Caremark Tunbridge Wells, Tonbridge and Malling

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 were not always protected from avoidable harm because risk assessments were not always clear, comprehensive and up to date. This was an area for improvement. Staff and leaders were able to identify situations that amounted to safeguarding and staff were confident to use the whistleblowing process if needed. Staff knew people well and were able to identify changes to health and identify care and support needs. Staff were recruited safely and were supported through training, there was a plan in place to make sure they had ongoing support in the form of supervision and appraisal meetings. Staff had not always been adequately deployed, staff reported consistent issues with insufficient travel time being rostered. Ongoing training made sure that staff had the skills needed to support people. The systems and processes to learn from incidents was not fully robust. The management team were able to discuss lessons learned from incidents, however, there was no system or documentation that evidenced how this was taken forward and shared with all staff.

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 and relatives told us the service met their needs and actions had been taken when they had raised concerns and issues. Relatives told us they were able to easily access the management team and were listened to when they did.

The manager told us that safety concerns and events were investigated and reported on, and lessons were learned to embed good practices. However, the documentation did not support this. Incident reports regarding medicine errors were completed without an outcome or actions to be taken to prevent a re-occurrence. Staff told us they did not have staff meetings. A staff member said, “We don’t have team meetings or newsletters. I would like to have team meetings as it would be good to add things to the agenda to be discussed.”

The systems and processes to learn from incidents was not fully robust. This was an area for improvement. The management team were able to discuss lessons learned from incidents, however, there was no system or documentation that evidenced how this was taken forward and shared with all staff. Analysis and lessons learned were not routinely recorded and shared with the staff team via staff meetings or supervisions. There was no learning from medicine errors recorded. For example, a person had had 5 medicines errors and this had not been cross referenced in to care plan or medicine risk assessment. There had been a recent safeguarding investigation in which the manager acknowledged improvements were required to the management of oxygen therapy, checking availability of spare oxygen equipment and staff access to people’s resuscitation status. We were shown updated documentation and risk assessments which will protect people from safe care going forward. The management team told us that accidents, incidents and changes were discussed and documented in meetings and in supervision meetings. However, this was not supported by documents viewed and there had been no meetings with care staff.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were safe and were protected from harm. A person told us, “We feel very safe with our carers and have no complaints at all.” A relative said, “I do feel she feels safe with her carers. They always take time to talk her through what they are going to do and they are very gentle with her.” Relatives told us they were confident to raise any concerns and knew that they would be responded to.

Most staff had received adult safeguarding training. Safeguarding training included safeguarding children. Staff understood their responsibilities to report a safeguarding concern. Some staff did not know who to report concerns to outside of the organisation. Most staff were aware of whistleblowing and were confident to speak up if needed. A staff member said, “I would report it to the manager, she would definitely deal with it. I could report it to safeguarding and I have the details and contact numbers in the staff handbook.”

There was a safeguarding and whistleblowing policy in place, and staff confirmed had they had read the policies as part of their induction and training. Records confirmed staff had received training in safeguarding. Procedures had been correctly followed, and the provider had made referrals as required to the local authority and notified CQC appropriately. People’s capacity was reflected in risk assessments but not in care and support plans. This was fully discussed and was being addressed by the management team. People's capacity to make informed decisions about their care and support had been assessed and recorded on their initial meeting and agreement of care provision documentation with the involvement of advocates including relatives where this was required. For example, where people on bed rest had bedrails or were restricted by locked doors in and out of the property. Some people had not been kept safe from abuse because the provider did not have robust checks in place to monitor staff supporting people with shopping. We found evidence in one person’s care records that staff had used their own loyalty cards when shopping on behalf of the person on one occasion. We reported this to the management team and they took appropriate action to address this.

People gave us positive views about how staff managed risks well. The service used equipment to help maintain people’s safety. People told us, “They have to hoist me and they are all very good. There are always 2 of them and they always wait for each other before they start” and “If they do have to hoist me then there are 2 of them.”

Staff knew people well and were confident they could identify any changes in people’s presentation that may be of concern. However, staff told us they had not seen risk assessments and were unaware if these. Comments included, “I have never really looked at risk assessments, I don’t know if they are on the app” and “Everything is on the app, we are not told about risk assessments.” The management team told us they had listened to our feedback about lack of risk assessments. They had reviewed a person’s care and risks and had developed some risk assessments.

