Caremark Lambeth

Caremark Lambeth is a domiciliary care agency providing personal care to older people living in their own homes. At the time of our inspection 50 people were receiving personal care at home from this provider. The Care Quality Commission (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

Most people using the service and their relatives told us the service had begun to improve during the last 12 months since our last inspection and the appointment of a new care manager who was now in operational day-to-day charge of the service. Whilst the relatively new manager is improving the service people receive and taking it in the right direction they acknowledge this remains a work in progress.

At our last inspection we found the provider had failed to always ensure people were not placed at risk of harm. This was because of the way they recruited and supported staff, assessed and managed identified risks people might face, maintained medicine’s records and operated their established governance systems.

At this inspection we saw enough improvement had been made by the provider in relation to the way they now recruited and supported staff, assessed and managed identified risks people might face, maintained medicine’s records and operated their established governance systems.

People were kept safe and protected against the risk of avoidable harm and abuse. People received consistently good-quality and safe personal care from the same group of staff who were familiar with their needs and preferences. Staff followed current best practice guidelines regarding the prevention and control of infection, including those associated with COVID-19. People continued to receive their prescribed medicines as and when they should.

People received an effective service. People were cared for and supported by staff who were suitably trained. Assessments of people's support needs and wishes were carried out before they started receiving any support from the provider.

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 supported people to have choices. Where staff were responsible for preparing people's meals and/or assisting them to eat and drink, people were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and well, and to access relevant community health and social care services as and when required.

The service was well-led. People were complimentary about the way the managers and the office-based staff now ran the service, and how accessible and approachable they all were. The provider promoted an open and inclusive culture which sought the views of people, their relatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people's packages of care at home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 January 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 2, 9 and 16 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check that had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

For both those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. Although, the key question safe, which has improved a bit but not enough to be rated good, the provider will therefore still need to demonstrate they can continue to move in the right direction and consistently keep people safe over a more sustained period of time.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caremark Lambeth on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information, we may inspect sooner.

Caremark Lambeth is a domiciliary care agency that provides care and support to people living in their own homes. At the time of our inspection, 20 adults were receiving personal care at home from this agency.

In addition, 24 people who also use the service did not receive any help with tasks that were not related to personal care including, shopping, cleaning and welfare checks. The Care Quality Commission (CQC) only inspects where people receive personal care. Where they do, we also consider any wider social care provided.

People’s experience of using this service

People receiving a home care service from this agency were not kept safe.

This was because the provider's staff recruitment procedures to check the suitability and fitness of new staff for their role were not consistently or safely applied. This meant people using the service had been placed at unnecessary risk of harm of receiving personal care and support from staff who were not properly vetted and therefore might not be 'fit' for their care worker role.

We were also not assured that people were suitably protected from harm because the risks they might face were not always properly assessed and managed. This meant staff did not always have access to detailed guidance that made it clear what action they needed to take to keep the people they supported safe.

In addition, medicines were not always safely managed. Medicines records were not kept up to date or accurately maintained. Care plans did not always include detailed guidance for staff to follow about how people needed and preferred their prescribed medicines to administered and not all staff had received up to date medicines training. This meant people were at risk of not receiving their medicines as they had been prescribed.

The service was not always effective. This was because staff did not have sufficient opportunities to routinely reflect on their working practices and professional development. This lack of support for staff meant people using the service were placed at unnecessary risk of being harmed.

The service was not consistently managed. This was because the provider’s oversight and scrutiny systems had failed to always identify and/or take appropriate action to address all the unsafe practices and issues we found during this inspection (see above). The provider needs to use their established governance systems more effectively in future to help them identify and take appropriate action to improve the home care service they provide people.

People did receive continuity of care from a small group of staff who were familiar with their personal needs and wishes and daily routines. Staff followed current best practice guidelines regarding the prevention and control of infection, including those associated with COVID-19.

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. Where staff were responsible for preparing people’s meals and/or assisting them to eat and drink, people told us their dietary needs and wishes were being met. Assessments of people’s support needs and wishes were carried out before they started receiving a home care service from this agency. People were supported to stay healthy and well, and to access relevant community health and social care services as and when required.

People were treated equally and had their human rights and diversity respected, including their cultural and spiritual needs and wishes. Staff treated people with dignity and upheld their right to privacy. People typically described staff as “caring” and “friendly”. People were encouraged and supported to maintain their independent living skills and do as much for themselves as they were willing and capable of doing so safely.

