Caremark Lambeth improved from Requires Improvement to Good overall following a focused inspection in December 2022, with previous breaches of Regulations 12, 17 and 18 remediated. The single remaining concern is staff punctuality, with approximately 25% of scheduled calls attended more than 15 minutes late, keeping the Safe domain at Requires Improvement.
Concerns (1)
moderate
Missed or late visits
: “staff were more than 15 minutes late for approximately 25% of all their scheduled calls... still fell well short of the providers own expectations regarding staff time keeping.”
Strengths
· Robust pre-employment checks now in place including DBS, identity, references and right to work verification
· Electronic call monitoring system fully operational, automatically flagging late, early or missed calls
· Medicines administration records had no recording errors or omissions and were regularly audited
· Staff received regular supervision, annual appraisals and mandatory training refreshed within last 12 months
· Provider worked in close partnership with GPs, district nurses, NHS continuing care teams and local authorities
Quality-Statement breakdown (15)
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Planning and promoting person-centred, high-quality care and supportGood
well-led: Engaging and involving people using the service, the public and staffGood
Caremark Lambeth deteriorated from Good to Requires Improvement overall, with Safe rated Inadequate due to breaches in recruitment vetting, risk assessment and medicines management. Caring and Responsive remained Good, but governance and staff supervision failings drove three regulatory breaches under Regulations 12, 17 and 18.
Concerns (8)
criticalStaff competency: “staff files did not always include two satisfactory character and/or employment references, or Disclosure and Barring Services [DBS] checks.”
criticalSafeguarding: “several staff's DBS check and references, although satisfactory, had not been obtained until after they had started working for the agency”
criticalCare planning: “care plans for several people with mobility needs who required various hoists to transfer safely did not contain any moving and handling risk assessments or management plans.”
criticalMedication management: “we found numerous recording omissions and errors on MAR sheets we looked at where staff had either failed to sign and date these records or had completed them incorrectly with the wrong code.”
criticalSupervision / appraisal: “most staff had not had an individual or group supervision meeting with their line manager or had their work performance formally appraised or routinely observed in the last 12 months”
criticalGovernance: “the provider had failed to identify and/or take appropriate action to address a number of unsafe practices and issues we found during this inspection”
moderateStaff training: “approximately half the staff team had not refreshed this [medicines] training in the last 12 months, contrary to recognised best medicines practice and the provider's medicines policy.”
moderateRecord keeping: “Medicines administration records (MAR) sheets were not always kept up to date or accurately maintained.”
Strengths
· Continuity of care from a small group of familiar staff
· Strong infection prevention and control practices, including COVID-19
· Staff treated people with dignity, respect and compassion
· Person-centred care plans tailored to individual needs and preferences
· Effective complaints handling process
Quality-Statement breakdown (22)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsGood