Caremark (Slough and South Bucks) was rated Good overall across all five key questions at its June 2019 inspection, with people and relatives highly positive about the personalised, dignified care delivered. Two recommendations were made regarding incomplete mental capacity assessments and the absence of documented end-of-life care preferences, neither of which affected the overall rating.
Concerns (3)
moderate
Consent / capacity
— “mental capacity assessments and best interest decisions were not always undertaken and documented for people who did not have the capacity to give consent to receive care”
minorEnd-of-life care — “there were no documented records to show the service had explored and discussed people's preferences and choices to end of life care”
minorCultural competency — “no specific training was in place for staff to understand the issues people from lesbian, gay, bi-sexual and transsexual community may face when using their service”
Strengths
· People overwhelmingly positive about care; strong person-centred approach with personalised care planning and staff matching
· Safe medicines administration supported by a dedicated medicines champion role developed from lessons learnt
· Robust safe recruitment practices and sufficient staffing levels confirmed by people and rosters
· Strong partnership working with health and social care professionals enabling timely referrals and specialist support
· Effective quality assurance including external audits, spot checks, supervisions and annual surveys
Quality-Statement breakdown (25)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: End of life care and supportRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood
Caremark (Slough and South Bucks) received a Good rating across all five key questions at its first inspection in October 2016, with inspectors finding a person-centred, well-staffed and effectively governed service. The sole area for improvement was the absence of evidence demonstrating how feedback from people was acted upon and communicated back to them.
Concerns (1)
minorGovernance — “Although people were encouraged to give feedback about the quality of care and their overall involvement with the service, we saw no evidence of how the feedback given was used to improve the service and how this was communicated to people.”
Strengths
· People felt safe and described staff as patient, kind and friendly, with positive relationships built on knowledge of people's histories, likes and preferences.
· Safe recruitment practices including DBS checks, written references and employment histories were consistently followed.
· Staff were competently trained, received regular supervisions and appraisals, and worked in line with the Mental Capacity Act 2005.
· Medicines management systems were effective, with staff completing MAR charts and having undertaken relevant training and competency checks.
· Person-centred care plans captured people's expressed views and were regularly reviewed, with people and relatives actively involved in planning.
Quality-Statement breakdown (21)
safe: Safeguarding people from abuseGood
safe: Safe recruitment practicesGood
safe: Staffing levelsGood
safe: Risk managementGood
safe: Medicines managementGood
effective: Staff training, induction and supervisionGood
effective: Mental Capacity Act and consentGood
effective: Nutrition and hydration supportGood
effective: Access to healthcare professionals
Good
caring: Treating people with dignity and respectGood
caring: Involvement in care planning and decisionsGood
caring: Meeting communication needsGood
caring: End of life care supportGood
responsive: Assessment and care planningGood
responsive: Responding to changing needsGood
responsive: Supporting social activities and interestsGood