Caremark (Barnsley)

Caremark (Barnsley) is a domiciliary care service providing personal care to 170 people in their own houses and flats in Barnsley and surrounding areas at the time of the inspection. The service supported people of all ages, with different health and care needs.

Not everyone who used the service received personal care. 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

People told us they were overall satisfied with their care when they received it, that staff were appreciated, well-liked and able to adapt to their changing needs. A main and significant issue which impacted on people however was the lack of reliability in call times and staffing. The provider and registered manager were honest about their current staffing issues. These had led to the service having to hand care packages back to the local authority, as well as a stop in receiving referrals until a more reliable, safe service had been established for people.

The Care Quality Commission (CQC) had not always been notified of certain events in line with the provider’s legal obligations. We saw however examples of such events having been investigated appropriately by the service. At the previous inspection we found governance systems had not always ensured a good quality service. We found some improvements at this inspection. The wider service staffing issues meant progress was slower than hoped for and more time and support was needed. The consistency of good governance still needed to be improved, including aspects of quality assurance. We made a recommendation regarding this, as well as the consistent completion of staff supervisions.

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 generally supported this practice. This had been addressed since the last inspection, however we made a recommendation for further, continued improvements.

The provider was implementing a new electronic governance system, to help monitor and progress the service. A positive example of service progress made was the appointment of medication champions, which had led to improvements. We highlighted a few areas for development, to ensure clear directions were given to staff when helping people with their medicines.

However, people and staff we spoke with were consistent in their praise for the caring culture of the service, which was led by a well-respected registered manager and their office team. The registered manager was honest that taking time to find the right, quality candidates meant slower progress in recruitment, but they did not wish to compromise on this. People praised care staff who supported their independent living and daily well-being. Care staff were knowledgeable of people, their needs, as well as backgrounds, and people praised this. Care plan development was ongoing; however we saw some good examples of progress already made and people felt involved in the planning of their care.

People described care staff generally as hard-working and carrying out a good standard of care with a supportive management system in place. People’s comments included, “They are kind and a great help with everything I need for my care plan. The carers know my personal requirements which is reassuring for me and my family” and “They are the source to my limited independent life. I am very happy to recommend these so helpful and kind people.”

The service worked with a variety of professionals to promote or maintain people’s health and wellbeing, as well as to achieve positive outcomes. Further opportunities to involve people using the service and staff had been introduced with regular coffee mornings. These also showed the service’s understanding of their role in trying to reduce people’s social isolation. Managers were continuously exploring additional learning opportunities to develop their own best practice as well as the staff team’s.

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 16 November 2018). At the last inspection we found the provider was in breach of regulations regarding good governance. 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.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches at this inspection in relation to staffing and notifying the Care Quality Commission (CQC) of certain events. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least Good. We will work with the 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 (Barnsley) is a domiciliary care agency operating in the Barnsley area. It provides personal care to people living in their own houses and flats in the community. Not everyone using Caremark (Barnsley) received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care:’ help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 134 people were receiving regulated activity support from this provider.

The service did not have a registered manager. The registered manager had left the service in February 2018 and had not completed the application process to de-register with the CQQ. The service had a new care manager in post. This person had started the application process to register with the Care Quality Commission.

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 felt safe with the staff who supported them. Staff understood their roles and responsibilities to keep people safe from harm.

Medicines were not always administered safely and records relating to the administration of medicines were not always updated appropriately.

There were risk-specific assessments in place which identified risks to the tasks provided to care and support people. Measures had been put in place to minimise these risks; these also covered the environment in which people were supported.

There were sufficient staff to meet people’s needs. However, consistency of staff had been a concern. The new care manager had recently changed how staff were deployed. Staff told us this had improved.

Staff recruitment pre-employment checks had been thoroughly carried out.

People who were supported with medication had not always had this administered safely and staff competencies had not always been checked. There was a detailed action plan to improve this area with demonstrated lessons learnt.

Staff had undertaken training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Staff were able to describe what this meant. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care records showed people had consented to care and treatment. Staff told us how they would always ask for consent to care before assisting people.

New staff were supported in their role, which included training and shadowing a more experienced staff member until they felt confident. Staff undertook regular on-going training. Staff received regular supervisions, appraisals, observations and spot checks to assess their competency.

Staff gave examples of how they accessed and worked with relevant healthcare professionals when required.

People we spoke with told us staff were kind and caring. Staff treated them with respect and took appropriate steps to maintain people's dignity and privacy. People's private information was kept confidential.

People had a person-centred care plan in place which showed how they wished their care to be undertaken. Their likes, dislikes, and preferences were also included. This enabled staff to provide the care and support required by each individual.

There was a complaints process in place. People told us they felt confident of what to do if they had any concerns or complaints.

Regular audits had not been undertaken and audits that had taken place had failed to identify required actions.

People told us the service was well led and all talked about how well they knew the registered manager.

They described how they were regularly asked for their input and feedback. Staff gave examples of how the registered manager responded positively to feedback. People spoke highly about the management of the service.

The manager described how the service worked in partnership with other organisations and healthcare professionals.

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

At the time of this inspection Caremark (Barnsley) was supporting approximately 200 people whose support included the provision of the regulated activity ‘personal care’.

There was a registered manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Caremark (Barnsley) took place on 11 August 2014. The service was rated ‘Good’ following the inspection.

This inspection took place on 24 and 25 October 2016 and short notice was given. We told the registered manager two working days before our visit that we would be coming. We did this because we needed to be sure that the registered manager would be available and to arrange for some care workers to visit the office during our inspection so we could speak with them.

People supported by the service and their relative’s spoke positively of the care workers that visited them. People said they felt safe with their care workers.

We found systems were in place to make sure people received their medicines safely.

Systems were in operation to ensure the safe handling and recording of people’s money to protect them.

Staff recruitment procedures ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff had a good knowledge of the people they were supporting.

Some people said the timing of visits did not always meet their needs and they did not always have regular care workers visiting them all of the time. Other people said they had a group of regular care workers who generally arrived on time and stayed the full length of time. No people reported any missed visits.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and the principles of the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

Each person had a care plan that accurately reflected their needs and wishes so these could be respected. Care plans had been reviewed to ensure they remained up to date.

Some people supported, and their relatives or representatives said they could speak with staff if they had any worries or concerns and felt they would be listened to. Other people told us they found the office staff less reliable and they felt communication could be improved.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys and the results of these surveys had been audited to identify any areas for improvement.