We carried out a review of the data available to us about Caremark (Bromley) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Caremark (Bromley), you can give feedback on this service.
Caremark (Bromley) provides personal care people living in their own homes. At the time of our inspection, the service provided personal care to 120 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 and what we found
People and relatives told us the service was safe. There were procedures to protect people from abuse. Risks associated with their needs were assessed and managed. People were supported with taking their medicines by staff. There were enough staff in the service. The management team were revising where staff were deployed to ensure they had enough time to travel between visits to people. We have made a recommendation about call monitoring systems because not all office staff knew how to access the system being used.
Accidents and incidents in the service were analysed to prevent reoccurrence. Staff followed safe practices to prevent and control infections. Staff were recruited safely and their backgrounds checked before they started working for the service.
Staff were supported with training to ensure their skills and knowledge were up to date. 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 were supported with maintaining their health and nutrition. The service worked with health care professionals, to ensure their health needs were met.
Staff were respectful and caring towards people. Staff understood the importance of promoting equality and diversity. People were supported to maintain their independence. Staff communicated with people appropriately, according to their communication needs.
Care plans were personalised. People were encouraged to attend community events or activities that were arranged by the provider. People knew how to make complaints about the service. Complaints were investigated by the registered manager.
Staff felt supported by the management team. Quality assurance systems included obtaining feedback from people and relatives. Spot checks took place to check staff followed safe procedures. The registered manager was committed to making continual improvements to the service.
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 (report published 1 March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
Caremark (Bromley) is a domiciliary care agency based in Orpington in the London Borough of Bromley offering a range of services in people's homes, including people living with dementia, learning and physical disabilities and people with palliative care needs. Services provided include, domestic support, waking and sleep in night services, 24 hour care and respite care. At the time of inspection the registered provider was supporting approximately 185 people and employed 97 members of staff.
There was 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 a service is run.
A comprehensive inspection of Caremark (Bromley) took place in May 2016. At that inspection breaches of regulations were identified in relation to records relating to the health and safety of people, management of medicines, recruitment of staff, compliance with the Mental Capacity Act, handling of complaints and sending notifications to the Care Quality Commission about events that they were required to by law. Following that inspection visit, the registered manager submitted an action plan to show what improvements they were going to make to ensure they met the fundamental standards.
A focussed inspection was carried out in September 2016 to check that improvements had been made around the management of medicines. At this inspection visit it was noted that improvements had been made to ensure prescribed medicines were suitably managed but other issues were found in relation to the management of medicines that were ‘as required’ and did not require prescription. The provider did not always record the administration of these medicines in line with their policy. This was a continuing breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities 2014. Following that inspection, we wrote to the provider requiring them to confirm the action they had taken to ensure compliance with the regulation.
We used this inspection 7 and 8 February 2017 to ensure action had been taken to ensure all fundamental standards were being met. We also carried out a comprehensive inspection to review the rating of the service.
At this inspection visit we found the required improvements had been made. Following the previous inspection visits the registered manager and provider had developed new systems involving care planning, the administration of medicines and dealing with complaints. This had led to improvement of the quality of the care plans and risk assessments. Systems had been implemented to manage and monitor risk to promote safety.
People told us when they required assistance with their medicines, staff were reliable and knowledgeable. Although we received positive comments about the management of medicines, we found that staff did not consistently complete accurate records for administering medicines. We have made a recommendation about this.
People were protected from the risk of abuse. We noted care plans and risk assessments were reviewed and updated when people’s health care needs changed or when new risks were identified. People who used the service told us their nutritional and health needs were met.
People spoke positively about the quality of service provided and spoke highly of the staff. People consistently told us improvements had been made within the service in the past six months. They said staff were reliable and turned up when expected most of the time. If they were running late, because of traffic or some other issue, the office contacted people to advise of a revised time for the call. The service had implemented a call monitoring system to track and record staff attendance at visits and had employed a dedicated member of staff to monitor the system. People said that this had led to a reduction of missed and late calls.
