Caremark (Redcar & Cleveland)

Caremark (Redcar & Cleveland) is a domiciliary care agency providing personal care to 293 people at the time of the inspection.

There were a higher number of people receiving support but 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

Medicines records were not always accurate and some medicines administered via a patch were not applied in line with manufacturers guidance. The provider acted quickly to rectify this following our feedback and new systems were put in place immediately.

Although people told us they felt safe, risk assessments were not always in place. Records did not always provide staff with the information necessary to minimise risk. We have made a recommendation about this.

Systems were in place to safeguard people from abuse. People were cared for by the same staff whenever possible. People received their care calls as planned. There were no missed calls and staff arrived on time. Safe recruitment practices were followed.

Staff were suitably trained and supported to meet people’s needs. 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 were happy with the care they received and told us staff were friendly and caring. Staff were kind and respectful towards people and their families, and people’s privacy and dignity were upheld. People’s independence was encouraged, and they were involved in decision making.

People received personalised care which reflected their needs and preferences. There was a complaints policy in place that was followed correctly when required. Staff knew how to support people if they had any complaints. People were appropriately supported at the end of their life by staff who had received training in this aspect of care.

The management team communicated well with people who used the service, relatives and staff. Feedback was asked for and acted upon. A range of audits and checks were carried out to monitor the quality and safety of the service. Action was taken if any issues or concerns were identified.

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 outstanding (published 26 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection there were over 300 people using the service with 204 of these people receiving personal care.

The staff team have worked as a part of Redcar and Cleveland rapid response team (which is where staff attend a person’s home if they activate their call alarm) for the last two years. Over the last three years the provider manages two extra care schemes and they are providing one-to-one support for people in supported living schemes. In addition the provider has piloted a drop-in service for people with learning disabilities, which offered relaxation activities, crafts, hobbies and IT sessions as well as having a gym and café on site.

Our last inspection of this service took place on the 24 April 2015 and we rated the service as ‘Good’ overall but we found improvements were needed to ensure staff received regular training. At that time we found the service to be in breach of Regulation 18 (staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our last inspection the provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the service.

At this inspection we found that the provider and manager had spent time reflecting on the measures that could be taken to improve staff completion of training. They had developed a training department, which was based at the location. The staff within the training department operated a constant rolling programme of induction and mandatory training. Staff were provided with comprehensive training including specialist training, which was delivered both in-house, via online resources and from external trainers. Staff told us they received regular supervision and competency assessments as well as annual appraisals.

There was a registered manager in post at the time of our inspection who had worked as the manager at the service since 2013. 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.

Within this vibrant, dynamic and innovative service there was the strong sense of leadership, commitment and drive to deliver a service which improved people’s lives. The culture embedded in the service was one where all the staff were committed to deliver a service that was focused totally on each person and responsive to their needs, which relatives and people described as defining what outstanding care looked like. They were committed to providing excellent person-centred care. Person centred is when the person is central to their support and their preferences are respected.

We found that the provider and manager had encouraged staff to constantly think about improvements and how to make the care delivery more effective. The management style had led to constant constructive review of the service and continuous improvement.

We found that following comments people who used made the service about their preference for continuity of care the provider and manager organised the staff into teams who were allocated to people. The small teams provided sufficient cover for holidays and absence but meant that the same staff worked with people over each week. For emergencies they had a floating field care supervisor who could step in at short notice.

We saw that the provider had also set up a very robust system for monitoring staff attendance at calls. A log-in system was operated, which flagged up on a computer-linked board in the office when staff arrived at the calls. Designated workers monitored this and should the log-in not be activated within 10 minutes they called the staff member. Every day of the week staff were monitoring attendance for calls from 7am to 11pm. If some untoward incident occurred which delayed staff one of the floating staff was dispatched and they rang the person and explain the delay. We were told by the people who used the service that this had led to a great improvement in the service and they now were confident that their support would always be available when expected. The introduction of this system had led to the virtual eradication of missed calls.

