This inspection took place on the 7 and the 13 February 2017 and it was announced.

Caremark (Worthing) is a domiciliary care agency, which provides personal care to people living in their own houses or flats in the community. The registered office is in Worthing however the service provides personal care to people across West Sussex including Worthing, Shoreham-By-Sea and Arundel. It provides a service to older people, people living with dementia, people with a physical disability, people with a learning disability, those with a sensory impairment, younger adults and children. At the time of our visit, they were supporting 110 people with personal care.

The service had 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 5 January 2016, we identified three breaches of Regulations associated with gaps in risk assessments and care plans, how medicines were managed, staff supervision and appraisal, how staff were deployed to meet people’s needs and how the provider monitored the quality of care provided to people. A recommendation was also made in relation to improving how the provider routinely recorded concerns and complaints. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider had now met all the legal requirements.

The last inspection noted significant gaps in people's Medication Administration Records (MAR). This was in breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found improvements had been made and this Regulation was now met. We received numerous compliments from people (and their relatives) sharing they were happy with how the service supported them with their medicines. At this inspection we identified there was a delay in daily notes and MARs being delivered to the office from people’s homes which could delay timely quality monitoring of those records. Due to the issues of significant gaps we found at the previous inspection with MARs; we have discussed this further in the Well-Led section of the report.

We received mixed feedback regarding people receiving calls at their preferred time and how the office communicated with people and their relatives about this and when changes were made to rotas. We discussed this with the registered manager and provider who offered explanations as to why this had been highlighted. We have discussed these issues within the Well-Led section of this report and recommended the provider reviews how they communicate with people and their relatives about what they are able to provide regarding times of care calls and when changes are made to allocated staff.

Accidents and incidents were responded to by staff without delay and the appropriate medical professionals were contacted for advice and support when required. Staff were able to speak about what action they would take if they had a concern or felt a person was at risk of potential abuse or neglect. The service followed safe recruitment practices. People and their relatives told us they felt Caremark (Worthing) provided a safe service.

People's consent to care and treatment was considered. Staff understood the requirements under the Mental Capacity Act 2005 and about people's capacity to make decisions. Some people received support with food and drink and they made positive comments about staff and the way they met this need. Changes in people's health care needs and their support was reviewed when required. If people required input from other healthcare professionals, this was

The inspection took place on the 5 January 2016 and was announced.

Caremark (Worthing) is a domiciliary care service providing support to people in their own homes. The service supports older people, people living with dementia, people with a physical disability, people with a learning disability, those with a sensory impairment, younger adults and children. At the time of our visit, they were supporting 125 people with personal care.

The service had a registered manager in post who had been registered since July 2015. 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.

All people had care records in place. These showed how people had been assessed prior to receiving support from the service and how current care was planned. When risks had been identified for people a risk assessment was put in place. However care plans and risk assessments did not provide the level of guidance required for staff supporting people in their own homes.

People spoke positively about the support they received from the service but also shared frustrations over staff not arriving at the preferred or agreed times, not knowing in advance which staff were attending and on occasions the incorrect numbers of staff arriving for visits. People told us that the agency was short staffed and the staff turnover was high therefore impacted how visits were carried out. We found that the deployment of staff had not ensured people’s safety or that their preferences of care times had been upheld.

Medicines were not always managed safely. The records in place did not demonstrate that people had received their medicines as prescribed. Staff administered medicines to people in their own homes in a personalised and professional manner however significant gaps were noted in the records. The registered manager had recognised this issue and had introduced new systems to drive improvements and minimise further risks to people.

Staff felt confident with the support and guidance they had been given during their induction and subsequent training. Staff also told us they were satisfied with the level of support that they were given from the management team. However, staff records showed that supervisions and appraisals were not consistently given to all staff to ensure they were supervised and supported appropriately. The registered manager was aware of this and was encouraging the frequency of spot check visits which included a supervision.

Staff spoke kindly and respectfully to people, involving them with the care provided. Staff had developed meaningful relationships with people they supported. Staff knew people well and had a caring approach. Staff demonstrated how they would implement the training they received. The registered manager had introduced systems to promote good practice. Field care supervisors provided consistency in the delivery of care and a link between the office and people in their own homes.

People had been asked their views on the service provided. People told us that they knew who to go to to make a complaint and how they would do so if required. People had access to contact information in their own homes. Complaints were recorded although it was not clear what the outcomes were, what actions had been taken and what learning had been achieved to improve the service.

We found three 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.

At the time of our inspection there were approximately 110 people who received personal care from the service. We spoke on the telephone with four people who used the service and two representatives (relatives) of people who used the service. They told us that they felt listened to and were able to take part in decisions about the care and treatment provided. People told us they were happy with the care provided. One person who used the service told us “It’s going fine. Everybody is so nice, no problems at all”. A relative said “The care has been brilliant.”

People told us that care and support had been well managed. One person said "If someone is not able to turn up someone else is always arranged. They know the care I need.” Another person told us "They do things well and they’re nice girls."

There was evidence in the care plans that needs and risk assessments had been completed and were regularly reviewed. This enabled care workers to support individuals in a safe and appropriate way. Records showed that there were recruitment procedures in place to ensure care workers were fit to carry out their work.

The service had arrangements in place to safeguard people who used the service and the service had acted safeguard them when there had been concerns for their wellbeing and safety.

We found that the service had an effective complaints procedure in place and that the provider took action to make improvements to the service accordingly.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences.

We spoke to five people who used the agency and also the partner of one person who used the service. All of the people we spoke with were happy with the service that the agency provided. People told us that that the staff who supported them were normally punctual and stayed the correct length of time. They said staff were friendly and cheerful and always treated them with dignity and respect.

One person told us.“I have the same carers in the morning and evening – regular people”.

Other comments from people included: “I can not fault them” “The staff are always friendly and cheerful” “I am happy with the service and have no concerns”.

None of the people we spoke with had made any complaints but they all said that they were aware of how to complain and were confident that any complaints would be dealt with appropriately.

We spoke with six members of staff. They said that they were well supported by the agency and that they were provided with the training and information they needed to support people effectively.