Caremark (Redcar & Cleveland)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People and staff were positive about the open culture of the service, they all said they were listened to, any concerns were addressed. Most systems were in place to ensure people received safe and person-centred care. However, improvements were required to some medicine records and some care records to ensure information about any identified risk was transferred to associated care plans to provide guidance to staff to keep people safe. Incidents and accidents were reported, investigated and lessons learned to reduce risk of re-occurrence. Systems were in place to ensure people were kept safe and protected from the risk of harm and abuse. People were supported to understand and manage risk. Detailed information was collected before people started to use the service and was available if they moved between services. Rotas were well-managed to make sure people received consistent safe and good quality care that was person centred. A relative commented, “Name has continuity of care which is good as they can get confused.” Staff received training that was relevant to their roles and responsibilities. They received support and regular supervision with opportunities for personal development. There was robust recruitment of new staff. Systems were in place to promote good infection prevention and control.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe and staff responded immediately if they needed support. Their comments included, “[Name] feels very safe with the carers as they know and trust them”, “The carers have a wonderful attitude and are very kind and patient” and, “[Name] is safe because [Name] knows all their carers and they are like part of our family.”

Staff told us communication was effective. Any incidents about people's safety was discussed with staff in a timely way, with action taken to mitigate further risks. A staff member told us, “I have had training and would report to the supervisor first” and “Communication is good, we always get updates.” However, we found staff were not implementing learning from incidents and we found evidence of repeated medicine errors.

People received safe care because staff learned from safety alerts and incidents. Staff recognised incidents and reported them appropriately, and the management team investigated them, and shared lessons learned. The registered manager analysed incidents and near misses on a regular basis so that any trends could be identified, and appropriate action taken to minimise any future risk.

Information was available about people if they moved between services to ensure their safety and continuity of care. A relative told us, “Staff do share information and are often there when the district nurses are there. I have been there when they have had to share information with a paramedic too.”

Staff were aware of when people had health or social care professional input. They said they felt confident working with other agencies. Recommendations from health professionals or other professionals had been implemented.

We did not receive any feedback from partner agencies relevant to this quality statement.

Systems were in place for staff to work with people and partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. People received a continuity of care when they started using or were discharged from the service. Detailed information was collected before a person started to use the service to help ensure people’s health and social care needs could be met by staff. People, their relatives, health and social care professionals were involved in the planning.

People told us they felt safe and trusted the staff who supported them. “People’s comments included, “There is not a time when I have not felt safe. I feel totally safe. I trust the staff and they trust me”, “I have never felt unsafe. Staff go out of their way to make me feel comfortable” and “I feel better when the carers are in the house. They are good, very kind, caring and gentle. I don’t know what I would do without them. They help me to walk, supporting me safely.” A relative told us, “[Name] is happy with the carers. They are trustworthy and well trained”, and “[Name] is absolutely safe with the carers I have no hesitation in saying that.”

Staff said they were trained in safeguarding and understood how to safeguard people from the risk of abuse. They said they would raise any concerns and were confident the registered manager would respond appropriately.

Processes were in place to protect people from abuse. Staff had received training on identifying and reporting abuse and knew what action to take if they identified abuse. Concerns were reported to the local authority as appropriate. Safeguarding incidents were investigated and showed evidence of action taken and effective lessons learned, where needed. Safe staff recruitment helped ensure people were protected from staff unsuitable to work in the care sector. The service was complying with the Mental Capacity Act 2005 (MCA). The MCA Act provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Records showed people's consent to care was sought. Where relatives, or others involved in people's care had the authority to make decisions on people's behalf, this was recorded in their care records. This included what decisions the person had authorised them to make.

People and relatives were involved in identifying, assessing and mitigating known and new risks. A relative commented, “The manager sat down with [Name] and myself and we have a care plan.”

