Caremark (Harlow Epping Forest) is a domiciliary care agency. It provides personal care to people living in their own homes for people with dementia and people with learning disabilities. We carried out this assessment between 12 August 2025 and 30 September 2025. At the time of our assessment 36 people were using the service with 32 of those people receiving support with personal care. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We found the provider was not meeting all the principles of Right support, right care, right culture. The last rating for this service was requires improvement (report published 23 November 2023). We carried out this assessment because the service had not been inspected for a long time. We also received concerns that staff were not trained, people’s care calls were late, risks were not assessed when they changed and overall governance did not support the principles of Right support, right care, right culture. We looked at all the quality statements relevant to those concerns and the overall rating for this service has stayed the same. The provider was previously in breach of the legal regulation in relation to safe care and treatment, staffing, good governance and notifying CQC of incidents that affect the safety of the service. Improvements were not found at this assessment, and the provider remained in breach of these regulations. Incidents that had occurred were not always recorded appropriately to investigate, identify causes and reduce risks through timely lessons learnt. Where there had been a change to people’s health needs these had not always been reviewed and actions taken to mitigate risks. Care plans lacked detailed information or had not been completed for individual risks. This meant there was a risk people may not be supported safely. Training had not been provided to staff in key areas. Senior staff received no additional training to support their role. Where training was completed most of these were through an e-learning platform and staff completed multiple units in one day. This meant training was not planned or effectively supported staff in their role. People had experienced significantly early care calls or significantly late calls from inconsistent staff. This was due to a lack of effective planning. There were no missed calls and overall timeliness improved during this assessment. Staff follow good standards of hygiene when providing care to people and have the required personal protective equipment (PPE) available to them and have attended infection prevention training. Staff were found to be working in accordance with the requirements of the Mental Capacity Act 2005 and knew how to support people who may lack capacity. The management team required further improvement to understand the systems and processes needed to support staff and people using the service. The provider’s governance systems had not been effective in identifying or addressing the areas for improvement we found during this assessment. The provider told us they had recognised the need to expand the management team, bringing in a new registered manager to ensure better oversight of the service. Staff also worked in senior positions although it was not clear how these roles would work together.
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Caremark (Harlow & Epping Forest) was rated Requires Improvement overall following an October 2023 inspection, with breaches identified across safe care and treatment (Reg. 12), staffing (Reg. 18), recruitment (Reg. 19), good governance (Reg. 17), and failure to notify CQC of incidents (Registration Reg. 18). Caring was the sole Good-rated domain, underpinned by positive feedback about staff compassion and dignity, while significant concerns remained around medicines management, risk assessment, training, supervision, and governance robustness.
Concerns (13)
criticalMedication management: “staff had signed that a cream had been applied to a person on 5 different days, but staff had previously recorded, the cream had not been available.”
criticalMedication management: “A person had been prescribed medication to treat high blood pressure. The MAR chart indicated the person had not taken the medicine for 18 days.”
criticalStaff training: “not all staff employed at the service had received all mandatory or refresher training...safeguarding, dementia awareness, epilepsy awareness and moving and handling training”
criticalSupervision / appraisal: “Staff did not receive regular support in the form of a supervision or spot checks...no effective arrangements in place to monitor staffs' practice, performance and professional practice.”
criticalGovernance: “No system was in place to make sure staff's recruitment files, induction, training and supervision data were audited to ensure these were in line with regulatory requirements.”
criticalIncident learning: “there had been occasions whereby statutory notifications had not been sent to CQC as required.”
criticalStaff competency: “Not all staff had completed medication competency assessments before supporting people with medication.”
moderateSafeguarding: “Not all staff had received up to date safeguarding training, including the registered manager.”
moderateCare planning: “Risk assessments which had been completed to provide staff with guidance on how to keep people safe and minimise risks had not been reviewed or updated.”
moderateComplaints handling: “I just get on with my work. I don't make any complaints even if I wanted to as I just don't think the management are very approachable and would listen.”
moderateRecord keeping: “gaps in recruitment files, such as not having an application form containing full employment history, an incomplete health declaration and not all references received had been verified.”
minorEnd-of-life care: “People's support plans did not include any information relating to people's end of life wishes.”
minorMissed or late visits: “A lot of the time they're late, big issue is time keeping which is atrocious on occasions.”
Strengths
· People and their relatives were involved in the planning and review of their care.
· Staff treated people with dignity and respect and were attentive to people's emotions and support needs.
· People's protected characteristics under the Equalities Act 2010 were identified as part of their needs assessment.
· An electronic system alerted office staff if a visit had not been made within 15 minutes of the scheduled time.
· Staff were provided with PPE which was replenished whenever required.
Quality-Statement breakdown (20)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
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 lives