Our inspection of Caremark took place between 5 and 8 June 2018. The inspection was announced and the service was given 24 hours' notice to ensure someone would be in the office. At the last inspection in May 2017, the provider was in breach of legal requirements concerning safe care and treatment and good governance. The service was rated as ‘requires improvement.’ At this inspection, we found work was still required to achieve compliance with Regulations.

Caremark - Bradford is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to both older people, adults, young people, people with learning and profound disabilities and people at the end of life. Not everyone using Caremark receives 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 the inspection 260 people were receiving personal care from the service.

A registered manager was in place. 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. Staff knew how to recognise and report any concerns about people's safety and welfare. Risks to people’s health and safety were not always assessed to help protect people from harm.

We found medicines were not always managed in a safe or proper way. In particular, we found discrepancies with documentation, namely between medicines administration records (MARs), information recorded in daily logs and recording of topical medication.

People were provided with care and support by staff who were trained. Staff were skilled and competent to meet the needs of people. Staff told us they had received induction and training relevant to their roles. This was followed up by competency checks, however, these were not always effective. Training was tailored to meet people’s care and support needs. People were supported by kind, caring and compassionate staff. Staff demonstrated a sound awareness of infection control procedures.

There were enough staff deployed to ensure people received care. However, staff did not always arrive on time or stay with people for the allocated amount of time. Safe recruitment procedures were followed to help ensure staff were of suitable character to work with vulnerable people.

Care records contained sufficient detail so staff knew what support to offer people. People felt they participated in planning their care. Care records included information about people’s preferences, likes and dislikes.

The service was compliant with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People’s consent was sought before care and support was offered.

People said staff were kind and caring and treated them well. We saw good positive relationships had developed between people and staff. People mostly received care from specific staff to enable familiarity between people and staff. This meant people received consistent care.

The service worked in partnership with other agencies including health professionals to help ensure people’s needs were met. People’s healthcare needs were assessed and plans of care put in place.

A complaints procedure was in place, which enabled people to raise any concerns or complaints about the care, or support they received. However, the service did not always respond to people in line with their complaints policy.

Staff told us they felt supported in their roles and their views were listened to through supervision and team meetings.

People using the

Our inspection of Caremark took place on 15, 16, 17, 18, 19 May 2017 and was announced. At our previous inspection in May 2016 we found the service in breach of Regulation regarding medicines management, quality assurance systems and failure to notify the Commission of safeguarding concerns. At this inspection, we found some improvements had been made and the service was no longer in breach regarding notifications. However, the service remained in breach regarding a lack of robust audit processes and we also found areas of concern remained relating to the safe management of medicines.

Caremark is a domiciliary care agency which provides care services to people in their own homes. At the time of our inspection 238 people were receiving a personal care service. The agency provides a service to adults and children, older people, people living with dementia, people with physical disabilities and people with sensory loss.

There was 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.

Most people who used the service felt safe with the care provided and we found there were systems in place to protect people from harm. Appropriate safeguarding notifications had been made. Staff had received safeguarding training and understood how to keep people safe.

Risk assessments and care plans were individualised and person centred. These were reviewed on a regular basis to ensure they contained accurate and up to date information. Staff we spoke with understood the care and support they provided to people and displayed a person centred and caring attitude to the people they supported.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS).

We found medicines were not always managed in a safe or proper way. In particular, we found discrepancies with documentation, namely between medicines administration records (MARs), daily records and information contained within people's care plans.

Sufficient staff were deployed with the relevant knowledge and training to support people's needs effectively. People were mostly supported by the same staff team and matched with staff from similar backgrounds to ensure wherever possible cultural needs were supported. Recruitment checks and systems were in place to ensure people employed by the service were safe to work with vulnerable adults. Staff received induction training, supervisions, observations and spot checks as well as annual appraisals. Staff meetings were in place and an annual satisfaction survey sent to all staff, with results analysed and actions taken.

People's feedback on the service was regularly sought through care plan reviews, telephone checks, surveys and quality checks by management when they visited people's homes. Most people told us staff were reliable and treated them with kindness and compassion although some people said they were not always notified if a staff member was going to be late.

There was a robust complaints procedure in place which enabled people to raise any concerns or complaints about the care or support they received. The service investigated complaints thoroughly and documented actions and outcomes.

There was a quality assurance monitoring system in place that was designed to monitor and identify any shortfalls in service provision. Some improvements to systems had taken place since our last inspection. However, we found some quality audits remained insufficiently robust to identify areas requiring improvement, such as medicines management.

Most staff we spoke with praised and felt supported by the management team. However some people and their relatives told

The inspection took place on 16 May 2016 and was announced to ensure the registered manager would be available.

This was the first inspection carried out since the provider registered at the current address.

Caremark is a domiciliary care agency which provides care services to people in their own homes. On the day of our visit 135 people were receiving a personal care service. The agency can provide a service to adults and children, older people, people living with dementia, people with physical disabilities and people with sensory loss.

There was 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.

Most people who used the service felt safe with the care provided and we found there were systems in place to protect people from harm. However, the service had not made statutory notifications, such as notifications of abuse, to the Commission.

Risk assessments and care plans were individualised and person centred. These were reviewed on a regular basis to ensure they reflected accurate and up to date information. Staff we spoke with were person-centred in their description of the care and support they provided to people.

There were policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards (DoLS).

We found some concerns around the safe management and administration of medicines, particularly in regards to appropriate gaps in between administration of medicines and the management of 'as required' (PRN) medicines.

We found that people were provided with care and support by staff who had the appropriate knowledge and training to effectively meet their needs. The skill mix and staffing arrangements were also sufficient, although some people told us they would like to see more continuity of care staff. We saw from reviewing records Continuity of care staff was provided wherever possible. Recruitment checks and systems were in place to ensure people employed by the service were safe to work with vulnerable adults, although in some instances references were not always obtained prior to commencement of employment.

People and their relatives told us staff treated them with kindness, care and respect and most people told us staff were usually punctual and reliable. People's feedback on the service was regularly sought through care plan reviews, telephone checks, questionnaires and quality checks by management when they visited people's homes.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager ensured staff received induction training, supervisions, observations and spot checks as well as annual appraisals. Staff training included mandatory subjects and additional training and development relevant to their role. However the training matrix had not been updated to reflect recent training.

There was a quality assurance monitoring system in place that was designed to monitor and identify any shortfalls in service provision. However, we found this was not sufficiently robust to identify areas that required improvement.

Staff and healthcare professionals we spoke with praised and had high regard for the management of the service, although some people and their relatives told us they felt communication could be improved.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take in relation to this at the back of the full version of the report.