Caremark Limited

Updated 18 December 2020

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 Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors, a pharmacist specialist, an assistant inspector who made calls to staff and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

The service had a manager registered with the Care Quality Commission however, they had decided to step down from their post following the initial inspection. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The area operations manager had taken on the role of the day to day management of the service until a newly recruited manager was due to start.

Notice of inspection

We gave the service four days’ notice of the inspection. This was because we needed to gain consent from people to receive a telephone call to give their feedback and arrange for the required documentation to be sent across electronically

Inspection activity started on 5 October 2020 and ended on 26 November 2020.

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, commissioners and professionals who work with the service. We used all this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with 11 people who used the service and 10 relatives about their experience of the care provided. We spoke with 13 members of staff including the area operations manager, registered manager and 11 care staff.

We viewed a range of records. This included ten people’s care records and medicine records. We looked at three staff files in relation to recruitment, staff supervision and training data. A variety of records relating to the management of the service, including policies and procedures, quality assurance checks and audits.

After the inspection

We continued to seek clarification from the management team to validate evidence found.

Updated 18 December 2020

About the service

Caremark Limited is a domiciliary care agency (DCA) that provides personal care to children 0-18 years of age, people who misuse drugs and alcohol and older people living in their own homes some of who were living with dementia. At the time of the inspection 118 people were 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.

Caremark Limited had chosen to take part in a pilot where DCAs were inspected virtually without a site visit. During the initial inspection we identified shortfalls in relation to people’s risk assessments, the management of medicines and quality assurance processes. As a result, the virtual DCA pilot was stopped and a focused inspection including a site visit was completed. An action plan had already been developed following the initial feedback and changes had been made to improve the service people received.

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

General feedback from people was positive about the service they received. One person said, “I wouldn’t change the care staff, they are great.” Another person said, “The staff are very caring and understanding and know me well.”

People’s care records had been reviewed and updated, they were person centred and outlined what people’s specific health needs were. Risk assessments had been reviewed to include people’s specific choices, and, potential risks of becoming seriously ill if they contracted Covid-19.

People’s needs had been assessed in relation to their medicines support. Staff followed specific guidance and had been trained in the administration of medicines.

Quality assurance systems had been reviewed and additional training had been given to the management team that were completing the spot checks and carrying out the audits. Feedback from people had been sought and acted on to improve the quality of the service they received. Communication between the management team, people and staff had been improved.

Staff understood their role to keep people safe and understood how to report any concerns they had. Staff knew the potential signs of abuse and action had been taken when concerns had been identified. Accidents and incidents were monitored to identify potential patterns or trends. Action was then taken to reduce the risk of reoccurrence.

Staff had been recruited safely following checks to ensure they were safe to work with people who required care. People and relatives told us staff wore personal protective equipment (PPE) during the care calls. Staff understood how to reduce the risk of infection and reduce the potential spread of infection. Potential risks posed to staff within people’s own homes had been reduced where required.

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. People were given choices about all aspects of their care such as what they wanted to wear and eat.

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 (5 December 2017).

Why we inspected

This focused inspection was prompted in part due to concerns that had been identified during the DCA pilot, which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk considering the Covid-19 pandemic. We identified concerns in relation to the assessment of risks, medicines and quality assurance processes. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.