Caremark (Hatfield &Welwyn)

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

People and their relatives offered positive feedback in relation to the management of the service and their experiences. However, we received mixed feedback from staff regarding the management and governance processes in place. Changes at both provider and management level had contributed to instability at the service. There was a lack of provider oversight, which had failed to ensure the service was operated safely and ensure action was being taken to make improvements where needed. Whistleblower concerns had been received. We found improvements were needed with regards to hearing the voice of staff, along with the recording, investigating and responding to concerns shared. During our assessment of this key question, we found quality assurance systems in place were not being operated effectively. Concern found at this assessment had not been identified through checks and audits and, where audits had been completed, these did not offer accurate information or oversight. This was a breach in regulation. You can find more details of our concerns in the evidence category findings below.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We received mixed feedback from staff regarding their experiences of management at the service. Whilst some staff felt supported, other staff felt unable to approach senior staff. It was clear from the feedback we received, changes in management at the service in recent months along with new ownership in February 2024 had created instability amongst the staff team.

The service did not have a registered manager in post. At the time of this assessment one registered manager had recently left employment at the service and one registered manager was on maternity leave. A new manager had been appointed. They submitted their application to register shortly after our assessment concluded. Prior to the publication of this report, we identified that both registered managers had completed the process to de-register. The provider had not completed an audit at the service for a period of five months prior to this assessment. By failing to have effective oversight of the service, the provider had not ensured that the service was running safely or ensure action was taken where needed to make improvements.

We received mixed feedback from staff. Whilst some staff felt able to speak up, other staff told us they were not always confident to raise questions or concerns. All staff confirmed they were aware of the whistleblower process in place, and this had been shared with them in a recent team meeting. Meeting minutes we received confirmed this was the case, however, did not indicate that attendees were provided with opportunities to discuss, or share concerns they might have. We continued to receive anonymous whistleblower concerns and feedback during this assessment.

The provider had a whistleblower policy in place; however, this had not been personalised or made specific to the service. Details of the senior staff or local organisations who staff could report whistleblower concerns to had not been added. Whistleblower concerns were recorded, however we found inconsistencies. Whilst the manager had recorded within the ‘governance log’, “I found that many of the whistleblowing reports were malicious allegations made by an anonymous source”, the provider told us that investigations into recent concerns had not concluded. This assessment was commenced due to CQC receiving a high number of concerns from whistleblowers. Both the provider and manager felt these reports were malicious, however our findings indicated that information shared with us was, in part, accurate and that action was needed to ensure that staff voice was heard and responded to.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us they knew their roles and what was expected of them. However, we received mixed feedback regarding the management processes in place with many staff not able to confirm any part where they felt able to contribute in driving improvements at the service.

Quality assurance systems in place were not being operated effectively. A series of audits and checks were in place, but these were not being completed accurately by the manager or senior staff. As a result, failings found at this assessment had not been identified. For example, we found that care visits were consistently being cut short, an analysis of completed call data was not completed yet audits stated that visits lasted the full duration. We found that medicine recording errors had occurred, yet audits stated that records were completed accurately and fully. We found inconsistencies within people’s care records, yet reviews identified no changes were needed. The provider and manager were acting on inaccurate information about risks and performance. This meant that improvements needed from the results of robust checks, audits or feedback from people, relatives and staff were not being made. The service improvement plan in place had been created by the previous registered manager. The focus of this action plan was the result of their self-assessment of compliance against standards. We found that targets set in were inconsistent with published guidance and, as a result, the planned actions would not lead to a demonstration that the service was meeting the required standards. The findings of this assessment confirmed this. The manager and provider gave assurance they would review the feedback we provided and take action to make the necessary changes.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.