We visited Caremark Poole & East Dorset on 21 May 2014 to review a compliance action from our previous inspection undertaken in November 2013 relating to consent to care and treatment. We also looked at four additional outcomes: Care and welfare of people who use services, safeguarding people who use services from abuse, management of medicines and assessing and monitoring the quality of service provision.The inspection was undertaken by one inspector over the course of two different days. Time was spent in the office, visiting people in their homes and talking with staff. In total we visited three people in their homes. We also spoke with one member of staff whilst they were on duty and two members of staff by telephone.
We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service caring?
' Is the service responsive?
' Is the service effective?
' Is the service well led?
This is a summary of what we found-
' Is the service safe?
Care was not always planned to meet people's needs. One person's moving and handling risk assessment stated that they required support from two carers. However when we visited this person in their home, we found that the person had been reassessed by an occupational therapist (OT) and was able to transfer with the support of one member of staff. This meant that the person was at risk of inappropriate or unsafe care.
We found that where people required assistance with taking their medicines, some care plans were inaccurate. For example, one person was recorded to require 'prompting' to take their medicine by care staff. However their medicine risk assessment stated that staff were required to 'administer' the medicine. This meant that there was contradictory guidance for staff regarding whether they needed to prompt, or administer this persons' medication. We looked at another person's medicine administration chart; we noted that they were prescribed medicines to be taken in the morning. However, when we examined their care plan, this was not reflected. This meant that care and treatment was not planned in a way that was intended to ensure people's safety and welfare.
People who used the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
' Is the service caring?
Throughout our inspection we received positive feedback from people who use the service and their relatives. One person commented that staff acted in a kind and caring manner. One person told us "Generally all of the staff are good. We did have one person who we didn't click with. They weren't doing anything wrong and we made that clear when we spoke to the office. They did listen to us and we haven't had that member of staff come back."
People confirmed that staff always took care to protect their privacy when providing personal care and encouraged them to do as much for themselves as possible even if this took longer.
' Is the service responsive?
Where a need was identified, there was not always a clear plan in place setting out how staff would meet this person's needs to meet this need.
There were arrangements in place to deal with foreseeable emergencies. One relative told us "My husband had a fall. The carer was very good and called the emergency services and then called me to let me know what was happening."
' Is the service effective?
We found that people's needs had been assessed before the package of care was started to ensure that they could meet their needs. However we also found that some care plans lacked the detail, or contradicted some of the delivery of care that the social services assessments had specified. For example, one person's assessment stated that staff must ensure that the person had a personal alarm on their person in case of emergencies. However the providers' care plan did not reflect this. We also saw that the person was assessed by social services as requiring a soft diet and liked cold drinks. However the providers care plan stated that the person enjoyed hot drinks and there was no record of dietary needs.
People told us that they were happy with the care they received and felt their needs were met. Staff spoken with understood people's needs and knew them well. One relative told us "We get our rota the week before. Generally we get the same staff visiting which is good."
People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.
' Is the service well led?
We found that the home had some systems for reviewing and monitoring the quality of service provided to people. However, these had not been implemented effectively to ensure that people were not at risk of unsafe or inappropriate care, or in a way that protected people from being at risk of harm.