People told us the office staff were very approachable and committed to providing an excellent service. They appreciated that staff took the time to let them know straight away if a carer was running a late. Staff found that they were given sufficient travel time, which reduced the potential for them to run late.

The manager closely monitored incidents and looked at how they reduce any errors. They treated any near misses as incidents so they could determine if any other measures could be put in place. Apart from the review of incidents leading to the development of an extensive system for monitoring of calls, it had also led to more frequent competency checks of staff medication practices. Both of these initiatives had significantly reduced incidents.

The provider was constantly looking at how the service could be improved and identified that to create an effective service that worked to benefit people there needed to be a strong workforce. Therefore they had employed a manager, deputy manager, senior care co-ordinators, care co-ordinators, field supervisors, human resources staff, training and accountancy teams as well as ensuring care staff levels were consistently above the minimum needed to meet current care packages. This had led to the provider being able to provide a very flexible and responsive service.

The provider was determined that staff working for the service promoted and encompassed their values and visions. We found the recruitment process underpinned this aim. The provider completed usual recruitment procedures such as obtaining references and Disclosure and Barring Service (DBS) checks. In addition to these checks they commenced induction training whilst awaiting the checks coming back and used this to check the attitude and competence of staff. Should any aspect of the checks or training indicate the potential staff member was not committed to delivering high quality, person-centred care they were not employed.

Staff had a comprehensive understanding of safeguarding and how to whistle blow. The service had emergency plans in place and took action when they became aware someone was at risk. Staff safely managed medications. People’s care needs were risk assessed with risk management plans in place and support for staff when they needed it.

Staff were devoted to the people they supported and we heard they would go the extra mile to ensure people felt valued. Relatives explained how one of the carer’s had taken Easter eggs for people and how staff used all of the time allocated so would spend time chatting with people or taking people out to do their errands. They found their relatives lives were enriched by contact with the service. It was evident that people’s voice was heard. The provider told us that people had described the lack of taxi services that could ably assist them go out, so in response they were setting up a taxi provision whereby the drivers had also been trained as carers. Therefore the taxi service would not only pick and drop the person off, but provide support if needed during the trip.

People were cared for by staff who knew them well and understood how to support them and maximise their potential. The service's vision and values ensured people’s rights to make choices were promoted to live a dignified and fulfilled life. They were flexible in adapting the way they provided care ensuring they were person centred. People told us that staff treated them with dignity and respect and supported them to be as independent as possible.

We found there was a culture within the organisation of striving for excellence and assisting all to reach their maximum potential. We found the service strived to value staff by promoting life-long learning and all staff were supported to obtain National Vocational qualifications to at least a level 3. Senior care staff had obtained level 5 awards in management and the manager had been supported to obtain a level 7 in strategic management and leadership. The provider routinely praised staff via thank you cards and ran carer of the month and year awards. When staff won the awards these were publicised in the local press. The director had also won awards for the operation of this franchise and completed charity events to raise monies for good causes.

The provider valued all of the staff and had introduced a wide range of incentives to ensure they retained staff such as providing interest free loans, a pool car for staff to use if their car was in the garage and a hardship fund. This, staff told us, encouraged loyalty to the company. People told us that over the last two years they had found little turnover in the carers who attended and found this level of consistency was excellent. They felt valued by the staff and were confident that the staff were able to meet their personal care needs but the retention of staff had also meant they were able to form strong therapeutic relationships with the carers and office staff.

People told us that they were well supported. We were told that the agency provided a reliable service. We were told that staff supported and encouraged people to be independent, which enabled people to stay in their own home. One person said, 'They've been great, I get the times I wanted on the days I wanted and they've never let me down.' Another person said, 'I love the fact that they never seem to be rushed, of course I know they have loads of people to go to, but they make me feel quite special.' We saw that people had their needs assessed and that support plans were in place.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person said. 'They're very gentle with me and I really appreciate that, I depend on them for everything.'

We found that appropriate arrangements were not in place to ensure that medicines were recorded and managed safely.

We saw that there was sufficient staff with the right knowledge and experience to support people.

We found that records were accurate and stored securely.