People’s care plans were person-centred, which helped staff provide them with the individualised home care and support they needed. Staff ensured they communicated and shared information with people in a way they could easily understand. People were encouraged to make decisions about the care and support they received at home and staff respected their informed choices. The provider had systems in place to manage complaints. Where appropriate, people’s end of life wishes and contacts were known and recorded for staff to refer to.

The registered manager promoted an open and inclusive culture which sought the views of people receiving a home care service, their relatives, and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of home care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good (published 21 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the way the provider managed staffing, including recruitment, training and coordinating home visits, care planning and risk assessing, and medicines. A decision was made for us to inspect and examine those risks.

At this inspection we found multiple breaches of regulations and the need for this provider to make improvements. Based on the findings at this inspection the overall rating for the service is requires improvement. Please see the key questions Safe, Effective and Well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches at this inspection because the provider had failed to safely and effectively manage staff recruitment and support, risk assessing and prevention, medicines, and their governance systems.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• Caremark Lambeth is a home care agency that was providing personal care to people living in their own homes in the community.

• The agency supports people who are living with dementia, have physical disabilities or a learning disability.

• At the time of our inspection four people aged 50 and over received a home care service from this agency.

People’s experience of using this service:

• People receiving a home care service from this newly registered Care Quality Commission (CQC) agency consistently received good outcomes.

• The service meets the characteristics of a good service and therefore we have rated them ‘Good’ overall and for all five key questions, ‘Is the service safe, effective, caring, responsive and well-led?’

• People told us they were happy with the overall standard of care and support provided by this home care agency. The following quote we received from a relative of someone who used the service sums up how most people felt about this home care agency, “My [family member] and I have both been very happy with the home care service Caremark (Lambeth) have given us since we joined them…It’s the best home care agency we’ve used.”

• People received a home care service from staff who were in the main suitably trained and supported to meet their personal care needs.

• However, staff who supported a person with autism had not received any specific autistic spectrum disorder awareness training, which the manager agreed staff would benefit from completing. We have made a recommendation about staff receiving learning disabilities or autistic spectrum disorder awareness training.

• People were protected from avoidable harm, discrimination and abuse.

• Risks to people had been assessed and was regularly reviewed to ensure people’s needs were safely met.

• Staff were usually punctual and never missed their scheduled visits.

• Appropriate recruitment checks took place before staff started working for the service.

• The agency had procedures in place to reduce the risk of the spread of infection.

• Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

• Where people needed assistance with taking their prescribed medicines this was monitored and safely managed in line with best practice guidance.

• Staff routinely sought the consent of the people they supported.

• Managers and staff were knowledgeable about and adhered to the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

• People were supported to maintain a balanced diet where staff were reasonable for this.

• People received the support they needed to stay healthy and to access health care services as and when required.

• People received support from staff who were kind and compassionate.

• Staff treated people they supported with dignity and respect.

• Staff ensured people's privacy was always maintained particularly when they supported people with their personal care needs.

• People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

• People needs and wishes were assessed and planned for.

• People, and where appropriate their relatives and professional representatives, were involved in discussions and decisions about how the home care service they would receive from this agency.

• People’s care plans were personalised and routinely reviewed to ensure they remained up to date.

• People's concerns and complaints were dealt with by the provider in an appropriate and timely way.

• No one receiving a home care service required support with end of life care, however there were procedures in place to make sure people had access to this type of care if it was required.

• The provider had effective systems in place to assess and monitor the quality of the home care service people received.

• The service was well-led and management support was always available for staff when they needed it.

• There was an open and transparent and person-centred culture.

• People, their relatives, professional healthy and social care representatives and staff were all asked to share their feedback about the service action was taken in response.

• The provider worked in partnership with other health and social care professional and agencies to plan and deliver an effective home care service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection:

• This service was newly registered with the CQC in February 2018 and therefore this inspection represents the first time they will have been rated by us.

Why we inspected:

• This was a planned comprehensive inspection since we inspect new services within 12 months of them being registered by us.

Follow up:

• The next scheduled inspection of the service will be within two and a half years of the published date of this report in keeping with our inspection methodology.

• We will continue to monitor information we receive from and about the service and if any concerning information is received we may inspect the service sooner.