At Home Care

Updated 7 August 2021

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.

Inspection team

This inspection was undertaken by two inspectors.

Service and service type

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

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

We gave the service notice of the inspection on 02 March 2021. This was because we needed to be sure that the registered manager or a senior member of staff would be in the office to support the inspection.

Inspection activity started on 03 March 2021 and ended on 31 March 2021. We visited the office location on 03 March 2021.

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 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. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spoke with four people who used the service, received written feedback from a further four people and five relatives about their experience of the care provided. We contacted 53 members of staff and received feedback from 28. We also spoke with the nominated individual and the registered manager. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also received feedback from a range of people involved with the service. This included three external professionals.

We reviewed a range of records. This included records relating to call times, risk management, safeguarding, medicine records and staff training records. We reviewed five staff files in relation to recruitment, spot checks and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 7 August 2021

About the service

Caremark Dacorum & St Albans is a domiciliary care service that is registered to provide personal care to people living in their own homes in the community. At the time of our inspection, 105 people were being supported by 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.

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

People told us that staff were kind and caring and they felt safe when receiving their care. However, some people told us that they felt less confident when new staff were sent to support them.

We found that there were mixed experiences from people who used the service with regard to staff using the correct PPE equipment. We have made a recommendation about the management of risks associated with Covid 19.

Where people received support with medicines, this was not always managed safely. Medicines administration records (MAR) were not always completed.

People had mixed views when asked about staff knowledge of their roles. The provider had failed to ensure that all the required recruitment checks were completed prior to staff working at the service. Records relating to recruitment were inconsistent.

The culture at the service was not always open or inclusive. Two people told us they had been asked by staff to provide good feedback on the service to the Care Quality Commission (CQC) and four staff told us they felt there was a bullying culture.

A lack of provider oversight and robust monitoring systems led to some areas of concern not being identified and actioned.

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 10 January 2019).

Why we inspected

We received concerns in relation to the management of medicines, safeguarding, infection control risks, the recruitment of staff, and the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. 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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 Dacorum & St Albans on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to the overall governance of the service at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.