care plans developed. We were informed that care was regularly reviewed and we saw records of a recent review in a person's file. One relative said 'she came to see us and asked us how we felt about a variety of things'. People received the same regular carers. Risk assessments had been conducted for the general environment and where specific risks had been identified. The service were in the process of implementing a new risk assessment form which would enable risks to be more clearly identified and addressed.

Staff received induction training and undertook a period of shadowing prior to working alone. Staff we spoke with generally felt well supported by the agency, we saw supervision records in some staff files and were informed that regular supervision was planned. The registered provider conducted bi-annual audits of the location.