This inspection took place on 19 and 22 May 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service. At the time of the inspection Caremark (Enfield) provided domiciliary care and support for 37 people in their own home. The service worked primarily with older people living with dementia and people with sensory and physical impairment.At our last inspection on 30 March and 1 April 2016, we identified breaches of regulations 9, 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to, care plans not being person centred; a lack of information and understanding of the Mental Capacity Act (MCA) and inadequate risk assessments that failed to address people’s personal risks. At this inspection we found that the provider had addressed the breaches regarding person centred care planning and the MCA. However, the provider had not adequately addressed the breach around risk assessments.
There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was present during the inspection.
Risk assessments did not provide staff with guidance on how to mitigate people’s individual personal risks. Risks had not been clearly identified and it was difficult to see what people’s risks were. Information contained within risk assessments was often the same on all risk assessments and failed to ensure that staff were aware of how to mitigate people’s individual risks.
People received their medicines safely and on time. The service had employed a medicines supervisor that audited medicines on a monthly basis and addressed any issues found. Staff received regular medicines training and competency observations.
The service operated safe staff recruitment procedures and ensured that all staff were suitable for the role before beginning any care work.
Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).
Staff did not receive regular supervision. However, the registered manager had identified this issue and a system was in the process of being put in place to address this. Staff had received an annual appraisal. Staff told us that they felt supported by the registered manager and senior staff.
Staff received a comprehensive induction when starting work including relevant training and shadowing more experienced members of staff before being able to work alone. Staff were provided with on-going regular training to support them in their role.
People were involved in planning their care and had regular reviews to gain their opinion on how things were. Staff knew people well and people and relatives felt that they were treated with dignity and respect.
Care plans were person centred and included information on how people wanted their care to be delivered as well as their likes and dislikes.
The service carried out regular monitoring visits on staff to ensure that people were receiving good quality care and support.
People and relatives were provided with information on how to make a complaint.
Staff and people knew the registered manger well and felt that he was responsive to their needs.
Staff meetings were not being held which would provide staff with a forum to be able to meet up and share ideas and concerns. However, this had been recognised and staff meetings were being booked.
At this inspection we found a continued breach of Regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to address some of the concerns we found during this inspection. We will publish what action we have taken at a later date. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.