People using the service told us they felt safe and secure. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.
People’s healthcare needs were monitored. Care plans were developed and maintained for people who used the service. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.
Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the relevance to their work. Capacity was routinely assessed and good practice guidelines were referred to when a person lacked capacity.
Training was provided for staff to enable them to carry out their tasks effectively. The service was working proactively to identify staff training needs. Staff praised the training on offer.
Suitable recruitment procedures meant staff were correctly checked before starting employment.
The registered manager had implemented a range of assurance systems to monitor quality and effectiveness of the service provided. We saw that audits were being carried out on a monthly basis by the senior management team and noted action had been taken when concerns were identified.
Systems were in place to seek feedback from all people who used the service as a means to develop and improve service delivery.
People who used the service praised the registered manager and their transparent way of working. People said the registered manager was approachable and they were confident if they had any concerns the registered manager would listen and take action.
People who used the service told us they were aware of the complaint’s procedure and their rights to complain. People and relatives who had experiences of making complaints told us they were happy in the way in which their complaints were managed and the outcome of the complaint.
Staff were positive about ways in which the service was managed and the support received from the management team. They described a positive working environment.
We also found that risks to people had not always been adequately assessed. The provider did not have appropriate systems in place to ensure people were appropriately assessed in line with the requirements of the Mental Capacity Act 2005. Appropriate recruitment checks for staff were not always in place and the provider had failed to submit notifications to CQC as required by the regulations. There were no effective systems in place to receive and respond to complaints, or to monitor and improve the quality of the service.
These issues were breaches of the regulations of the Health and Social Care Act (Regulated Activities Regulations 2014). We asked the provider for an action plan to make improvements to the issues identified above. We will check on the action the provider has taken in relation to the requirement notices at our next comprehensive inspection.
We undertook this announced focused inspection on 28 September 2016 to check that the provider had met the requirements of the warning notice. At this inspection we looked at aspects of the key question 'Is the service safe?' We also looked at the provider’s management of incidents following information received from notifications the provider submitted to us. This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Caremark (Bromley) on our website at www.cqc.org.uk.
Caremark (Bromley) is a domiciliary care provider located in the London Borough of Bromley, providing care and support to people across the borough and surrounding areas. There was a registered manager in post at the time of our inspection. 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 this inspection we found that the provider had made improvements to the areas we had identified at our previous inspection in relation to anti-coagulant medicines and the recording of people’s medicines on MARs.
However, we also found that medicines prescribed ‘as required’ were not always administered at the recommended dose intervals in line with the prescriber’s instructions, and the provider did not always record ‘as required’ medicines in line with their policy.
This was a continued breach of Regulation 12 of the Health and Social Care Act (Regulated Activities Regulations 2014). However, following our inspection we wrote formally to the provider requiring them to confirm the action they had taken to ensure compliance with the regulation. We were assured the provider had taken appropriate actions in response to our inspection, and therefore we will continue to monitor the service and check on the provider’s progress with this at our next comprehensive inspection.
We also found that the provider had appropriate systems in place to investigate, monitor and respond to incidents.
As a result of the findings of this inspection, we have reviewed the rating for the key question 'Is the service safe?' which remains rated as ‘Requires Improvement’ because of the further issues we identified regarding the unsafe management of medicines. Therefore there is also no change to the overall rating for the service which remains 'Requires Improvement'.
Caremark (Bromley) provides support and personal care to people in their own homes. At the time of the inspection, approximately 189 people were receiving care and support from the service. The service has a contract with the local authority to provide personal care to people within the Bromley borough and some people who use the service also organise their care and support privately.
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.
People’s medicines were not managed safely. Appropriate information was not always available for the safe management of medicines and appropriate procedures were not followed in managing anti-coagulant medicines in line with the provider’s policy. CQC is currently considering appropriate regulatory response to address this breach in legal requirement. We will report on this at a later date.
