Caremark (Mid Surrey)

Updated 16 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by 2 inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. A new manager had been in post for three months and had submitted an application to register.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 28 June 2023 and ended on 4 July 2023. We visited the location’s office on 28 June 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke to 5 members of staff including the registered manager. We spoke with 5 people who used the service and 4 relatives about their experience of the care provided. We received feedback from 1 professional who was involved with the service. We reviewed a range of records. This included 4 peoples care records and multiple medication records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 16 February 2024

About the service

Caremark (Mid Surrey) is a domiciliary care agency providing personal care to people living in their own homes. The service provides support to people with a variety of health needs. At the time of our inspection there were 52 people using the service. Not everyone who received a 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. There were 11 people being supported by staff with personal care.

People’s experience of using this service and what we found

We have made a recommendation that the provider improve the planning for end of life care, people are better supported when they may lack the mental capacity to make decisions independently and they can be assured staff are recruited safely.

People’s needs, choices and preferences were not assessed or recorded accurately, timely or in a person-centred way. There was a risk that staff who were new to supporting people would not know what their needs were and therefore not provide adequate care.

Risks to people were not always assessed and staff lacked guidance on how to manage specific risks. Staff lacked practical training, training specific to the needs of the people they were supporting and some training was significantly outdated. People and relatives were not always confident that staff had been supported to have the knowledge required to provide the care required.

The manager lacked the support and infrastructure in the senior management team to manage a robust oversight of the service and to focus on improvements. Where they had the opportunity to make changes, such as with rotas and staff morale, we saw evidence of positive impact. The manager had a plan to address the concerns identified and would benefit from more support to action these promptly.

There were sufficient staff to enable consistent workers who could establish relationships with people and become familiar with their needs. A system of shadowing and communicating between staff equipped staff with some knowledge of individual needs.

Staff provided a thoughtful, kind and considerate service to people. Staff had made efforts with people to improve their mood and quality of life. They worked efficiently in partnership with other professionals and relatives to coordinate care effectively for people.

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 supported this practice.

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 26 July 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staff training. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. 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 (Mid Surrey) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, safe care and treatment, staffing and good governance at this inspection. Full 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 an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.