Conversations with staff confirmed they were aware of the risks associated with people’s care and the action they needed to take to keep people safe. A staff member said, “Risk assessments are completed prior to commencing visits.” Another staff member commented, “Records we need are on an App on our telephone, we have access to the information needed including any risk assessments.” However, we found that the implemation of the risk assessments was not always correct which meant risk mitigation was not always in place.

Processes were in place to assess risks associated with people’s care and their home environment. Information from assessments was recorded in most care records. However, we advised the registered manager not all identified risk was transferred to an associated care plan with agreed actions to reduce the risk.

Staff supported people safely and appropriate equipment was available if people needed assistance to mobilise or to assist with other support needs.

Staff told us they had received training in safe working practices and they felt safe working at the service. They said they had appropriate equipment to move people safely and had received training on how to use it. They felt supported when management were not on duty as an on-call system was available to provide support and guidance, in an emergency.

Environmental risks were assessed, with measures put in place to remove or reduce the risks. Regular health and safety checks were completed, this included of equipment such as, hoists and stand-aids.

Most relatives confirmed their family members received their care and support from a small team of staff they knew, and for the length of time agreed. Their comments included, “The rota doesn’t change unless someone is ill and I am informed by the office, the staff try to ensure [Name] has regular carers who stand in to cover to ensure continuity” and “Staff are all friendly and [Name] has regular care.” A person told us, “I do have regular carers that I know and trust.”

Staff had no concerns about staffing levels. One staff member commented, “The hours are flexible” and “I think we have enough staff.” Staff spoke positively about the training they completed and the support they received. A staff member told us, “We get email reminders about required mandatory training, I’ve received training in mental health, safeguarding and Learning Disabilities.” Another, staff member commented, “I do face to face and e learning training, you can get help if you need to ask questions from the training. The induction was good, I received training for medicines and had observation to check.”

Rotas were managed effectively so people received care in a timely and person-centred way. Most people said they received care from a reliable and consistent team. Systems and processes were in place to ensure staff were recruited in a safe way. New staff had appropriate pre-employment checks in place which included photo identification, work history, references and a Disclosure and Barring Service (DBS) check in place. DBS checks provide information including details about convictions and cautions held. Staff received training to give them insight into people’s care and support needs. A system of supervision and appraisal was in place to help support staff members.

There were effective infection prevention and control systems in place. People told us staff wore personal protective equipment [PPE] as required. A relative commented, "My relative is happy with the carers, absolutely. They arrive on time and stay the full duration. They wear gloves. They wear PPE."

Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. They confirmed they had received infection control training. A staff member commented, “We always have supplies of PPE, if you need can pick up at the office or they [manager’s] will drop it off at the person’s home.”

Improvements were needed in the records and guidance for creams applied by care staff. We found that records did not show where creams had been applied and there were incomplete records. A process for ensuring people received visits to give time sensitive medicines at the right time was in place. However, we saw that 1 person on regular pain relief did not have a 4 hour gap between some visits. Other people needed medicines 30 minutes before food and other medicines, but the records did not demonstrate this. Clear information for was not available for medicines prescribed when required. Protocols for 1 person who did not have capacity were not in place as detailed in their care plan.

Staff told us they had completed medicines training and had been assessed as competent. The registered manager told us about the variety of medicines audits completed. They had identified some of the issues we found. Post inspection we received a detailed action plan addressing the shortfalls we had identified including a variety of new audits and processes to address the issues we found.

Basic policies and procedures were in place to support the safe administration of medicines. Care plans were in place to describe what support people needed with medicines, but these were not always sufficiently detailed or up to date. The Provider was in the process of updating them at the time of our visit. Medicine administration records (MAR) were completed with few gaps and included recording people’s allergies. However, some medicines were not accurately listed. Where medicines were not administered the non-administration code was not always clear. Where a variable dose was prescribed it was not clear how much had been given. Improvements were needed in the records for when required medicines needed. Some were not listed on the MAR, for others the directions on the pharmacy label was different to that on the MAR. Although people were not harmed there was a breach of regulation for good governance and records.