Archived: CMCL Care

Caremark (Bradford) is a domiciliary care agency which provides personal care to people in their own homes. At the time of the inspection the service was providing personal care to 159 people.

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 using this service:

People provided mixed feedback about the overall quality of the service they received. Most people were happy with Caremark however there was a sizeable minority that was unhappy and said management had not been effective in addressing their issues or concerns.

Medicines were not managed in a safe or proper way. People did not always receive their medicines as prescribed and medicines administration records were not always clear or fully completed. Unsafe medicines management had been an issue at the last three inspections demonstrating the service had a poor track record in this area.

Some risks to people’s health and safety were assessed but this approach was inconsistent. We found a number of key risk assessments missing or lacking the required detailed.

Most people told us they felt safe using the service. However there had a been a high number of safeguarding incidents and we saw robust systems were not always operated to protect people from abuse or harm.

People said there were variations in the quality of staff and some unsuitable care workers that shouldn’t be working for the service. We saw robust recruitment procedures were not always operated.

Staff received a range of training and support which was relevant to their roles. Training was kept up-to-date. However, some people experienced a high number of different care workers in a given week or month which was a barrier to providing consistent, high quality care.

Most people received calls at the times that they needed them, however this was not consistently the case. A number of calls were significantly shorter than they should have been, and some people said staff rushed.

Most people said staff were kind and caring and treated them well. However, this view was not universal, and a number of people gave us examples of how they had not always been treated with dignity and respect by staff or the management team.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not always support this practice.

The service was not well led because the service continued to be in breach of regulation and had not deteriorated since the last inspection. Audit and checking procedures were not suitably robust in identifying errors and taking action to prevent them re-occurring.

We found seven breaches of regulation. We raised these issues with the service and requested an immediate action plan to state how they would mitigate the risks to people. We also made safeguarding alerts to the local authority about some of the more serious concerns.

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 14 August 2019) and there were two breaches of regulation. We issued two warning notices, for regulation 12 safe care and treatment and for regulation 17 good governance.

At this inspection the service had not improved or met the warning notices and was still in breach of these regulations.

Why we inspected

The inspection was prompted in part due to concerns received about overall care quality and due to a number of safeguarding incidents which had occurred in the service. A decision was made to bring the planned comprehensive inspection of this service forward to allow us to inspect and examine those risks.

This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caremark (Bradford) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, safe care and treatment (medicines and risk management), safeguarding, consent, recruitment, complaints and good governance.

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

Information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request updated action plans to understand what they will do to improve the standards of quality and safety. 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Caremark - Bradford is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to both older people, adults, young people, people with learning and profound disabilities and people at the end of life. Not everyone using Caremark receives 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 the inspection 260 people were receiving personal care from the service.

A registered manager was 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.

People told us they felt safe. Staff knew how to recognise and report any concerns about people's safety and welfare. Risks to people’s health and safety were not always assessed to help protect people from harm.

We found medicines were not always managed in a safe or proper way. In particular, we found discrepancies with documentation, namely between medicines administration records (MARs), information recorded in daily logs and recording of topical medication.

People were provided with care and support by staff who were trained. Staff were skilled and competent to meet the needs of people. Staff told us they had received induction and training relevant to their roles. This was followed up by competency checks, however, these were not always effective. Training was tailored to meet people’s care and support needs. People were supported by kind, caring and compassionate staff. Staff demonstrated a sound awareness of infection control procedures.

There were enough staff deployed to ensure people received care. However, staff did not always arrive on time or stay with people for the allocated amount of time. Safe recruitment procedures were followed to help ensure staff were of suitable character to work with vulnerable people.

Care records contained sufficient detail so staff knew what support to offer people. People felt they participated in planning their care. Care records included information about people’s preferences, likes and dislikes.

The service was compliant with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought before care and support was offered.

People said staff were kind and caring and treated them well. We saw good positive relationships had developed between people and staff. People mostly received care from specific staff to enable familiarity between people and staff. This meant people received consistent care.

The service worked in partnership with other agencies including health professionals to help ensure people’s needs were met. People’s healthcare needs were assessed and plans of care put in place.

A complaints procedure was in place, which enabled people to raise any concerns or complaints about the care, or support they received. However, the service did not always respond to people in line with their complaints policy.

Staff told us they felt supported in their roles and their views were listened to through supervision and team meetings.

