This comprehensive inspection took place between 1, 3 and 15 October 2018 and was announced.

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

Not everyone using Caremark Harrogate receives a regulated activity; 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.

The service had a registered manager who was also the sole director of Monark Limited and the provider's nominated individual. 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 in July 2017, there was a breach of regulation regarding the governance of the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least 'Good'. We found the provider had failed to achieve this and identified a continuing breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the commencement of our inspection the service supported 32 mainly older people. At the end of the inspection 20 people were supported. This was because people found alternative providers or their care needs had changed. The provider acknowledged they did not have the capacity to meet the needs of some people being supported due to staff leaving and asked the local authority to become responsible for supporting them.

People did not have personalised and detailed risk assessments with up to date care plans which had been reviewed. The service was not identifying all the risks which people faced to enable staff to respond and manage these risks.

Staff were not safely recruited. There were gaps in staff recruitment checks and we could not be assured if they were safe to work with vulnerable people. On the first day of our inspection the recently appointed care manager, had developed a matrix which showed where they had identified checks needing to be completed and the action taken already to address them.

The provider lacked systems to ensure the safe management of medicines. People were not always supported by staff who were appropriately trained, competent and skilled. Staff were not provided with regular supervision to do their job effectively. People's care records were not always as per the requirements of Mental Capacity Act 2005 (MCA). Not all people's care plans were person centred. Care plans to guide staff where people needed support with eating and drinking were not detailed.

Some people had missed and late care visits and the provider did not have sufficient systems in place to manage and prevent this from happening again.

Confidentiality was not always maintained. We recommend the service address this through appropriate training.

Complaints were not being managed in line with the provider's complaints policy. We found complaints were not responded to or in a timely manner and they had not been monitored to identify any trends.

The registered manager was not completing regular quality monitoring checks to review the quality of the service and make plans to make improvements. People were not asked for their feedback about the quality of the service being provided.

People told us the staff who supported them regularly, were kind and caring and respected their privacy and dignity.

The registered manager voluntarily decided not to accept any new care packages and agreed to be supported by the local author

Caremark (Harrogate) is a domiciliary care service providing care and support to people living in their own homes. The provider of the service is Monark Limited. They are registered to support people who need assistance with personal care.

We inspected this service on 21 and 28 July 2017. The inspection was announced. The provider was given 48 hours’ notice of our inspection, because the location provides a domiciliary care service and we needed to be sure someone would be in the location’s office when we visited. At the time of our inspection, there were 32 predominantly older people using the service. This was our first inspection of this location since the service moved offices in August 2015. The provider’s previous location was rated ‘Good’, when we inspected in May 2015.

The service had a registered manager who was also the sole director of Monark Limited and the provider’s nominated individual. 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. We have referred to the registered manager as ‘manager’ throughout this report.

During the inspection, we found people’s care plans and risk assessments had not been consistently updated as their needs changed. Whilst the manager was in the process of addressing these concerns, it showed us that effective systems had not been put in place to ensure people’s needs were regularly reviewed and their care plans updated.

We identified some issues with Medication Administration Records (MARs). The provider’s audits had not identified and addressed these concerns. People’s MARs and daily notes had not been returned to the office and audited in a timely manner to monitor and identify any issues or concerns with staff’s practice. Recruitment records did not consistently evidence when Disclosure and Baring Service checks had been completed.

We received mixed feedback about staff’s reliability and punctuality. We noted there had been some issues with missed visits and variation in the time that staff arrived to provide people’s care and support. We spoke with the manager about the need to more robustly monitor and analyse issues with staff’s punctuality and reliability in response to people’s feedback about staff arriving late. They agreed to look into these concerns.

We received mixed feedback about the management and organisation of the service. We concluded the issues and concerns we found showed us the service had not been consistently well-led. Whilst improvements were being made, more robust systems of quality assurance were needed to monitor and maintain consistency.

These concerns were a breach of regulation relating to the governance of the service. You can see what action we told the provider to take at the back of the full version of this report.

Despite these concerns, people who used the service told us they felt safe with the care and support staff provided. People were protected from the risk of abuse by staff who were trained to recognise and respond to safeguarding concerns.

Staff completed training and spot checks were completed to monitor their practice. Staff told us they felt supported by management and that additional advice and guidance was available if needed.

Staff sought consent before providing care. Consent to care was documented in people’s care plans and capacity assessments and best interest decisions were made where necessary. Staff provided effective care and support to ensure people ate and drank enough. When people were unwell, staff ensured they were supported to access healthcare services.

People told us staff were kind and caring. Feedback showed us people had developed positive caring relationships with the staff that supported them and clearly valued the mean