At Home Care

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.

This was the first inspection of this service since registering with the Care Quality Commission on 30 October 2017.

There was a registered manager in post at the time of this 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.

People were supported by staff who knew about safeguarding and how to report any concerns. Risk assessments were in place to help staff to support people safely and measures were in place to reduce people’s assessed risks. Staff had been recruited safely with pre-employment checks completed before they started working at the service. People’s needs were met in a timely way by enough staff with the right skills and knowledge to support them. People’s medicines were administered as prescribed and managed safely. Systems were in place to reduce the risk and spread of infection.

Staff were trained to meet people’s care and support needs. Staff were supported through individual supervisions, team meetings and competency checks. People were supported with eating and drinking when required. Staff supported people to access healthcare professionals when required.

People were involved in their care decisions and staff promoted people’s independence as much as possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff were aware of the Mental Capacity Act (MCA) and how it related to people who used the service.

People received a caring service by staff who knew them well. People’s privacy and dignity was respected by staff. People were involved in the development and review of their care plans. The service operated flexibly and was centred around people’s needs, lifestyles and preferences. There was a complaints and comments process in place and people were aware of how to make a complaint or raise a concern. They were confident any concerns raised would be properly addressed and resolved.

The registered manager led by example and encouraged an open, transparent and inclusive culture within the service. There were appropriate quality assurance systems and processes in place to monitor the overall quality and safety of the service. People were asked to give feedback on the service and their views were taken into account. The provider and registered manager worked cohesively to help make continual improvements. Audits included the review of documents, care plans and risk assessments. Along with staff training and recruitment records.