Caremark (Kirklees) was rated Good overall following a January 2020 inspection of 109 people receiving domiciliary care, with Requires Improvement in Safe due to multiple medicines administration record gaps, incorrect dosing intervals, and failure to cease a completed medication course. All other key questions remained Good, supported by strong person-centred care, staff training, safeguarding awareness, and effective governance.
Concerns (4)
critical
Medication management
: “one person was receiving paracetamol four times a day...staff were giving this person paracetamol without leaving the correct length of time between doses.”
moderateMedication management: “medicine administration records had not always been completed accurately and we could not be sure people had received their medicines as prescribed.”
moderateMedication management: “Staff had continued to apply cream to one person when the course of medication had been completed.”
moderateRecord keeping: “Where handwritten prescriptions had been entered onto the MAR they were not signed or countersigned in line with good practice guidance.”
Strengths
· Staff understood safeguarding procedures and safe recruitment practices were followed.
· People were supported by small teams of regular, familiar care workers.
· Person-centred care plans were in place reflecting individual choices and preferred routines.
· Staff received induction, ongoing training and supervision, including use of innovative methods such as a Care Certificate board game.
· Complaints were handled appropriately with investigation, written response and apology where needed.
Quality-Statement breakdown (20)
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infection; Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law; Supporting people to eat and drink enoughGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
responsive: Meeting people's communication needsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
well-led: Working in partnership with othersGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; duty of candourGood
Caremark (Kirklees) received a Good rating across all five key questions in its first inspection since registering in December 2015, demonstrating safe recruitment, well-managed medicines, personalised care planning and effective governance. One minor concern was noted regarding punctuality of calls following a recent expansion in the number of people supported, which the registered manager agreed to address.
Concerns (1)
minorMissed or late visits: “one relative told us...there had been a decline in service provision during the week of our inspection, in terms of the times of calls...since the registered provider had agreed to increase the number of people”
Strengths
· People consistently reported feeling safe and confirmed no missed calls at the time of inspection
· Robust recruitment practices including DBS checks, reference checks and ID verification
· Staff trained in medication administration with regular competency checks and monthly MAR audits
· Detailed, personalised care plans that respected people's choices, preferences and independence
· Regular supervision, annual appraisals and ongoing training including the Care Certificate for all new staff