Caremark Norwich

Caremark Norwich is a domiciliary care agency that offers care and support to people who may misuse drugs and alcohol, live with dementia, who are detained under the Mental Health Act, have mental health needs, who have a learning disability, who have an eating disorder and/or autistic people. The service can provide care and support to children and older people.

At the time of our inspection there were 49 people receiving support with personal care in their own homes. 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

At the time of this inspection, the location did not care for or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

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. However, whilst people told us staff stayed for the agreed amount of time and supported them in the ways they needed, they told us they did not always know which staff member was supporting them or what time they were expected to arrive. People told us, and records showed, that staff did not consistently attend at the times agreed.

Right Care:

Whilst people told us they received a service that was person-centred and met their needs, care records did not demonstrate this. We found that care records were not consistently accurate or complete and they could not be relied upon to evidence what care and support had been delivered. However, people told us they had confidence in the staff and that they were consistently kind, patient and encouraging. Staff were adept at maintaining people’s dignity and promoting their independence.

Right Culture:

The systems the provider had in place to assess, monitor, and mitigate the risks to the health, safety and welfare of people who used the service had failed. For example, there were two medicines administration systems in place and neither effectively ensured people received their medicines consistently safely or in line with best practice. This placed people at risk of harm. Additionally, staff had not received all the training the provider deemed mandatory, and improvements were needed in relation to staff recruitment records. Not all feedback received on the service had been acted upon in a prompt manner.

However, people felt able to raise concerns and told us they felt listened to and engaged. Staff felt supported and valued. The culture was positive, and people spoke highly of the registered manager telling us they were involved, accessible and communicative. The registered manager responded proactively to the concerns identified at this inspection and acknowledged that due to prioritising care calls, governance had deteriorated and required improvement. They provided us with assurances in relation to how they would address this.

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 27 October 2017).

Why we inspected

We inspected this service due to the length of time since the last inspection.

Enforcement

We have identified breaches in relation to risk management, medicines administration and governance 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and phone calls to engage with people using the service as part of this inspection.

Caremark Norwich is a domiciliary care agency which provides personal care to people with a variety of needs including older people, people living with dementia, younger adults, people with a learning disability and/or physical disability. The agency's office is located in Norwich. At the time of our inspection, the service was providing personal care to 77 people.

A newly appointed manager was in post, who had recently registered with Care Quality Commission in August 2017. 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.

We received mixed feedback regarding people receiving calls at their preferred time and how the office communicated with people and their relatives about this and when changes were made to rotas. We discussed this with the provider and registered manager who offered explanations as to why this had been highlighted. We have discussed these issues within the Well-Led section of this report and recommended the provider reviews how they communicate with people and their relatives about what they are able to provide, regarding times of care calls and when changes are made to allocated staff.

People and healthcare assistants spoke highly of the care co-ordinators and the company. People expressed satisfaction with the service they received. However, we found that quality assurance systems were not always being used to ensure accurate records were maintained and to drive improvements. We identified there was a delay in daily notes and medication administration records (MAR) being delivered to the office from people's homes which could delay timely quality monitoring of those records. The provider updated their audit tool on the day of inspection to improve this; however we will need to assess how this improvement has been embedded and sustained at our next inspection. We found no evidence that the lack of audits and gaps in records had affected the quality of service people received.

Risks to people's wellbeing and safety had been effectively mitigated. We found individual risks had been assessed and recorded in people's care plans. Examples of risk assessments relating to personal care included moving and handling, nutrition, falls and continence support. Health care needs were met well, with prompt referrals made when necessary.

People told us they felt safe receiving the care and support provided by the service. Staff understood and knew the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern. Training schedules confirmed staff had received training in safeguarding adults at risk.

Robust recruitment and selection procedures were in place and appropriate checks had been made before staff began work at the service. This contributed to protecting people from the employment of staff who were not suitable to work in care. There were enough staff to protect people's health, safety and welfare in a consistent and reliable way.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed safely.

The management team and staff had an understanding of the Mental Capacity Act 2005 and consent to care and treatment.

People chose their own food and drink and were supported to maintain a balanced diet where this was required.

People said staff were caring and kind and their individual needs were met. Staff knew people well and demonstrated they had a good understanding of people's needs and choices. Staff treated people with kindness, compassion and respect. Staff recognised people's right to privacy and promoted their dignity.

We looked at care records and found good standards of person centred care planning. Care plans represented people's needs, preferences and life stories to enable staff to fully understand people's needs and wishes. The good level of person centred care meant people led independent lifestyles, maintained relationships and were fully involved in the local community.

There was a complaints policy and information regarding the complaints procedure was available. There was one complaint in the past 12 months. Records demonstrated this was listened to, investigated in a timely manner, and used to improve the service. Feedback from people was positive regarding the standard of care they received.

Staff felt supported by management, they said they were well trained and understood what was expected of them. Staff were encouraged to provide feedback and report concerns to improve the service.

The provider had developed an open and positive culture, which focused on improving the experience for people and staff. The provider welcomed suggestions for improvement and acted on these. At this inspection we found the registered manager open to feedback and enthusiastic about providing a high standard of care to people. The registered manager had introduced systems to promote good practice. Field care supervisors had been introduced who provided consistency in the delivery of care and an additional link between the office and people being supported in their own homes.