We inspected Caremark (Barnsley) on 3 and 9 October 2018. The inspection was announced on both days. Our last inspection took place in October 2016 when we rated the service good. As this inspection we found the evidence that the service required improvement.

Caremark (Barnsley) is a domiciliary care agency operating in the Barnsley area. It provides personal care to people living in their own houses and flats in the community. Not everyone using Caremark (Barnsley) received a regulated activity; 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. At the time of our inspection 134 people were receiving regulated activity support from this provider.

The service did not have a registered manager. The registered manager had left the service in February 2018 and had not completed the application process to de-register with the CQQ. The service had a new care manager in post. This person had started the application process to register with the Care Quality Commission.

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 told us they felt safe with the staff who supported them. Staff understood their roles and responsibilities to keep people safe from harm.

Medicines were not always administered safely and records relating to the administration of medicines were not always updated appropriately.

There were risk-specific assessments in place which identified risks to the tasks provided to care and support people. Measures had been put in place to minimise these risks; these also covered the environment in which people were supported.

There were sufficient staff to meet people’s needs. However, consistency of staff had been a concern. The new care manager had recently changed how staff were deployed. Staff told us this had improved.

Staff recruitment pre-employment checks had been thoroughly carried out.

People who were supported with medication had not always had this administered safely and staff competencies had not always been checked. There was a detailed action plan to improve this area with demonstrated lessons learnt.

Staff had undertaken training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Staff were able to describe what this meant. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care records showed people had consented to care and treatment. Staff told us how they would always ask for consent to care before assisting people.

New staff were supported in their role, which included training and shadowing a more experienced staff member until they felt confident. Staff undertook regular on-going training. Staff received regular supervisions, appraisals, observations and spot checks to assess their competency.

Staff gave examples of how they accessed and worked with relevant healthcare professionals when required.

People we spoke with told us staff were kind and caring. Staff treated them with respect and took appropriate steps to maintain people's dignity and privacy. People's private information was kept confidential.

People had a person-centred care plan in place which showed how they wished their care to be undertaken. Their likes, dislikes, and preferences were also included. This enabled staff to provide the care and support required by each individual.

There was a complaints process in place. People told us they felt confident of what to do if they had any concerns or complaints.

Regular

Caremark (Barnsley) is registered to provide personal care. Support is provided to people living in their own homes throughout the town of Barnsley. The office is based in the S75 area of Barnsley, close to transport links. An on call system is in operation.

At the time of this inspection Caremark (Barnsley) was supporting approximately 200 people whose support included the provision of the regulated activity ‘personal care’.

There was a registered manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Caremark (Barnsley) took place on 11 August 2014. The service was rated ‘Good’ following the inspection.

This inspection took place on 24 and 25 October 2016 and short notice was given. We told the registered manager two working days before our visit that we would be coming. We did this because we needed to be sure that the registered manager would be available and to arrange for some care workers to visit the office during our inspection so we could speak with them.

People supported by the service and their relative’s spoke positively of the care workers that visited them. People said they felt safe with their care workers.

We found systems were in place to make sure people received their medicines safely.

Systems were in operation to ensure the safe handling and recording of people’s money to protect them.

Staff recruitment procedures ensured people’s safety was promoted.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff had a good knowledge of the people they were supporting.

Some people said the timing of visits did not always meet their needs and they did not always have regular care workers visiting them all of the time. Other people said they had a group of regular care workers who generally arrived on time and stayed the full length of time. No people reported any missed visits.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and the principles of the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

Each person had a care plan that accurately reflected their needs and wishes so these could be respected. Care plans had been reviewed to ensure they remained up to date.

Some people supported, and their relatives or representatives said they could speak with staff if they had any worries or concerns and felt they would be listened to. Other people told us they found the office staff less reliable and they felt communication could be improved.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys and the results of these surveys had been audited to identify any areas for improvement.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was announced. The service was last inspected on 2 July 2013 and was meeting the requirements of the regulations we checked at that time.

Caremark (Barnsley) is a domiciliary care agency registered to provide personal care to people in their own homes. Those using the service include people living with dementia, people with complex needs and people with mental health needs. At the time of our inspection, 219 people were using the service.

There was a registered manager in place at the service. A registered manager 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 the law; as does the provider.

People using the service told us they felt safe and comfortable with their care workers.  Staff had a good understanding of safeguarding and knew how to recognise, and protect people from abuse. They received training in safeguarding and the Mental Capacity Act 2005.  The service reported any safeguarding incidents to the local authority as required.

Individual risk assessments were completed for people so that identifiable risks were managed effectively. People were included in the completion of these and they were reviewed regularly and in response to changes.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. Staff told us there were sufficient staff on duty to meet people’s needs. However, when visits were missed, the current system in place did not always identify when this occurred. This meant there was a risk of people not receiving support when they needed it. The service was looking to introduce electronic call monitoring which would alert in real time when calls were missed.

Staff completed induction, training and received ongoing support. They had opportunities to undertake further training to ensure they were able to meet people’s individual needs. People were supported to maintain good health and staff sought advice and information from other health professionals in relation to people’s care.

People and relatives were predominantly positive about the care and support they received and the individual care workers providing the support. They told us that staff respected their privacy and dignity and acted upon their preferences which were recorded in their care files. However, they were concerned about the high turnover of staff which meant care workers often changed. People said they would prefer to have the same care workers to support them for consistency and in order to build up relationships.

People’s care and support needs were assessed before they started receiving support and where people’s needs changed, support was adjusted to accommodate these changes.

People and relatives we spoke with were aware of how to make a complaint or raise a concern. They had information available in their care files detailing the service’s complaints procedure. All said they would feel comfortable in raising any issues.

Staff felt supported by the manager and directors. Team meetings were frequent and good practice was shared to help the service improve. Accidents and incidents were monitored by the manager and the service to ensure any trends were identified. There were effective systems in place to monitor and improve the quality of the service provided.