Caremark (Hatfield &Welwyn)

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 consistently not receiving care visits for the planned duration. The provider and manager did not complete an analysis of completed care calls data and were unaware of the shortfalls we found. Robust evidence of staff training was not available, and we received inconsistent feedback regarding the support and supervision in place, compared to the records we reviewed. Overall, processes in place to record, monitor and provide oversight of the safety of people and the delivery of care required improvement. The ‘governance log’ used by the manager to record and complete analysis of incidents, accidents and untoward events was inaccurate. Audits and checks completed were inconsistent with actual events. This meant that responsive action was not being taken as needed. Risks to people’s health, safety and wellbeing along with environmental risks had been assessed. However, we found that assessments and resulting care plans had not always been updated when people experienced a change in their needs and were not always specific to each individual. Safeguarding referrals had been made when required, however outcomes were not consistently recorded and a learning culture was not evident. Despite our findings, people felt safe when receiving care and gave positive feedback regarding their experiences. During our assessment of this key question, we found the concerns in relation to staffing and staff training to be a breach of regulation. You can find more details of our concerns in the evidence category findings below.

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 felt the care they received was safe and that staff were attentive to their needs. One person told us, “Any minor issues are always acted on.” A relative told us, “Yes, [person] is being kept very safe, staff are kind, sympathetic, helpful and attend to every detail.” However, we also received feedback from relatives that, while they were confident to raise any safety concerns, they were not always satisfied with the responses received. One relative told us, “We did have issues with [specific concern]. I wrote a letter of complaint to [name of registered manager], [they] handled the situation very badly that day.” Another relative told us of a complaint they made when they had not been immediately informed of a safety concern affecting their relative.

We received mixed feedback from staff. Whilst some staff members felt that incidents and accidents had been learnt from, others did not know of any outcomes or learning having been shared once incidents or accidents were reported to the office. Recent team meeting minutes did not evidence that safety concerns were a routine topic of conversation. However, some staff told us that supervision meetings were used to address safety concerns.

Processes in place did not demonstrate a learning culture. The manager maintained a ‘governance log’ to record and review any incidents, accidents or untoward events. They shared with us, “This is used to capture all information re: incidents, accidents, safeguarding and whistleblowing. We conduct lessons learnt after each incident and an overall quarterly one to ensure corrective action has been effective and analyse if there are any other actions to take/identify broader trends.” We found that, whilst incidents were recorded along with any immediate action taken, no lessons learnt had been entered on to this log. We found no other examples within the documentation provided for this assessment where lessons learnt had been recorded or shared with staff. Analysis of untoward events completed by the manager each quarter did not always correspond with the number of incidents recorded and we found that, despite themes of similar incidents having been identified, actions had not been recorded as being required. The manager provided an example of a ‘lessons learnt’ process, however this had not been shared with people or staff due to the provider deeming the situation within it as confidential. When we discussed the example with the provider to obtain further information, they confirmed the investigation had not yet been completed into the circumstances of the event. We therefore found this example was ineffective, as the lessons learnt exercise had been completed prematurely and before full insight had been gained or an outcome determined.

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 and their relatives shared feelings of being safe with regards to the care and support provided by staff. One relative told us, “[They feel] very safe as someone is with [them] 24 hours a day. No signs of abuse or any safeguarding issues.” Another relative told us, “Yes, [they feel] safe because the carers understand and accommodate [their] needs very well day to day, no abuse or safeguarding concerns at all.”

All staff confirmed they knew how to respond to and report any concern in relation to allegations of abuse to senior staff or the manager. Staff had completed safeguarding training.

Whilst the provider had a system in place for the recording and reporting of any safeguarding concerns, effective oversight was not evident. The manager maintained a safeguarding log which detailed referrals made to the local authority, however we noted that outcomes and lessons learnt were not fully completed for all of the entries made. There were also 3 entries to the log which were unrelated to any safeguarding concern. The provider had an up-to date policy in place; however, this lacked details of the local safeguarding team and had not been personalised with information relevant to the service.

