Caremark Sutton, Epsom & Ewell, Reigate & Banstead Also known as Caremark Sutton, Epsom & Ewell, Reigate and Banstead

Caremark Sutton, Epsom & Ewell, Reigate & Banstead supports people with their personal care in their own homes. Not everyone who used the service received personal care. 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. At the time of our inspection the service was supporting 87 people with their personal care. This included supporting people through a 6 week reablement service to assist with rehabilitation and recovery, a domiciliary care service and a 24 hour live in service. The service was supporting adults and children with a variety of needs, including those living with dementia, people with physical disabilities, people with learning disabilities and/or autistic people.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. As the service was supporting people with a learning disability and autistic people we have assessed the service against the ‘right support, right care, right culture guidance’.

Right Support:

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. Staff provided any support required with medicines management, supporting people’s health and supporting them to maintain a healthy balanced diet. People received care and support in line with their needs. People were involved in their care and support was adapted as people’s care needs changed. Staff were aware of the risks to people’s safety and provided support to minimise those risks.

Right Care:

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. Cultural education sessions were held to support staff to know more about different cultures and how to support people. The service also had links with the local Iman to gather further advice about how to support people in line with their faith. People received kind and compassionate care from a team of consistent care workers. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs and promoted people’s independence. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so, including working with the police on an initiative to make people feel safe living in their own homes. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff turned up on time and stayed the allocated length of time to meet people’s needs.

Right Culture:

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views. There was a governance programme in place to review the quality and safety of care delivery, identifying and making improvements where required. Staff worked with other professionals to develop the service and ensure continuous improvement. The management team created a supportive culture amongst the staff team, recognising people’s differences and how staff could work together to support each other in order to provide high quality care.

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 good (published 11 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This inspection took place on 12 July 2018. We gave two days’ notice to the provider to ensure someone was available to assist us with the inspection.

We last inspected the service in April 2016 and found the provider was meeting the fundamental standards. We rated the service ‘Good’ overall. At this inspection we found the service continued to be 'Good'. However, the provider had not always provided care in line with the Mental Capacity Act 2005 (MCA) so we rated the key question 'Is the service Effective?' 'Requires improvement'.

People felt safe with the staff who cared for them and the provider had systems in place to safeguard people from abuse and neglect. Staff received training in safeguarding and understood their responsibilities in relation to this.

Risks relating to people’s care were reduced as the provider assessed and managed risks.

Systems were in place to manage people’s medicines safely and the provider was improving the frequency of medicines audits to check people received their medicines safely.

There were enough staff deployed to care for people and staff were recruited through processes to check their suitability.

Staff received a suitable induction with regular training in topics relevant to their role. Staff received supervision with the line manager although this had been less frequent than planned due to senior staff changes. A programme of staff supervision was planned going forwards. The provider checked staff provided care to people in the best ways through spot checks and supported staff to improve where necessary. Staff felt well supported by the provider.

People received the support they required in relation to maintaining their health. People received food and drink of their choice and any support they required in relation to eating and drinking.

The provider assessed people’s care needs by meeting with them and their relatives to find out their needs and wishes. The provider also reviewed any professional reports in developing care plan for people.

People’s care plans contained sufficient detail to guide staff on people’s physical, mental, emotional and social needs and informed them of their personal history.

Staff were caring and developed good relationships with people. Staff knew the people they cared for. Staff treated people with dignity and respect and people’s privacy was maintained. People were supported to maintain their independence and people were involved in decisions about their care.

The provider investigated concerns and complaints and used them as part of improving the service.

The registered manager was on long-term leave and were soon to terminate their employment. A new manager had been recruited who would register with CQC. The service was led by two competent directors in the meantime. One director won several awards in the past year in relation to the way they led their business. Staff also understood their role and responsibilities.

The provider had systems in place to oversee the quality of service including audits and gathering feedback from people, relatives and staff. However, this system had not identified the issues we found relating to the MCA. The provider communicated openly with staff and external professionals.

Chloe Drury Limited operates under the brand name Caremark (Sutton). Chloe Drury Limited provides personal care and support to people in their own homes. This includes a service to younger and older adults, and those living with physical disabilities, mental ill-health and/or dementia. In addition Chloe Drury Limited provides an escort service for children, and social and domestic calls to older people. At the time of our inspection 72 people were receiving a service, 66 of whom were receiving support with their personal care.

The service had a registered manager. 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. At the time of our inspection the registered manager was on leave. The managing director and operational director were managing the service whilst the registered manager was away.

People received the support they required with their personal care. Assessments were undertaken to identify people’s support needs. People were involved in discussions about their care and support. Plans were developed detailing the level of support people required and how people wanted that support delivered. Care workers were clear about what duties they were required to perform at each appointment. They involved people in discussions and offered them choices about their care.

