The inspection was announced and took place on 11 and 17 October 2017.

Caremark Limited is a domiciliary care agency that provides personal care to people in their own homes in West Sussex. At the time of our visit the agency provided personal care to over 200 people and children. This included 95 people who resided in extra care accommodation at three different locations. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service only.

During our inspection the manager was present. They had been employed since November 2016 and had submitted an application to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previously inspected the service in May 2016 when it was rated ‘Requires Improvement’ overall and in all domains apart from the ‘Caring’ and ‘Well Led’ domains which were rated ‘Good.’ Two breaches of regulations were made for medicines and staff support. In response to this the provider sent us an action plan that detailed the steps that would be taken to achieve compliance. At this inspection we found that sufficient action had been taken and that the breaches of regulations were met.

Safe medicine procedures were now being followed and care workers were maintaining medicine records that reflected the support they gave to people. The manager had also reviewed the structure and organisation of the agency office. This had led to better communication between people who received a service and people employed by the agency. The level of support that staff received had also improved with staff now receiving regular supervision and training that enabled them to meet people’s individual needs.

People were happy with the service they received and complimented the care workers who supported them. They said that generally visits took place at times of their choosing and if care workers were going to be late they were notified of this in advance. People felt they were treated with kindness and said their privacy and dignity was respected. People's care plans contained information about what was important to them and how care should be delivered. People were involved in reviewing care plans with members of the management team. People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible.

Care workers knew how to keep people safe. They understood their responsibilities under safeguarding procedures and were confident the management team would act swiftly and deal with any issues appropriately. Recruitment procedures ensured care was provided by staff who were safe to support people in their own homes. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely. There were some gaps in risk management records that the manager was addressing.

People were happy with the support they received to eat and drink. Changes in people's health care needs and their support was reviewed when required. If people required input from other healthcare professionals, this was arranged. People who used the service felt able to make requests and express their opinions and views. A formal complaints process was in place that people were aware of.

The manager was committed to continuous improvement and feedback from people, whether positive or negative was used as an opportuni

The inspection took place on 17 and 20 May 2016 and was announced.

At our last inspection, in April 2015, we found breaches of the regulations in relation to medicines, staffing levels, staff training and support. At this inspection we found that there had been improvement in how the service was managed and delivered. New staff had been recruited and the breach in relation to staffing numbers was met. We found, however, that further work was needed to make and sustain progress in the areas of medicines management and staff training and support.

Caremark Limited is a domiciliary care service that provides support to people in West Sussex, including in Pulborough, Henfield and Horsham. At the time of our visit the service was supporting 112 people, including six children, with personal care.

The service had a registered manager. 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.

People were at risk because guidance for staff on the support they required with their medicines was sometimes missing or inconsistent. Records of the medicines administered to people contained gaps where staff had not always signed to confirm that people had received their prescribed medicines.

Some people did not have a care plan in their home and other care plans did not reflect the person’s current needs. This meant that staff would not have accurate information to refer to and put people at risk of receiving inappropriate or unsafe care. People and staff told us that there had been an improvement in recent months and that reviews had been taking place.

Risks to people’s health and safety had been assessed and there was guidance for staff on how to minimise risk. We noted that there were no risk assessments in place for the use of bed rails and the registered manager took prompt action to address this.

Staff felt supported and said there had been improvement in the service. They spoke highly of the training they received. We found, however, that staff training had not always been updated and that supervisions and spot checks had not taken place at the frequency required by the provider. Further work was needed to ensure that staff understood individual needs and that people received effective care at all times.

Staff understood local safeguarding procedures and reported any concerns promptly. We found, however, that some staff who were supporting children had not completed child safeguarding training.

There were enough staff employed to meet people’s needs. People told us that the timing of their visits and the continuity of the staff who visited them had improved.

People spoke highly of the staff and told us that they treated them with dignity and respect. They told us that they had been involved in planning the care that they received. Staff understood how consent should be considered in line with the Mental Capacity Act 2005.

Staff supported people to prepare meals and to eat and drink if required. Where there were changes in people’s health staff responded promptly and made referrals to other healthcare professionals when additional support was required.

People had been asked for their feedback on the service and the registered manager was responding to their concerns. The majority of concerns shared with us related to new staff not understanding people’s needs and the fluency of English of some staff. The registered manager was monitoring the rotas to ensure that introductory visits were taking place so that staff were always introduced to a person and their needs before being required to provide support.

People felt able to contact the registered manager or staff if they had concerns and said that they received a good response. People told u

We spoke with five people who use the service, two on the day of our visit and three by telephone afterwards. We also spoke with relatives of three people who were unable to tell us directly about their experience. We used the results of a telephone survey carried out by the agency in the week of our visit to capture the views of a further 17 people.

