Caremaid Services Ltd was rated Good overall at its October 2018 inspection, with a Requires Improvement rating for Safe due to a persistent pattern of missed and late calls that had not yet been fully resolved despite provider action. All other key questions were rated Good, reflecting strong person-centred care, well-trained staff, safe medicines management, and effective leadership and governance.
Concerns (4)
moderate
Missed or late visits
: “During the months of September and October there had been three service quality concerns raised by the local authority regarding missed calls.”
moderateMissed or late visits: “Their timekeeping is not that great and I have raised this with the manager quite a few times. Sometimes they are either too late or too early.”
moderateComplaints handling: “Some complaints had been actioned to address the issues that had been raised, however concerns over late calls were ongoing and had not yet been fully addressed.”
minorPerson-centred care: “New workers will show up, which leaves my family member unhappy as they find it extremely difficult to communicate. Due to unfamiliarity it is often easy to feel unsafe.”
Strengths
· Staff understood safeguarding responsibilities and could describe types and signs of abuse
· Medicines were managed safely with no gaps in medicine administration records (MARs)
· Robust staff recruitment including DBS checks ensuring only suitable staff were employed
· Care plans were person-centred, comprehensive and regularly reviewed
· Staff completed the Care Certificate and received training in moving and handling, first aid, infection control and medicines administration
Caremaid Services Ltd requires improvement overall, with a regulatory breach under Regulation 12 due to unsafe medicines management including unsigned MAR charts, unexplained omissions, and ineffective audit follow-through. Effective, caring and responsive domains were rated Good, reflecting strong care planning, trained and supported staff, and positive feedback from people and relatives.
Concerns (5)
criticalMedication management: “Staff did not always follow the procedure for the management of people's medicines and there was a risk that people were not receiving their medicines as prescribed.”
moderateRecord keeping: “MAR charts did not always include the start date of a medicine so it was difficult to carry out effective audits.”
moderateGovernance: “medicines audits had not been effective in addressing shortfalls in the management of medicines.”
moderateMissed or late visits: “They were two hours late once and they don't always ring. They never apologise. I can't plan my day”
moderateIncident learning: “apart from a text message to staff to remind them to sign appropriately, no further action had been taken to make more permanent improvements in the way medicines were managed.”
Strengths
· People's needs were assessed prior to receiving a service and care plans were developed in a person-centred way with sufficient detail for staff.
· Risks to people's wellbeing and safety had been assessed with mitigation measures in place.
· Robust safeguarding procedures were in place and staff were trained and aware of their responsibilities.
· Sufficient staffing levels with contingency plans; appropriate recruitment checks including DBS were carried out.
· Staff received a structured five-day induction, Care Certificate training, mandatory refresher courses, regular supervision and yearly appraisals.
Caremaid Services Ltd was rated Requires Improvement overall at its first inspection in August 2016, with breaches of Regulations 9, 12, 17 and 19 relating to person-centred care, safe treatment, governance and recruitment. While care workers were widely described as kind and caring, significant concerns were identified around generic risk assessments lacking person-specific detail, ineffective recruitment checks, poor care plan quality and audit systems that failed to detect these shortfalls.
Concerns (8)
criticalCare planning: “Care plans were written from the person's perspective, however these were basic and lacked detail.”
criticalStaff competency: “a potentially unsuitable member of staff had been providing care and support to people for seven months before a Disclosure and Barring Service (DBS) check was received”
criticalGovernance: “Audits had failed to highlight that there were no detailed plans in place for some of the risks identified during people's assessments.”
moderateRecord keeping: “accident/incident forms had not been completed, which meant that it was difficult to audit the amount of episodes and what actions the provider had taken”
moderateMissed or late visits: “Almost everyone we spoke with complained about the care workers being late...at times, care workers had been up to two hours late.”
moderatePerson-centred care: “care and support plan for a person receiving end of life care, and saw no advanced guidance or advice for staff to follow when the person's condition deteriorated”
minorComplaints handling: “Some people were not confident that if they made a complaint, this would be taken seriously and their concerns addressed.”
minorSupervision / appraisal: “The provider told us that staff had not yet received an appraisal but this was being put in place and would be undertaken this year.”
Strengths
· People and relatives described care workers as kind, caring and respectful, with most receiving care from regular workers with whom they had built trust.
· Safeguarding procedures were in place, staff were trained and aware of their responsibilities, and the registered manager raised alerts appropriately to the local authority.
· Sufficient staffing levels were maintained with contingency plans and a bank staff pool to cover absences.
· Staff received induction training including the Care Certificate, shadowing periods, and regular spot checks were carried out.
· Medicines administration records were completed with no gaps in signatures and all staff had received medicines training with yearly refreshers.
Quality-Statement breakdown (16)
safe: Risk assessmentRequires improvement
safe: Recruitment / fit and proper personsRequires improvement
safe: Medicines managementRequires improvement
safe: SafeguardingGood
safe: Staffing levelsGood
effective: Mental Capacity Act / consentGood
effective: Staff training and supportGood
effective: Health and nutritional needsGood
effective: Health and nutritional needs
Good
caring: Kindness, respect and dignityGood
caring: Involvement in care decisionsGood
caring: Cultural and religious needsGood
responsive: Person-centred care planningGood
responsive: Complaints handlingGood
well-led: Quality assurance and auditingRequires improvement
well-led: Leadership visibility and communicationRequires improvement
well-led: Staff and people engagementGood
caring: Dignity, respect and kindness
Good
caring: Involvement in care decisionsGood
responsive: Care planning and person-centred careRequires improvement