Staff worked with people to identify risks to their safety, health and welfare. Staff discussed with people those risks and worked with them to develop risk management plans. Staff supported people with their health needs. Staff were knowledgeable about signs that a person’s health was deteriorating or their risks had increased, and supported people to obtain the advice and support they required. Staff liaised with people’s GP or emergency services if they had concerns about a person’s health. Staff supported those people that required it with their medicines, and checked that people took their medicines as prescribed.

There were sufficient staff to meet people’s needs. Systems were in place to ensure staff attended people’s homes in line with their care packages, and to ensure care workers attended visits on time and stayed the required length of time. There was sufficient time built into staff rotas to accommodate travel time between visits.

Care workers were matched to people based on their personalities, skills and backgrounds. People were asked about their cultural and religious needs and the management team allocated staff who were able to meet those needs. The management team were rolling out a programme to develop staff’s understanding of different cultures to help break down barriers and aid understanding.

Staff received the training and support they required to undertake their role. A programme was in place to provide refresher training to staff to ensure they had up to date knowledge and skills. The management team also liaised with the local NHS trust and hospice to provide staff with additional training. Care workers received regular support from their supervisor and were in frequent contact with them.

Staff were aware of their legal responsibilities and the provider’s internal policies and procedures. This included understanding their responsibilities in regards to safeguarding adults, the Mental Capacity Act 2005 and incident reporting. The management team liaised with the local authority as appropriate if they had concerns regarding safeguarding procedures or people’s safety.

The management team reviewed the quality of service delivery. This included undertaking spot checks, completing competency tests and reviewing the quality of care records.

The management team liaised with other organisations to share learning, build links with the local community and to identify how they could further support people with certain health diagnoses. The staff offered additional services in line with people’s interests and to help reduce social isolation. This included a therapy pet service and coffee mornings.

The management team were aware of their CQC responsibilities and adhered to the conditions of their registration.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives and the staff supporting them and from looking at records.

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

Is the service safe?

People using the service and their relatives told us they felt safe. There were safeguarding policies and procedures in place, which staff, people using the service and relatives were aware of. This helped to ensure that signs of abuse could be picked up and acted on quickly. We saw that the service had acted appropriately when an allegation of neglect was raised.

Staff had competency assessments to make sure moving and handling people and administering medicines were carried out safely. People had assessments that identified any risks to their safety and welfare. Care plans covered these risk areas. Although it was not always clear what action the provider had taken to reduce and manage risks, staff were aware of actions they needed to take to keep people safe.

The provider checked that people received the agreed amount of time with staff to ensure they were kept safe and their needs were met. One person told us, 'I feel completely safe and I've never felt neglected.'

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant people would be safeguarded as required.

Is the service effective?

Competency assessments for staff were carried out in the presence of expert professionals to ensure that care reflected relevant guidance. People and their relatives were consulted throughout the assessment and care planning process so that the care provided reflected what people wanted and needed. Records of care showed that care was delivered in line with people's care plans so that they received the care that they had been assessed as needing.

Staff told us they felt well equipped to provide care effectively. They received an induction based on national standards and training was planned to cover specific areas that reflected the individual needs of people who used the service. The provider had systems to identify further training needs and these were followed up. This enabled staff to develop the knowledge and skills required to provide care to a high standard.

Is the service responsive?

The provider regularly contacted people who used the service by telephone to check that they were happy with the service and ask whether any changes were required to care plans. A person who used the service told us, 'They ask over the phone and act on my suggestions.' The provider promptly made any changes required as a result of people's feedback. The care plan was flexible and adjusted to reflect people's changing needs and preferences so people received the care they required at all times and staff were aware of people's changing needs. The service had not yet received any formal complaints but people who used the service were aware of the complaints policy and told us they had not needed to use it because the provider had responded to their concerns before they became complaints. One person said they were 'very impressed with how they dealt with it.' This meant that the provider ensured a high quality of care by continually checking that people were satisfied and quickly acting on their feedback.

Staff told us the provider listened and responded to their feedback to help them improve the quality of the service.

Is the service caring?

Staff spoke about people they cared for in a respectful and caring manner, telling us about how they made sure people's privacy, dignity and independence were respected. A relative of a person who used the service told us, 'Staff definitely treat my relative with dignity and respect. They are polite and do what she asks them.'

The provider took steps to ensure that people understood the care choices available to them and had opportunities to be involved in planning their care. The service made adjustments to take into account people's cultural background and other diverse needs. This helped to ensure that people's individuality and values were respected. People who used the service told us, 'They took my individual needs into account' and 'I feel very well cared for.'

Is the service well-led?

In this report the name of a registered manager appears who was not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. CQC has received a registration application for the new manager.

Staff told us they were in regular contact with supervisors and managers and felt that they received the support they needed to carry out their work. The provider carried out regular checks to monitor the quality of the service and responded quickly to address any issues, including providing the necessary support that staff required to learn from identified concerns.

There were clear lines of accountability within the service. On-call managers were on duty at all times and assessments were only carried out by experienced senior staff. This meant that decisions about care and treatment were made by the appropriate staff at the appropriate level.