About the serviceCaremark (Harrogate) is registered to provide personal care and support to people of all ages.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This means tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, there were 17 older people who were receiving a service, 10 of whom received personal care calls.
People’s experience of using this service and what we found
People told us they felt safe and trusted staff who supported them. People felt that staff had good knowledge of how to protect people from the risk of harm and abuse. People and their relatives told us they were supported to access health care appointments when required.
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 told us staff promoted their independence, choices and protected their dignity. Staff could describe people’s diverse needs and how they supported them.
Risk assessments were in place to guide staff on how to manage identified risks to people considering least restrictive options.
The provider had made improvements to their recruitment processes to ensure staff were recruited safely, and employment checks completed before they started working alone with vulnerable people.
Staff completed an induction but did not always have sufficient time shadowing other staff to ensure they were competent and confident before working alone. Staff received regular training, although the provider was unable to evidence PEG training had been completed for some staff. We identified that supervisions were not held in line with the provider’s policy and not all staff employed over 12 months had received an annual appraisal. The manager had not always completed checks to ensure staff were competent in their role.
On regular occasions the provider had been unable to staff some calls. There was some reliance on agency staff to ensure some calls were covered. Since the inspection the provider has been working with other agencies to improve the service delivery.
Medicines management was not always robust. The provider had failed to ensure recommendations made by the pharmacist in December 2018 were actioned. This was an area of focus and the local authority and other agencies are working with the provider to ensure improvements are made.
Staff knew how to support people to eat a healthy diet and maintain good hydration.
Care plans had been reviewed and people and/or their relatives had been involved in this process. These had a person-centred focus and described people’s preferences and routines. There was no-one receiving end of life care at the time of the inspection. However, the manager told us that any end of life care planning would be recorded when needed to ensure peoples’ choices were respected.
Communications had improved, and people told us they received satisfaction surveys or spoke with the manager to give feedback about the service. Complaints had been recorded and investigated in line with the provider’s policies.
The provider’s quality monitoring system required further improvements to be made. Regular audits had not always been completed as the manager was covering other tasks that had taken up their time. Where advice and recommendations had been by made health professionals, these had not always been fully implemented.
The current registered manager was supported by another manager whom shared responsibility for the day to day running of the service, we have referred to them as the manager throughout this report.
Feedback from staff, people and their relatives about the manager was positive. Staff said they could raise issues with them and found them supportive. People and their relatives found the manager approachable and effective in their management skills.
Both the registered manager and the supporting manager acknowledged further improvements were required. These were improvements in relation to the running and governance of this service which needed to be sustained and embedded over a longer period of time. The registered manager advised that they had plans to ensure the manager took over their responsibility of the registered manager’s role in the near future. This would enable both to focus on the oversight of the service and drive improvements to sustain a better quality of care for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Inadequate (published 4 December 2018) and there were multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, improvements had been made in some areas. However, further work was required to ensure improvements were sustained and the provider was still in breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This service has been in Special Measures since 2 December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.