Caremark Norwich

Updated 17 November 2023

The inspection

We carried out this inspection under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.

Inspection team

The inspection team consisted of 1 inspector and 2 Expert by Experiences. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 5 days’ notice of our inspection. This was because we intended to use remote technology to undertake the assessment and needed to ensure the provider was able to facilitate this type of assessment. This included uploading documents into a secure portal and facilitating calls to people who used the service, their relatives, staff, and health professionals.

Inspection activity started on 12 October 2023 and ended on 24 October 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was in the process of completing the provider information return (PIR) at the time of this inspection. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. This was considered as part of this inspection.

During the inspection

We spoke with 12 people who used the service and 10 of their relatives. We spoke with 3 staff including the registered manager. Written feedback was received from an additional 16 staff and 3 professionals. We assessed the care plans, associated records, and medicine administration record (MAR) charts for 4 people. Several governance records were also assessed including staff recruitment records for 3 staff, quality assurance audits, training and supervision records, policies, and procedures.

This inspection was carried out without a visit to the location’s office. We used telephone calls and emails to enable us to engage with people using the service, their relatives, professionals, and staff, and electronic file sharing to enable us to review documentation. Inspection activity started on 12 October 2023 and concluded on 24 October 2023 when feedback was given to the registered manager.

Updated 17 November 2023

About the service

Caremark Norwich is a domiciliary care agency that offers care and support to people who may misuse drugs and alcohol, live with dementia, who are detained under the Mental Health Act, have mental health needs, who have a learning disability, who have an eating disorder and/or autistic people. The service can provide care and support to children and older people.

At the time of our inspection there were 49 people receiving support with personal care in their own homes. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

At the time of this inspection, the location did not care for or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, whilst people told us staff stayed for the agreed amount of time and supported them in the ways they needed, they told us they did not always know which staff member was supporting them or what time they were expected to arrive. People told us, and records showed, that staff did not consistently attend at the times agreed.

Right Care:

Whilst people told us they received a service that was person-centred and met their needs, care records did not demonstrate this. We found that care records were not consistently accurate or complete and they could not be relied upon to evidence what care and support had been delivered. However, people told us they had confidence in the staff and that they were consistently kind, patient and encouraging. Staff were adept at maintaining people’s dignity and promoting their independence.

Right Culture:

The systems the provider had in place to assess, monitor, and mitigate the risks to the health, safety and welfare of people who used the service had failed. For example, there were two medicines administration systems in place and neither effectively ensured people received their medicines consistently safely or in line with best practice. This placed people at risk of harm. Additionally, staff had not received all the training the provider deemed mandatory, and improvements were needed in relation to staff recruitment records. Not all feedback received on the service had been acted upon in a prompt manner.

However, people felt able to raise concerns and told us they felt listened to and engaged. Staff felt supported and valued. The culture was positive, and people spoke highly of the registered manager telling us they were involved, accessible and communicative. The registered manager responded proactively to the concerns identified at this inspection and acknowledged that due to prioritising care calls, governance had deteriorated and required improvement. They provided us with assurances in relation to how they would address this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 October 2017).

Why we inspected

We inspected this service due to the length of time since the last inspection.

Enforcement

We have identified breaches in relation to risk management, medicines administration and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and phone calls to engage with people using the service as part of this inspection.