Caremark (Broxtowe & Erewash)

Caremark (Broxtowe & Erewash) is a domiciliary care agency providing the regulated activity of personal care. The service provides support to adults of all ages, people living with dementia, and people who have learning or physical disabilities. At the time of our inspection there were 123 people using the service.

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.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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; however the policies and systems in the service did not always support this practice. We have made a recommendation the provider reviews people’s mental capacity assessments and best interest decision documentation.

Right Care

The service was not able to fully demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture. The service had not always ensured staff had the skills, knowledge and experience to deliver effective care and support. We found care plans to contain personalised information on risks which affected people's daily lives. People were supported to receive their medicines safely and there were sufficient numbers of suitable staff.

Right Culture

The provider did not have an effective governance system in place to identify issues we found on inspection. However, the provider promptly addressed our findings and sent us an action plan. People and staff spoke positively about the culture of the service and the service had supported people to achieve positive outcomes.

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

Rating at last inspection

The last rating for this service was Good published 10 September 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, and well-led. During the inspection we found there was a concern with mental capacity assessments and staff training so we widened the scope of the inspection to include the key question effective.

For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Enforcement and Recommendations

We have identified breaches in relation to staffing in respect of training and the management of governance systems at the service. We have also made a recommendation that the provider reviews people’s mental capacity assessments and best interest decision documentation.

Please see the action we have told the provider to take at the end of this report.

Follow Up

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

There was a registered manager in post at the time of our inspection. They joined the service in April 2018 and became registered with the CQC in August 2018. 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 the inspection, 94 people received some element of support with their personal care. This is the service’s second inspection under its current registration. At the previous inspection on 20 July 2017 the service was rated as ‘Requires Improvement’ overall. An action plan was submitted which stated how the service would become compliant. At this inspection, they improved the overall rating to ‘Good’.

Improvements had been made to the way the risks associated with people’s care were assessed. Medicines were now managed safely. Accidents and incidents were appropriately assessed and reviewed. There were enough staff to support people safely. Staff arrived on time and understood how to reduce the risk of people experiencing avoidable harm. This included who to report concerns about people’s safety. Staff were aware of how to reduce the risk of the spread of infection.

People’s care was provided in line with current legislation and best practice guidelines. Staff were well trained and felt supported. Staff performance was regularly monitored. People’s nutritional needs were met. Other health and social care agencies were involved where further support was needed for people. People were supported to have maximum 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.

People felt staff were kind and caring and treated them with respect and dignity. People felt involved with decisions about their care and felt staff acted on their wishes. People’s independence was encouraged wherever possible. People’s records were handled in line with the Data Protection Act

People’s care needs were assessed prior to joining the service. Care plans were then put in place to support staff with caring for people. Care records were person centred which ensured their care was provided in the way people wanted. Efforts had been made to ensure people had information that was accessible and in a format they could understand. People’s diverse needs had been discussed with them to reduce the risk of discrimination. People understood how to make a complaint and felt they were acted on. Some people felt the way office staff dealt with complaints could be improved. End of life care was not currently provided, however discussions were held with people during their initial assessment.

The registered manager had made significant improvements since the last inspection. Robust and effective quality assurance processes were now in place and these had impacted positively on the quality of the service people received. The provider and the registered manager worked effectively together to address the concerns from the last inspection. They were supported by dedicated staff in doing so. The registered manager carried out their role in line with their registration with the CQC. High quality staff performance was rewarded. People felt able to give their views about the development and improvement of the service.

On the day of our inspection there was not a registered manager in place. 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. We were informed by the nominated individual that a new manager had been recruited and would commence their employment in August 2017. They also told us the new manager would apply to become registered with the CQC immediately. We will monitor this application and address any delays with the provider.

The risks to people’s safety were not always appropriately assessed and were not always reflective of people’s individual care and support needs. People felt their medicines were managed safely by staff; however, people’s records did not always contain sufficient personalised risk assessments or care planning documentation to ensure their medicines were always administered safely. People felt safe when staff supported them in their homes, however records showed the CQC had not been notified of incidents that could have had an effect on people’s on safety. Care staff could identify the potential signs of abuse and knew who to report any concerns to. Some people and relatives were satisfied that staff arrived at their homes on time; however, some felt staff punctuality could be improved.

Some people raised concerns that they did not always receive care and support from a consistent team of staff. A recent high turnover of staff had contributed to this, although the care coordinator felt improvements were being made. Staff training was in the majority of cases up to date, with refresher courses booked where needed. Staff received supervision of their role, although the frequency with which a small number of staff received theirs, needed addressing to ensure consistency.

The principles of the Mental Capacity Act (2005) had not always been appropriately followed when decisions were made about people’s care. Knowledge of which relatives held lasting power of attorney over their family member’s health and welfare needs was limited.

Guidance for staff to communicate effectively with people living with dementia was limited. People were supported to maintain good health in relation to their food and drink intake, however guidance for staff on how to support people living with diabetes was limited. People felt their day to day health needs were met by staff.

People found the care staff to be kind, and caring; they understood their needs and listened to and acted upon their views. People felt the care staff treated them with dignity and respect. People were involved with decisions made about their care and were encouraged to lead independent a lives. People were provided with information about how they could access independent advocates.

Personalised care planning documentation was not always in place. Care plans were currently in the process of being re-written to address this. Guidance on how to support people living with dementia was limited. Information recorded in people’s care records relating to their day to day routines was detailed. People felt staff would respond appropriately if they made a complaint.

Current quality assurance processes were not always effective in ensuring that people received a high quality service at all times. The issues highlighted within this report had not been identified by the provider’s quality assurance systems. However, the nominated individual had recruited the services of an external consultant to offer guidance and advice on how to make sustained improvements at the service. Efforts had been made to gain people’s views on developing and improving the service. Not all notifiable incidents had been reported to the CQC. Staff understood how to report serious concerns via the provider’s whistleblowing policy.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.