The provider had not always assessed and managed risks to people's safety. No risk assessments had been made of people’s environments to ensure staff were able to work safely. The care plans were inconsistent in the quality of information. They lacked a person-centred approach. The depth of information regarding the person and their mental health status were varied. There was little reflection of how the person’s mental health diagnosis may impact on care delivery. A person lived with a mental health diagnosis. However, this was not reflected in their care plans as to how this may impact on visits by care staff (such as refusal). Risks to most people had been identified, assessed and plans were in place to ensure risks were mitigated. We were told people were involved in creating their own care plans and their views and personal preferences were respected. However, the documentation was signed by the staff but not the person. Risk assessments were in place relating to the individual risks people faced. For example, mobility, falls, constipation, eating and drinking. There were inconsistencies within some care plans and these were discussed with the office management team. After we provided feedback to the management team, corrective actions were taken to improve risk assessments.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives gave us mixed views about their experience of staff providing care and support at the right time for them. Comments included, “I do think there are enough staff. If I need the loo they always take me on time although they have to keep to their times”; “There are not enough staff though, they seem to be having a very high turnover recently. It used to be the same staff and much more consistent and they don’t always shadow”; “Just a small complaint from my parents is that they don’t meet the times requested. That is the only observation they have both had so far. Sometimes they will arrive to prepare a meal half an hour early which means my parents will end up eating earlier than they normally would” and “My [loved one] feels safe with his carers and they stay the time needed. Sometimes they may leave a few minutes early but everything is always done and dusted.” A relative told us that their loved one is sometimes supported with their bedtime call too early which resulted in their loved one “wakes up aching from being in bed for so long.”

Staff told us they had not always been given adequate time on their rota to travel between care calls which meant they were late for care visits and had to cut some visits short to catch up. Comments included, “There is not always enough travel time allocated, I do feedback and they listen and make changes and then after a short while it reverts back to not enough time again”; “We do have travel time, it is not always enough, this morning the travel time would have been ok but there were huge traffic jams in Tunbridge Wells and that made me late for all the calls afterwards” and “There is not enough travel time, it is a frequent problem, we are all reporting it to the office all of the time and nothing changes. It is not fair as we sometimes have to cut 5 mins off of someone’s call to ensure we have enough time to get to the next call. It is not fair at all, they are paying for that call.” Staff told us about the training and support that provided them with the skills they needed to support people safely. Training was provided online as well as face to face, depending on the topic. The training records showed that 1 live in carer who had been working with a person had not received all of their training to meet the person’s needs. The training records held did not always include all the staff listed on the provider’s staff list. We raised this with the management team. Staff were enthusiastic about learning new skills and keeping their training up to date. Staff were knowledgeable about the people they were supporting. The management team took action to meet with staff and resolve travel time concerns following our feedback.

Records showed that some staff had not had regular supervisions. The provider’s induction process was a mixture of training and shadowing experienced staff to gain confidence and experience. The provider’s training matrix showed that most staff had completed mandatory training. However, only 13 out of 33 staff had completed oxygen training. The manager told us that staff without the training would not visit people who were prescribed oxygen. Care visits were often covered by staff working in the office and with other staff taking on extra calls/work which could increase the risk of untrained staff supporting people. We were not assured that staff had been adequately deployed. We carried out analysis of the provider’s electronic call monitoring data which evidenced that there were a high number of short calls, some calls were late (27 of the 311 calls that were late were over 45 minutes late). Our analysis also detected care visits where 2 staff should be supporting and 2 care staff were not present at the care visit at the same time. We also detected staff being logged in at 2 different places at the same time. We reported this to the management team who carried out an investigation. Results from the investigation showed some improvements were required but also showed that data black spots caused issues with logging in at some care calls. There was a robust out of hours system. This was evidenced on the individual care plans and incident forms that the on-call person had been contacted and responded when needed. Staff had been safely recruited. We examined 4 staff files and all of the required checks had been carried out and documents were all in date. In files we saw copies of references, interview notes, photographic identification and Disclosure and Barring Service forms (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.