Caremark Tunbridge Wells, Tonbridge and Malling

Caremark Tunbridge Wells, Tonbridge and Malling is a domiciliary care agency providing care and support to people in their own homes. At the time of the inspection care was being provided to 53 people including 4 ‘live in’ clients. Some people lived with dementia and other health conditions which affected their health and wellbeing.

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

There had been a lack of management oversight with follow up actions for accidents and incidents. Some risk assessments reviews were overdue and not all auditing processes had been completed. There was no formal way that people could provide feedback anonymously. The new manager had identified these issues and new systems and processes were in place however, these needed time to embed.

Staff were clear about their roles and responsibilities. Positive relationships had been made between staff and people which supported positive outcomes for people. People, relatives and staff all had opportunities to feedback about the service and were able to raise concerns and highlight aspects of the care and support provided they felt were working well. Although only in place for a short time, the manager had created a positive atmosphere and everyone spoke well of them, telling us they were approachable and provided a visible presence.

People were protected from harm and told us they felt safe. Risks had been assessed relevant to individuals and these were documented and made available to staff. Staff were able to tell us correctly, the steps they would take in the event of a safeguarding, an accident or other incident. They knew to make situations safe and to report to managers and other professionals if needed. Some people were supported with medicines and this was achieved safely by staff trained in medicine administration. People were protected from the risk of infection, staff had been appropriately trained and knew the correct procedures with personal protective equipment (PPE).

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 told us that staff were kind and treated them with respect and dignity. People’s privacy was respected and any cultural, faith or other specific needs were documented and supported. People were supported to be as independent as possible without compromising their safety.

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 28 November 2017).

Why we inspected

This inspection was prompted by a review of information new held about the service.

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

The overall rating for the service has remained as good based on the findings of this inspection.

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

Follow up

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

There were 13 people using the service who were receiving personal care at the time of the inspection.

This inspection was carried out on 18 September 2017. This was the first inspection of this service since it was registered. We gave the service short notice of the inspection because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

The service was exceptionally caring and staff were passionate about delivering the caring values of the organisation. Staff knew the people they supported well and worked in small teams to ensure consistent support and to ensure that people always had a staff member they knew well. We found examples where the staff and the management team had gone beyond the agreed care plan to provide additional support to people to ensure people’s comfort, safety and wellbeing. Support was often provided to people’s relatives to ensure their emotional well being. The registered manager and staff had an excellent understanding of the needs of people living with dementia. They understood how to support people at times of confusion to meet their emotional needs. People and their relatives were complimentary about the caring nature of the staff and the compassionate values of the service.

People were supported sensitively at the end of their life. Staff treated people with compassion and worked closely with the hospice to enable them to have a comfortable, dignified and pain free death.

People told us they felt safe and well cared for using the service. People were protected from abuse and harm and risks to their welfare were assessed and minimised. Staff promoted people's independence and encouraged people to do as much as possible for themselves. People had effective care plans that ensured their health needs were met. They were supported to manage their medicines in a safe way. People were supported to have enough to eat and drink.

There were sufficient numbers of skilled and competent staff to meet people's needs. People and their relatives could be assured that staff were of good character and fit to carry out their duties because robust recruitment procedures were followed. Staff felt valued and supported by the management team. People received effective care from skilled, knowledgeable staff. Staff were encouraged and supported to undertake qualifications relevant to their roles and for their personal development.

People received a responsive, flexible and person centred service. Their care and support was planned in partnership with them. People were asked for their consent before care was given and they were supported and enabled to make their own decisions. People's views about the quality and safety of the service they received were sought through a range of means. Feedback provided by people was consistently used to improve the service.

The service was well led. The vision and values of the service were person centred and made sure people were always at the heart of the service. We found that these values were effectively cascaded through the care team and this meant that people received a person centred service. There were effective systems for monitoring and improving the quality of the service.