People and their relatives were satisfied with the service. One said, “They’re very kind and efficient”. Another told us, “They’re all really helpful and friendly” and, “They’re a good crowd”. One person during a telephone survey had responded, ‘I look forward to my carers visits, they make me feel safe’. Relatives told us that the staff were diligent. One said, “We’ve stabilised with a number of girls that X gets on well with”.

We spoke with six care workers, three supervisors, one office based care co-ordinator and the manager. They told us that they enjoyed their work and that they felt supported. One care worker said, “I absolutely love the job”.

We found that people experienced safe and effective care delivered by regular staff who knew them well. Staff had received appropriate training. The interactions between care workers and people that we observed during home visits were positive. People were offered choices about the care that they received and support was provided in a kind and respectful manner. Everyone that we spoke with told us that they could approach the staff and manager if they were unhappy or had ideas to discuss.

We spoke with three people, or the relatives of people who have used the service. We also spoke with three members of staff who were involved in providing care to people. Apart from one, all interviews were carried out by telephone after we had visited the office. People expressed satisfaction with the agency and with the quality of care provided. People said that care staff treated them with respect and that they felt safe with the care and support they received. Care staff told us they felt well supported in their work.

Not everyone could remember if they had been given a copy of their care plan. But they told us that they had agreed to the care provided. They also told us that they had regular contact with the agency to review the care provided to ensure their needs had been met.

Everyone said that, usually, care staff arrived on time for visits. They said that, if care staff were going to be late, they were usually informed of this. They also told us that, when necessary, they could contact the office to change the times of calls so could attend hospital or doctors’ appointments or if they chose to go out.

One person told us, “The service I get is satisfactory. They are sometimes a bit late, but that can’t be helped.” Another person said, “I think they have been very good.”

This inspection took place on 9 and 10 April 2015 and was announced.

Caremark Limited is a domiciliary care service that covers West Sussex. There are three area teams; Horsham, Pulborough, Storrington/Steyning. The service supports older people, people living with dementia, people with a physical, learning or sensory impairment and those with mental health conditions. At the time of our visit, they were supporting 110 people with personal care.

The service did not have a registered manager. A new manager had been in post for six months but was not registered with us. They were due to begin the process of registration once checks with the Disclosure and Barring Service were complete. 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.

People spoke positively about the support they received but expressed frustration over variation in their call times. They told us that this made it difficult to plan their day and some people found it confusing. They told us that staff were kind and patient. Most people received support from regular care workers who knew them well and understood their needs. They told us that they were involved in their care and that staff encouraged them to be as independent as possible.

The service was going through changes. The new manager had identified that the staffing levels had not kept pace with the growth of the service. They had put a stop to new care packages in order to stabilise and to improve the quality of the service provided. The management team was working to recruit new care workers and were reviewing some of the staff conditions, including unpaid travel time. In the meantime, supervisors and the manager were involved in delivering care to people. This was having an impact on the smooth running of the service as management and administrative tasks had fallen behind.

Improvements had been made to people’s care plans and to how the call monitoring system was used but we found that audits, for example, in how medicines were administered, had not always been effective at identifying issues. The manager received support from a representative of the provider and new systems were being put into place, along with action plans to monitor progress. Staff spoke positively about the new manager and had confidence in their ability to make improvements. They felt able to approach the manager with suggestions or concerns and felt that they were listened to.

Staff did not feel they had received appropriate support and training. They were not satisfied with the induction training and did not feel sufficiently skilled or supported to carry out their roles. There were gaps in supervision, appraisal and refresher training for staff. A training administrator had been appointed and staff training provision was under review.

Medicines were not managed safely. The records in place did not demonstrate that people had received their medicines as prescribed. There were significant gaps in the records and confusion among staff as to which documents they needed to complete. The provider took prompt action to address these concerns and launched a full audit of medicines practice and records following our visit.

People’s care had been planned and individual support plans were in place. We have made a recommendation about how changes in people’s needs are communicated to staff.

Where risks to people had been identified these were assessed and actions had been agreed to minimise them. People received support to prepare meals and, where necessary to eat and drink. We have made a recommendation about how food and fluid monitoring is recorded.

People were involved in determining the care that they received and staff understood how consent should be considered. Staff were vigilant to changes in people’s needs and their support was reviewed when required. If people required input from other healthcare professionals, this was arranged. Staff often supported people to attend GP or hospital appointments.

Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. Where concerns had been raised, these had been reported.

People were asked for their views on the service provided and understood how to make a complaint if necessary. They told us that the manager or office staff usually responded promptly to their concerns.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.