At this inspection, we found that although the provider had made improvements to identifying and addressing risks to people, we found continued concerns in relation to individual risks not being identified or addressed. We also found breaches of regulations in respect of staff recruitment and capacity assessments for people who were unable to make specific decisions for themselves were not in place. We found that the provider was not always acting on complaints and systems in place for assessing and monitoring the quality of the service were not effective in driving improvement. Also the provider had failed to notify the Care Quality Commission of safeguarding allegations as part of their statutory notifications.
Although appropriate numbers of staff were deployed to support people, issues regarding staff attendance needed to be addressed. We found that people experienced high volumes of late calls and sometimes missed calls. People felt the service was not always caring towards them because there were organisational and administrative issues. Overall, people said they felt safe using the service; however a few people said they did not feel safe when new care workers were deployed to their home without them being informed.
The provider had safeguarding and whistleblowing policies and procedures in place and staff knew of their responsibility to safeguard people they supported. Staff were aware of seeking people’s consent before providing the care. Records showed staff were supported through induction, training and supervision to ensure they had appropriate skills and knowledge to undertake the role which they had been employed for. People were supported to eat and drink sufficient amounts for their well-being. Where required people were supported to gain access to healthcare professions to ensure their needs were met. People’s privacy and dignity was respected and people’s independence promoted. People and their relatives were involved in the care planning process to ensure their needs were met. People were provided with appropriate information when they started using the service. Where required, people were supported to engage in stimulating activities.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service. This was an announced inspection. We gave the registered manager two days notice of our inspection.
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 and has the legal responsibility for meeting the requirements of the law; as does the provider.
This service provides personal care to people living in their own homes. It provides care and support to adults of all ages, but most people who used the service were older people. The service has a contract to provide personal care with a local authority and some people who use the service organise their care and support privately. At the time of our inspection there were 163 people in receipt of the service.
We last carried out an inspection at the service on 7 March 2014 and found that the provider met the one regulation that we inspected and there were no concerns.
We found at this inspection that while some risks to people were addressed, not all risks to people were being identified or being addressed in the care plan. This was a breach of the regulation in relation to the care and welfare of people using the service. You can see what action we told the provider to take at the back of the full version of the report.
People we spoke with told us they felt happy and safe with the service. They said staff treated them with respect and dignity. Staff understood how to safeguard the people they supported from abuse and avoidable harm and how to raise an alert if needed. There were adequate numbers of staff and appropriate recruitment checks were carried out to protect people from the risks of employing unsuitable staff.
People told us care workers were caring and respectful. People’s needs had been assessed and their care was provided in a way that suited their needs. They and, where relevant, their relatives were involved in making decisions about their care and support. People’s care plans were being revised to include more detailed information about how each person should be supported. This helped to make sure care workers knew how to meet people’s needs.
Care workers and office staff were suitably trained, skilled and experienced. People told us the care workers were kind and gave them the privacy they needed. People were encouraged to share any concerns and complaints they had. They were also asked for their views of the service on a regular basis.
Staff and people who used the service told us it was well managed and that concerns were addressed. There were regular staff meetings and communication updates to staff on their rotas or on a quarterly newsletter. This kept staff informed about any changes or developments.
We saw that there were regular checks made on staff while they worked and any issues identified were addressed.
The provider had a regular system of audits that monitored the progress and quality of the service. We saw that issues identified at the last audit were being addressed.
At our inspection on 26 April 2013 we found the provider had taken action to meet these essential standards.
We did not speak to people using the service as part of this inspection because of the nature of the compliance actions that we were following up.
People told us they were receiving the right level and kind of care and support, and they had been involved in designing their care plans. They said the service was well managed
People said the care and support workers were good at their jobs. One person said; 'they just get on with it and need no prompting. They're helpful, going above and beyond the call of duty, and use common sense'.
We saw people were well supported and that their privacy, dignity and independence were respected. Recruitment procedures and training and support for staff ensured people's needs were met by fit and competent staff. However procedures for recording incidents and responding to allegations of abuse were not fully embedded.