This focused inspection took place on 16, 17 and 24 November 2017. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and provides a service to older adults. At the time of the inspection the service was supporting 49 people.

The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 19 and 22 May 2017 we asked the provider to take action to make improvements to how individual risks to people using the service were documented. This included guidance provided to staff to help minimise the known risks to people that they worked with. This action had been completed.

Risk assessments gave staff detailed guidance and ensured that risks were minimised in the least restrictive way. There was a plan in pace to ensure that risk assessments were reviewed and updated regularly.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report to if people were at risk of harm.

People told us that they felt safe with the staff providing care and were positive about the care that they received.

The service was aware of how to ensure infection control when working with people. Staff were supplied with gloves and aprons to ensure that people were safe.

The service completed regular audits on areas such as, medicines, quality assurance and risk assessments.

There were good examples of information sharing between staff, including regular staff meetings, management meetings and a weekly newsletter produced by the provider.

People and relatives told us that they felt their views on how the service was run were asked for and that they felt able to make comments and suggestions.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

This inspection took place on 19 and 22 May 2017. The provider was given 48 hours' notice because the location provides a domiciliary care service. At the time of the inspection Caremark (Enfield) provided domiciliary care and support for 37 people in their own home. The service worked primarily with older people living with dementia and people with sensory and physical impairment.

At our last inspection on 30 March and 1 April 2016, we identified breaches of regulations 9, 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to, care plans not being person centred; a lack of information and understanding of the Mental Capacity Act (MCA) and inadequate risk assessments that failed to address people’s personal risks. At this inspection we found that the provider had addressed the breaches regarding person centred care planning and the MCA. However, the provider had not adequately addressed the breach around risk assessments.

There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was present during the inspection.

Risk assessments did not provide staff with guidance on how to mitigate people’s individual personal risks. Risks had not been clearly identified and it was difficult to see what people’s risks were. Information contained within risk assessments was often the same on all risk assessments and failed to ensure that staff were aware of how to mitigate people’s individual risks.

People received their medicines safely and on time. The service had employed a medicines supervisor that audited medicines on a monthly basis and addressed any issues found. Staff received regular medicines training and competency observations.

The service operated safe staff recruitment procedures and ensured that all staff were suitable for the role before beginning any care work.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff did not receive regular supervision. However, the registered manager had identified this issue and a system was in the process of being put in place to address this. Staff had received an annual appraisal. Staff told us that they felt supported by the registered manager and senior staff.

Staff received a comprehensive induction when starting work including relevant training and shadowing more experienced members of staff before being able to work alone. Staff were provided with on-going regular training to support them in their role.

People were involved in planning their care and had regular reviews to gain their opinion on how things were. Staff knew people well and people and relatives felt that they were treated with dignity and respect.

Care plans were person centred and included information on how people wanted their care to be delivered as well as their likes and dislikes.

The service carried out regular monitoring visits on staff to ensure that people were receiving good quality care and support.

People and relatives were provided with information on how to make a complaint.

Staff and people knew the registered manger well and felt that he was responsive to their needs.

Staff meetings were not being held which would provide staff with a forum to be able to meet up and share ideas and concerns. However, this had been recognised and staff meetings were being booked.

At this inspection we found a continued breach of Regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regula

This inspection took place on 30 March and 1 April 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service. Caremark (Enfield) provides domiciliary care and support for around 45 people in their own home. The service works primarily with older people living with dementia and people with sensory and physical impairment.

The service had recently moved location. This was the first inspection at the current address. However, the service was last inspected 8 February 2014 at the previous location and at that time was meeting all the regulations inspected. There was a registered manager in post. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law; as does the provider. The registered manager was present during the inspection. The provider was also present during the inspection.

Medicines were not always accurately recorded on medicine administration (MAR) sheets. The registered manager did not complete medicines audits. Staff had received training on medicines administration and people told us that they were supported to take their medicines safely.

Risk assessments were often a tick box format and did not give staff guidance on how to mitigate risks. Risk assessments failed to provide staff with appropriate information with regards to the people they were taking care of. Risk assessments were not always updated regularly.

Care plans were not person centred and did not state people’s likes, dislikes or how they wanted their care to be provided. Care plans were brief, often only several sentences and did not provide staff with an appropriate level of knowledge to be able to work with people.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm.

People were involved in decisions about their care. Where people were unable to have input, people’s families were consulted. However, this was not recorded appropriately. The service did not record best interests meetings in respect of making decisions about care when people using the service were unable to do so independently. Staff had an understanding of the systems in place to protect people who could not make decisions outlined in the Mental Capacity Act 2005. However, the service worked with people living with dementia and there were no records of mental capacity assessments around decision making.

People received continuity of care. The provider always tried to ensure that the same care workers looked after people. This promoted good working relationships with people who used the service.

There was a system in place to monitor any missed visits. Missed visits were investigated and followed up.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

Staff received regular, effective supervision and attended monthly team meetings. Senior staff completed regular monitoring of care staff via monitoring visits.

We found that there was an open culture that encouraged staff and people to discuss issues and ideas, though team meetings and informal discussion.

There was a complaints procedure that people and relatives knew how to use.

The service operated an on-call system for any issues that arose out of hours. People and relatives told us that there was always someone available to help.