Caremax Homecare Services Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 2 breaches of the legal regulations within Safe. Information from the provider’s call monitoring system identified concerns in relation to location of staff and people’s calls being shorter than commissioned. The provider could not demonstrate induction and ongoing training was completed and effectively used to support people safely. As a result there were not enough suitably trained staff to meet people’s assessed needs. Care plans included information about risk; however, because of the lack of training and competency checks, we were not assured staff had the relevant skills to manage all risks safely. This included management of medicines. The provider had safeguarding systems in place. Concerns were reported and actioned.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people told us they felt safe with the staff who supported them. A person told us, “I cannot survive without them. They arrive on time. I feel safe with their care. They are indispensable.” A relative told us, “[Person] has no issues. They have difficulty walking but feels safe in their care.” However, some people were concerned about some staff’s ability to communicate effectively. A relative said, “[Family member] gets very confused and there is a language barrier with some carers which they find frustrating.” Another relative told us, “Although [family member] appears happy, some carers cannot be understood.”

The provider had safeguarding systems in place. Concerns were reported and actioned. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. We checked whether the service was working within the principles of the MCA. During the assessment we identified a concern where staff were locking a person’s door, there was no information recorded about potential risks related to this process or discussions with the person or their representatives. Following the assessment the registered manager sent us information to confirm they had now sought all people’s views in relation to this concern. There were no mental capacity assessments found in relation to medicines, the provider told us they contacted people’s social workers if they had any concerns about people’s capacity or decision making.

Staff had completed online safeguarding training and understood internal reporting processes; however, some staff were not aware of how to access the services policies and procedures or who to report to externally if this were required. A staff member told us, “I would call the senior or the office. I do not know about reporting externally but would try to find out. I have never been told about whistleblowing, only what I knew myself.” Another staff member said, “I would tell my manager if I had any concerns. I do not know what whistleblowing is.”

People’s care plans and risk assessments provided information about potential risks to people. However, not all staff had received sufficient training to understand all potential risks to people. Senior staff were showing new staff how to use manual handling equipment and tasks associated with catheter care and stoma care. Senior staff did not have the correct skills and knowledge to deliver this practical training and minimise risk to people.

Staff told us the care plans were always provided to them prior to visiting a person. A staff member told us, “When we get a new client the care plan is emailed, and we can see everything on the app. I go through everything.” Another staff member said, “The care plan tells me everything I need to know. Then we speak with people. We have an app, and we get an email with their care plan, we get told everything.” However, we were not assured staff had received all the training required to manage all risks safely. Staff told us senior staff showed them how to use equipment related to people’s mobility needs such as hoists and slide sheets. Additionally, we were told senior staff also demonstrated to new staff how to manage catheters and stoma bags. However, we were not assured senior staff had the training needed to demonstrate these tasks safely. A staff member told us, “I have never been told how to use a slide sheet, I was just shown by another carer, I have no idea if we are doing it the right as it was impossible to see from the from online training.” Another staff member said, “I was given a person with a catheter, and I was shown by Senior [staff] how to connect/disconnect. I was told nothing about risks only connecting night bag. I know what risks to look out for but learnt this in a previous job.”

The service used an electronic care planning system and care plans contained risk assessments about people's individual care, support, and environmental needs. People told us staff supported them with risks associated with their care. A person told us,” I am happy with the carers. They do all their tasks. I get on well with them. They look after me well.” A relative said, “Personal care is excellent. The carers are polite and chatty. They always ask [family member] what they need. They give medication and ointment. They wear PPE.” However, we identified some staff had not always received appropriate training in relation to risk. While the people we spoke with expressed that they were generally happy with their care, our assessment found some people did not have access to information recorded in relation to risk. A relative told us, “I do not have access to the app (care planning app) so I have to report any updates for them to put on the app for continuity. I am not happy with this arrangement as I can’t access their (staff) notes recorded on that App.” Another relative said, “[Family member] has a care plan but I have no access to the App, I have requested it.”

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The call monitoring system showed around 59% of calls had no planned travel time between visits. During feedback, the registered manager told us they would change the rotas to ensure all calls contained travel time for staff. Newly employed staff, including staff without care setting experience, had not received a full/comprehensive induction, this was unsafe practice. Not all staff had completed the ‘Care Certificate’ as part of their induction. The ‘Care Certificate’ is a set of standards that social care and health workers should adhere to in their daily working life. Staff were not enabled or supported to understand expectations of their role and ways of working. Where staff had been promoted to a senior role, they had not received induction to this position. The registered manager confirmed instructions were provided to new employees by other members of staff without an appropriate ‘train the trainer’ qualification. Where people needed support with moving and handling, catheter care or a stoma, new employees were shown this by another staff member who could not demonstrate all appropriate training, competency checks for their own practice or qualifications to train others. Recruitment checks prior to employment were not robust to ensure staff’s suitability to work with vulnerable people. For example, references and information relating to employment history had not always been gathered.

We received mixed feedback from staff about their rotas and the ability to attend their visits on time. A staff member told us, “We have no gaps [travel time] at all, and houses are quite far apart, so I am often late. We do not cut people’s time, but we are constantly running behind so calls are late. We can call people and tell them we are running late, often when we are late, and they cancel the call.” Another staff member said, “Our rotas are not well organised, all our calls are back-to-back, there is no walk time, we are not given it. We are constantly running late so this eats into our break.” However, other staff told us they did receive travel time. A staff member told us, “The rota is according to area and most clients are very close only 2/3 minutes, if far they provide travel time. There is enough staff, and we stay the right amount time.” Another staff member said, “I'm fortunate to have sufficient travel time between calls, allowing me to give each person the care and attention they deserve. Time management is crucial, and I prioritise allocating adequate time to effectively meet each individual's care needs.” Staff told us they had not always received training to meet people’s needs. A staff member told us, “The training is all online, you shadow when you start. Hoists and most things were shown to me on shadow shifts, and I watched what carers did. I do look after catheters; we do empty them. I was not shown on my training, I had to ring one of the carers to show me what to do.” Another staff member said, “I was given a person with a catheter, I was told nothing about risks only how to connect the night bag. I know what risks to look out for, but I learnt this in a previous job.” We also received mixed feedback from staff about whether they were receiving supervision. A staff member told us, “We do not have supervision or staff meetings; we get spot checked but I have only had 1.” Another staff member said, “I receive regular supervision."

We received mixed feedback from people and relatives about the visits and the competency of staff they received. Some people told us they often did not receive their care calls on time particularly when their usual staff were not available. A person told us, “They do fulfil the times I want, and they do stay but if they have done everything then I tell them to go.” A relative told us, “There are not enough staff and when the main carer is on holiday, it is chaos. I worry if the new carers have had due diligence checks. Some are good but it seems that after a couple of ‘shadowing’ visits they are ‘thrown in at the deep end.” Another relative said, “The skills and abilities of some carers are poor. They need more shadowing and supervision, more training. The language barrier means they are not learning properly.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We were not assured the provider had an effective system to ensure staff were competent to administer medicines. Medicine policies and procedures were in place and audits were carried out. Staff had received online medication training and had their competency assessed to ensure they remained competent to undertake this task safely. However, the registered manager confirmed staff’s competency was assessed by other members of staff whom had not completed appropriate ‘train the trainer’ qualification which enabled them to train others in the organisation. Staff told us; “I do administer medicines; we do not get told what they are for, and no-one has checked my competency” and “I had training in medicines, the other senior showed me how to do it. The senior came and checked me.” Oversight of day-to-day administration of medicines was effective with the electronic system alerting managers of any concerns. However, we identified a person had requested their medicines to be mixed with food, the registered manager had not sought guidance from a pharmacist about whether this would affect the properties of the medicines. The provider responded to this concern immediately following the assessment and a medicine for this person was changed to a liquid form.

People were not always positive about the support they received with their medicines and again feedback was mixed. A relative told us, “It is vital that [family member] receives their medication at the correct time and administered in the right way. Staff do not show due diligence in this.” Another relative said, “They wear PPE and give [family members] medication. They all know what they are doing and there are no problems.”