People using the service, relatives, staff and healthcare professionals we spoke with were generally positive about the management team. Staff said the registered manager was approachable and supportive.

We found the providers quality monitoring systems were not always working as well as they should be. Some of the concerns we found at our inspection should have been identified through a robust system of checks.

We found two breaches of regulations in relation to safe care and treatment and good governance. We are considering the appropriate regulatory response to our findings.

Caremark is a domiciliary care agency which provides care services to people in their own homes. At the time of our inspection 238 people were receiving a personal care service. The agency provides a service to adults and children, older people, people living with dementia, people with physical disabilities and people with sensory loss.

There was a registered manager in post. 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.

Most people who used the service felt safe with the care provided and we found there were systems in place to protect people from harm. Appropriate safeguarding notifications had been made. Staff had received safeguarding training and understood how to keep people safe.

Risk assessments and care plans were individualised and person centred. These were reviewed on a regular basis to ensure they contained accurate and up to date information. Staff we spoke with understood the care and support they provided to people and displayed a person centred and caring attitude to the people they supported.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS).

We found medicines were not always managed in a safe or proper way. In particular, we found discrepancies with documentation, namely between medicines administration records (MARs), daily records and information contained within people's care plans.

Sufficient staff were deployed with the relevant knowledge and training to support people's needs effectively. People were mostly supported by the same staff team and matched with staff from similar backgrounds to ensure wherever possible cultural needs were supported. Recruitment checks and systems were in place to ensure people employed by the service were safe to work with vulnerable adults. Staff received induction training, supervisions, observations and spot checks as well as annual appraisals. Staff meetings were in place and an annual satisfaction survey sent to all staff, with results analysed and actions taken.

People's feedback on the service was regularly sought through care plan reviews, telephone checks, surveys and quality checks by management when they visited people's homes. Most people told us staff were reliable and treated them with kindness and compassion although some people said they were not always notified if a staff member was going to be late.

There was a robust complaints procedure in place which enabled people to raise any concerns or complaints about the care or support they received. The service investigated complaints thoroughly and documented actions and outcomes.

There was a quality assurance monitoring system in place that was designed to monitor and identify any shortfalls in service provision. Some improvements to systems had taken place since our last inspection. However, we found some quality audits remained insufficiently robust to identify areas requiring improvement, such as medicines management.

Most staff we spoke with praised and felt supported by the management team. However some people and their relatives told us they felt communication could be improved.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take in relation to this at the back of the full version of the report.

This was the first inspection carried out since the provider registered at the current address.

Caremark is a domiciliary care agency which provides care services to people in their own homes. On the day of our visit 135 people were receiving a personal care service. The agency can provide a service to adults and children, older people, people living with dementia, people with physical disabilities and people with sensory loss.

There was a registered manager in post. 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.

Most people who used the service felt safe with the care provided and we found there were systems in place to protect people from harm. However, the service had not made statutory notifications, such as notifications of abuse, to the Commission.

Risk assessments and care plans were individualised and person centred. These were reviewed on a regular basis to ensure they reflected accurate and up to date information. Staff we spoke with were person-centred in their description of the care and support they provided to people.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards (DoLS).

We found some concerns around the safe management and administration of medicines, particularly in regards to appropriate gaps in between administration of medicines and the management of 'as required' (PRN) medicines.

We found that people were provided with care and support by staff who had the appropriate knowledge and training to effectively meet their needs. The skill mix and staffing arrangements were also sufficient, although some people told us they would like to see more continuity of care staff. We saw from reviewing records Continuity of care staff was provided wherever possible. Recruitment checks and systems were in place to ensure people employed by the service were safe to work with vulnerable adults, although in some instances references were not always obtained prior to commencement of employment.

People and their relatives told us staff treated them with kindness, care and respect and most people told us staff were usually punctual and reliable. People's feedback on the service was regularly sought through care plan reviews, telephone checks, questionnaires and quality checks by management when they visited people's homes.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager ensured staff received induction training, supervisions, observations and spot checks as well as annual appraisals. Staff training included mandatory subjects and additional training and development relevant to their role. However the training matrix had not been updated to reflect recent training.

There was a quality assurance monitoring system in place that was designed to monitor and identify any shortfalls in service provision. However, we found this was not sufficiently robust to identify areas that required improvement.

Staff and healthcare professionals we spoke with praised and had high regard for the management of the service, although some people and their relatives told us they felt communication could be improved.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take in relation to this at the back of the full version of the report.