We carried out this responsive assessment between 30 September 2024 and 07 November 2024. We looked at how Caremark Tunbridge Wells, Tonbridge and Malling assessed people's care needs, and how they trained and supervised staff to support people according to their needs and preferences. Caremark Tunbridge Wells, Tonbridge and Malling is a domiciliary care service providing personal care to people in their own houses and flats in the community. At the time of our inspection there were 34 people using the service who required supported with their personal care. This included 3 people who received care from live in carers. Not everyone who used the service received personal care. 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. The service provides support to older people, younger adults, people living with dementia, people with physical disabilities, people with a sensory impairment and people with mental health conditions. We spoke with 6 people, 4 relatives and 10 staff including the manager and nominated individual during the assessment. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed 5 people’s care plans, 4 staff recruitment records as well as general records for the service. These included staff training records, meeting records, policies and procedures and audits.
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Caremark Tunbridge Wells, Tonbridge and Malling is rated Good overall, with safe and caring domains both Good, but well-led rated Requires Improvement due to gaps in management oversight of accidents and incidents, overdue risk assessment reviews, and the absence of formal anonymous feedback mechanisms. A newly appointed manager had already identified and begun addressing these issues, though improvements needed time to embed.
Concerns (4)
moderateIncident learning: “several reports had no management actions or recommendations recorded”
moderateGovernance: “some assessments that had not been recorded as having been reviewed for over 12 months”
moderateGovernance: “a broader process of auditing was needed to ensure managers had complete oversight of the service”
minorCommunication with families: “There was no formal way for people or their relatives to provide feedback apart from verbally to managers and staff.”
Strengths
· People felt safe and staff demonstrated clear understanding of safeguarding procedures and escalation processes.
· Medicines were managed safely with trained staff, electronic MAR charts, and regular spot-check supervisions.
· Sufficient staffing levels with good geographical coverage and contingency arrangements for late or missed calls.
· Staff treated people with kindness, dignity and respect, with cultural, faith and dietary needs recorded and honoured in care plans.
· People were supported to maintain independence and involved in decisions about their own care.
Caremark Tunbridge Wells, Tonbridge and Malling was rated Good overall at its first inspection, with an Outstanding rating for caring, reflecting staff who consistently exceeded their contracted duties and demonstrated exemplary compassion, dementia care expertise and end-of-life support. No regulatory breaches or failure themes were identified; the service demonstrated strong governance, robust staffing practices and a deeply embedded person-centred culture.
Strengths
· Staff were passionate about delivering the caring values of the organisation and frequently went beyond the agreed care plan to ensure people's wellbeing.
· Small staff teams were assigned to each person to ensure consistency and development of positive, caring relationships.
· Excellent understanding of dementia care, including person-centred responses to confusion and hallucinations.
· Outstanding end-of-life care, including federation membership with a local hospice and bereavement support for relatives.
· Robust recruitment, induction, training and supervision processes, with all staff working towards Level 3 qualifications.
Quality-Statement breakdown (19)
safe: Safeguarding people from abuseGood
safe: Risk assessment and managementGood
safe: Staffing levels and safe recruitmentGood
safe: Medicines managementGood
effective: Staff training, induction and competencyGood
effective: Mental Capacity Act and consentGood
effective: Nutrition and hydrationGood
effective: Access to healthcare professionalsGood
caring: Kindness, compassion and dignity
Outstanding
caring: Involvement in decisions about careOutstanding
caring: Promoting independenceOutstanding
caring: End-of-life care and supportOutstanding
responsive: Person-centred care planningGood
responsive: Flexibility and responsiveness to changing needsGood
responsive: Complaints handlingGood
well-led: Leadership vision and valuesGood
well-led: Quality assurance and governanceGood
well-led: Staff engagement and cultureGood
well-led: Partnership working with external organisationsGood