Caremark (North Herts & Stevenage)

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

People’s experience of using this service:

People received personalised care and their preferences were met. People were supported to remain independent and in control of their care.

People’s privacy and dignity was respected. People were positive about how they could make choices and do things independently.

People felt supported and the care they received was safe. Staff received training in safeguarding and understood the importance of reporting concerns internally and externally.

People received their visits on time, they also confirmed if staff were running late they were contacted. Staff confirmed there was adequate travel time between visits

Staff received regular training, supervisors completed spot checks to observe and check staff competencies. Staff received appropriate training to meet people’s needs.

People and relatives were happy with the care provided by Caremark. Staff were kind and caring. People`s dignity and privacy were protected.

People and relatives knew who to contact should they have concerns. We saw that any concerns were responded to in line with the providers complaint policy

Care plans were developed when people started using the service, risk assessments were in place for each identified risk to people`s health and wellbeing.

Staff were responsive to people’s needs and supporting them the way they wanted.

The service had policies and procedures based on current legislation and best practice guidance. Staff received updates when required to ensure lessons were learned when things went wrong. Staff understood their roles and responsibilities.

Audits and checks were in place to ensure best practice. There was evidence that improvements to the service were implemented. A new monitoring system and communication application had recently been implemented to improve the way care and support was delivered.

Rating at last inspection: Good (report published 10 August 2016).

Why we inspected: This was a planned inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Potential risks to people’s health and well-being were identified by staff and they knew how to manage these effectively and protect people from harm. Risk assessments were completed to keep people safe.

People told us that they were involved with their care and staff always asked for their consent when providing care.

People and their relatives told us that their family members were kept safe and well cared for when they were being supported by the service. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse.

Recruitment processes were robust and ensured staff employed to deliver care and support for people were of a good character and suitable to meet people`s needs safely. There were sufficient numbers of staff available to meet people’s individual needs, and the service provided was flexible.

People told us staff supported them to take their medicines. Staff were trained in safe administration of medicine practices and had their competency regularly observed.

People and their relatives were very complimentary about the abilities and experience of the staff that provided care and support. Staff received training and regular updates to ensure they were up to date with their knowledge and best practice guidance.

Staff supported people to stay safe in their homes, and people were supported to maintain their health and well- being. Staff developed appropriate positive and caring relationships with the people they supported and their families, and feedback from people was consistently positive about the service they received.

People and their relatives where appropriate were involved in the initial planning of the care and support people received. People's personal information was stored securely and confidentiality was maintained.

People told us they felt the staff provided care and support that was delivered in a way that promoted their dignity and respected their privacy. Staff were knowledgeable about people`s preferred routines and delivered care that was individualised to the person they were supporting.

People told us they felt that staff listened to them and responded to them in a positive way. People and their relatives knew how to raise concerns and they were confident that the manager would take appropriate action to address any concerns in a timely way.

People were asked to provide feedback about the service they received regularly and we saw these were positive. Yearly surveys were sent to people who used the service, their relatives, staff and health and social care professional to gather feedback about the service they offered.

People and their relatives were positive about the staff and the management of the service. The registered manager regularly audited the service any improvements needed were actioned.

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 02 April 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

During our inspection of the service people told us they had been treated with respect and dignity. One person said, 'They [staff] help me in a way that is very respectful and kind; I never feel awkward. At first I was very worried, anxious and embarrassed. I need not have worried'.they put me at ease and reassured me straight away and now I feel comfortable.'

We looked at records which showed that people's care and support needs had been assessed, documented and reviewed. They were personalised and gave staff clear guidance on how to deliver safe and appropriate care that met people's individual needs. One person told us, 'They [staff] look after us wonderfully well and record what happens in our support plan which we can read.'

Published guidance about safeguarding vulnerable people had been made available to staff and put into practice. People who used the service had been protected from the risk of abuse and told us they felt safe. One person commented, 'I feel very safe and secure with them [the service].'

We saw that the provider had put suitable arrangements in place to identify, monitor and manage potential risks to the health, welfare and safety of people who used the service.

For example, we saw that visits made by care staff to people in their homes had been monitored electronically. Information about potential delays or other problems impacting on the ability of staff to attend scheduled calls was immediately brought to the attention of a member of the management team. This was achieved by real time monitoring and by both email and mobile phone text alerts linked to the computer system. This meant that the risks associated with late or missed calls had been significantly reduced.

Is the service effective?

People told us they had been involved in the assessment of their individual needs and in the planning, delivery and reviews of the care and support they received. One person said, 'I have been kept fully involved in what goes on from the beginning. My care plan is reviewed regularly and they [staff] make any amendments that I ask for. I feel in control of what goes on which is great.'

People had access to their care and support plans. We saw that these had been reviewed and updated with them on a regular basis.

The provider had put suitable arrangements in place to ensure that staff were appropriately trained and supported to perform their roles. One member of staff told us, 'The induction and training were really good. All staff must complete training, practical assessments, observations and competency checks before being allowed to deliver personal care alone. The manager supports and encourages us to develop new skills.'

Is the service caring?

We spoke with three people who used the service and two relatives who were very positive and complimentary about the levels of care provided and the care staff who supported them. The relative of one person who used the service told us, 'The carer is lovely, always arrives on time, is polite and always does what needs to be done. My [family member] has the same carer all the time who is never late and always stays the agreed amount of time.'

We spoke with three members of staff who all demonstrated a kind, respectful and caring attitude toward the people they supported. One member of staff commented, 'The care plans are very good but I also ask people what they want. I get to know them and their needs. I take time to find out about them. I talk with them, reassure them and make them feel at ease and respected.'

However, we looked at care records relating to three people who used the service and found that some of them were incomplete in some respects.

For example, in two of the assessment of needs records we looked at, the sections used to record information about people's background information, personal history and preferences had not been completed. This meant that some aspects of people's care records were not as accurate, complete or effective as they could have been.

Is the service responsive?

People told us they had been provided with sufficient information which enabled them to understand and make informed choices about the levels of care and support they received. One person said, 'I have been given a really good information pack that contains lots of useful information and advice. The staff have got to know me well which means they can look after me in a way that suits me.'

We saw that people had been given information about how to make a complaint if the need arose and had provided their signatures to acknowledge receipt of a copy of the relevant policy and procedure. Everybody we spoke with told us they knew how to make a complaint but had not had the need to do so.

Is the service well led?

Records showed that the provider had put suitable arrangements in place to manage risks effectively and to regularly assess and monitor the quality of services provided.

For example, we saw that systems had recently been introduced which enabled the provider to review management information gathered from a variety of sources about the quality of service and potential risks. This included information about complaints, care plan and medication audits, punctuality, staff performance and the outcome of quality assurance calls and visits to people who used the service.

A relative we spoke with commented, 'The management have been very efficient and effective. We have had regular contact from them asking about our views on the quality of service and they have dealt with any concerns or issues we have raised very quickly. They encourage us to provide feedback and let us know straight away when changes or improvements have been made.'