Caremark (Aylesbury and Wycombe) is a domiciliary care service offering care and support to adults, young people and children in the Buckinghamshire area. One the day of our visit there were 210 people using the service. The service offer support to people who have mobility limitations, mental health problems, and other long term conditions.

There was a registered manager at the service who had been in post since August 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.

One person told us, “Yes friendly and efficient, they help me with house work, have a cup of tea and a chat. It’s nearly always the same staff”. A relative we spoke with told us, “Mum has a main carer 24 hours seven days each week. They have a two hour break where other ‘regulars’ take over”.

Comments from staff were, “They are generally a good company. In terms of caring for their staff they are excellent”.

Staff received training in safeguarding. They told us they would not hesitate to report any concerns. One member of staff told us, “Caremark are a good company, a family business they always put clients first”. We saw evidence staff had raised concerns about a person’s well-being. It had been appropriately followed up and investigated according to the company’s policy and procedure.

Safe recruitment procedures were carried out. Files we saw contained relevant documentation required to ensure only suitable staff were appointed. Staff received appropriated induction, training and supervision. Staff received a training programme that spanned the first 12 weeks of working for the company. Support was ongoing and an essential part of continuing development.

Staff told us, “We can have additional training if we want it.”

Policies and procedures for the safe management of medicines were in place and being followed. Medicine charts we saw had been completed appropriately. People were given support if required to manage and administer their own medication. However, where people required staff to administer their medicine a risk assessment was in place to ensure the request was appropriate and staff were competent to carry out this role.

People said they knew how to make a complaint and were given the information to do so when they first received the service. One relative told us, “If I had any concerns I just ring the office they are approachable and listen and usually sort things out quickly”.

People had access to healthcare services to maintain good health. One member of staff told us, “We have a good rapport with the Occupational Therapist. We can go straight to them if we need advice or equipment”. The registered manager told us they work alongside nursing staff when required.

The service had effective quality monitoring systems in place to drive improvements and ensure the safety of people who used the service. Quality assurance checks were carried out by the Field Care Supervisor or Care Manger in people’s homes.

People told us they were very satisfied with the care and support they received. We found each person had a care assessment and plan which clearly set out what was to be done to support them. Care plans included details of the individual concerned, their particular needs and preferences when they received care. People told us they could change the times of their visits, for example when they had hospital or other appointments. "They always try and help us provided we give them enough notice" was what one person said.

We spoke with a staff member. They had a very good understanding of how people's dignity should be respected and upheld during personal care. They told us dignity and respect had been covered in their initial training and had also been discussed by the staff team during meetings. This ensured good practice was maintained and learning reinforced.

People told us they had been asked for their views on their care service. They told us they also had visits from care supervisors who came to make sure they had been satisfied with the standard of care provided. They said they discussed times and durations of calls and checked if their care plans and daily care record sheets were up to date. We looked at an individual review form. This provided evidence that care needs had been regularly reviewed to ensure they were being met appropriately.

People told us that their care needs had been assessed and that care and support was being delivered in line with their individual care plan.

In February 2012 during our last review of Caremark (Aylesbury and Wycombe) we reported conversations with or on behalf people who receive a care service in which they told us that they were satisfied with the standard of care they received.

On the 10 May 2012 we spoke with two people who had daily contact with care staff providing care or support and they confirmed that they received a reliable and consistent service. "We have no complaints" one person told us.

One other person we had a conversation with told us that whilst they could find 'no fault with the care' which 'on the whole works well', they did feel that communication about changes in the care visit timings could be improved.

We spoke on the telephone on the 10 May 2012 with someone who is responsible for a person who receives assistance with their medication. They told us that the care staff always recorded this each time and that there had 'never been a problem'.

People and relatives told us they were involved in decisions about their care and support. They told us they had been able to talk about the care and support they needed before a care package was arranged.

We were told that people using the service had been visited before they received care to discuss their needs.

One person using the service told us they were very happy with the care they received and said that thanks to the staff their life had been made much easier.

We were told that staff had the skills and experience to meet their care needs and that they were kind and caring. They said that people were visited by people from the agency and asked if they were happy with their care.

At our visit on 20 January 2014 and 21 January 2014, we looked at the care records of 19 people using the service. We telephoned five people who use the service and /or their relatives and visited three people.

We spoke with staff. We looked at 14 staff records. We looked at feedback the provider had received from people using the service and their responses.

One person told us “it’s an excellent service” and another that they “were happy with care”. Another person told us that they "never knew when staff would arrive”. One person told us “there was a lack of response from the office” when they telephoned. Another person told us their perception was “staff did not stay for the allotted time" and "staff were always in such a hurry”. Another told us “staff were often late but when there they were fine”. Another person told us that when they had problems with lateness of staff, the provider "sorted it out and it was resolved".

Risk assessments and care plans sampled documented people’s preferences for how they wanted care provided and were reviewed. We saw on care records that people who use services and/or their representatives had signed consent to agree care.

We noted the provider had appropriate arrangements in place to manage medicines and administer medicines safely.

Staff records evidenced staff received induction training, updates and regular supervision.