People’s care plans and risk assessments had not always been reviewed as needed. We found that one person had assessments in place which had not been reviewed for over 12 months. Two other people had experienced a significant change in their needs and their care plans were not reflective of this. We found that information within people’s care plans and risk assessments were identical from person to person and were not always specific to the individual. This included one example of a person being referred to by another person’s name and multiple examples of the incorrect gender being used. Despite our findings, people told us they felt safe receiving care and felt risks to their health, safety and wellbeing were managed well via their care plans. One person told us, “I feel safe. I have a care plan which is reviewed every 6 months, and we can discuss any changes needed in my care.”

Staff told us they made aware of risks to people via accessing their care plans and associated risk assessments. Care staff told us they were not involved in the assessment of risks but would inform senior staff via the office, if they had concerns or felt that changes were required.

The provider used a computerised care planning system which included the assessment of risks to people. As we described previously, we found that while assessments were carried out with people, and their relatives where appropriate, but these were not always reflective of people’s current needs. These discrepancies had not been identified through any reviews or audits completed. The manager confirmed they would complete a review of the issues identified and ensure that action was taken to ensure assessments in place were accurate and up to date.

People and their relatives confirmed that support was given to manage risks in people’s homes. This included the use of equipment. One relative told us, “An OT (occupational therapist) visited to assess any potential hazards which have all been addressed.” Another relative told us, “The carers do all [person’s] personal care and move [them] with the use of a hoist which is used very safely. [They] always feel safe with their care.”

The majority of staff told us they felt safe at work and had access to the equipment needed in their work.

Assessments of potential risks in people’s homes were completed and reviewed. However, as with individual risk assessments, we found that environmental and equipment related assessments contained identical information from person to person and were not specific to the individual. These included examples of assessments having been completed regarding trips and falls, when a person was supported with all transfers and they did not mobilise independently. We also found that one person had a range of safety equipment in place, and these were not included in any of their assessments or plans. The manager confirmed they would complete a review of the issues identified and ensure that action was taken to ensure assessments in place were accurate and up to date.

People did not receive care for the duration of time determined as needed and scheduled for them. Whilst we found that staff arrived at people’s care visits on time, visits were consistently cut short. This varied from staff leaving visits a couple of minutes earlier than planned, up to a third of the scheduled visit not being completed. However, people and their relatives gave positive feedback when speaking about staff. One person told us, “I see the same carers on the whole, everything is alright. I feel very safe.” One relative told us, “Staff are normally on time unless they get held up. Mostly familiar staff, all know [person] well.”

We received mixed feedback from staff. It was clear that office-based staff felt they had a manageable workload and received effective support. However, care staff shared occasions where they felt under pressure. Staff told us that they received regular training, spot checks and supervision however records reviewed showed some gaps for staff including the manager.

The provider used computerised call scheduling software to deploy staff. The provider and manager confirmed they did not analyse completed call data to review the duration of call visits, or the timeliness of staff. We reviewed four weeks of completed call data and as described previously, found that staff were consistently leaving care visits prior to completing the scheduled duration. For one 8-day period we reviewed, most of the people receiving a service were affected by this practice and this equated to over 80 hours of care not being provided as scheduled. We raised this with the manager and provider who were unaware of this practice and confirmed they would complete a review. We also shared our findings with the local authority who funded most people’s care packages. Staff training records were incomplete. The provider explained that this was due to a malicious data loss experienced at the service, however they were unable to explain how they had assured themselves since this that staff had received sufficient training relevant to their role. The manager had begun to complete a new training spreadsheet for all staff but had failed to identify that training specific to the needs of people receiving their service, such as diabetes, dementia, epilepsy or end of life care should be considered mandatory. Staff recruitment was safe and all essential pre-employment checks were completed prior to a staff member starting work. A recent audit of all recruitment documentation had been completed by an external agency on behalf of the provider.

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.

People and their relatives told us that medicines were managed safely. One relative told us, “Medication is now in blister packs which the carers administer with no problem.” Another relative told us, “Her medication is administered correctly with no issues.” We saw that people’s preferences as to how they wished to be supported with the administration of their medicines was included in care plans, where this was an identified need.

Staff told us they understood the safe management of medicines. They confirmed they had received training, and their competency was checked during spot checks.

There were regular audits of medicines and associated records, however we found they did not accurately reflect actual events. For example, medicine recording errors had been recorded on the ‘governance log’ yet the audits completed for these people did not include detail on these and stated that all records were ‘completely satisfactory’. The manager confirmed that action had been taken to improve the recording of medicines, however this had not effected the required change. They told us that further action had since been taken.