This was our second comprehensive inspection of Caremark - Charnwood. The visit was announced and was carried out on 7January 2019. The provider was given notice because the location provides a domiciliary care service. We needed to be sure someone would be in the office. The service provided domiciliary care and support to people living in and around the town of Loughborough, Leicestershire. At the time of our inspection there were 61 people using the service.

Not everyone using Caremark - Charnwood received the regulated activity; personal care. CQC only inspects the service received by people provided with personal care, help with tasks related to personal hygiene and eating. Where they did we also took into account any wider social care provided. Of the 61 people using the service, 57 were receiving the regulated activity, personal care.

At our last inspection in May 2016, the service was rated overall ‘Good’. At this inspection we found the service ‘Required Improvement’.

The service had a 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.

The provider’s safeguarding processes had not always been followed by the management team when a safeguarding allegation had been received.

Whilst the risks associated with people’s care and support had been identified, not all had been included in the risk assessment process. Risk assessments seen were generic in content and lacked personalised information.

Whilst auditing systems were in place, these did not always pick up omissions within the documentation held at the service.

Whilst the majority of people received the calls they required, we evidenced one occasion when a person’s call, which was mainly to prompt them to take their medicines, had been missed.

People and their relatives told us they felt safe with the staff who visited them. Staff had received training on the safeguarding of adults and knew what to do if they were concerned for someone’s welfare.

Appropriate checks had been carried out when new members of staff had been employed to make sure they were suitable to work at the service. Staff members had received an induction into the service and relevant training had been provided to enable them to meet people’s needs.

The staff team had received training in the management of medicines. Where people required support with their medicines, they were supported in line with the provider's medicines policy.

People were supported to maintain good health. They were supported to access relevant healthcare services and they received on-going healthcare support. People who required support at mealtimes were supported to have enough to eat and drink to keep them well.

People were supported to have maximum 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.

The staff team had received training in infection control and understood their responsibilities around this. People were protected by the prevention and control of infection.

The staff team were kind and caring and treated people with dignity and respect. People were supported to make choices about their care and support on a daily basis.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong and a business continuity plan was available to be used in the event of an emergency or untoward event.

Whilst the staff team had received training on the Mental Capacity Act 2005 (MCA) not all could remember completing this. People's consent was always obtained before their care and support was provided. The management team understood the principles of th

We inspected the service on 18 May 2016. The inspection was announced. The provider was given 48 hours’ notice because the location provides domiciliary care; we needed to be sure that someone would be in.

Caremark –Charnwood is a domiciliary care agency that provides personal care to people in their own homes. On the day of our inspection the service was supporting 45 people.

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 and associated Regulations about how the service is run.

People and their relatives told us that they felt safe. Staff were aware of their responsibility to keep people safe. Risks were assessed and managed to protect them from harm and staff understood what to do in emergency situations.

Safe recruitment practices were being followed. Systems were in place to ensure that people received support at the times that they wanted to and this was monitored. People were supported by a number of different staff and most expressed a preference for fewer different staff to support them.

People received their medicines as required. Medicines were administered safely by staff who were appropriately trained and competent to do so.

Staff had received training and supervision to meet the needs of the people who used the service. Staff told us that they felt supported. Their competence to do their role was regularly assessed. Some people felt that less experienced staff required a greater level of training and supervision.

People made decisions about their care and the support they received. People were involved and their opinions sought and respected. The registered manager understood their responsibility to ensure people were supported in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s nutrition and hydration needs were assessed and met. People’s health needs were met and when necessary, outside health professionals were contacted for support. People’s health records were being maintained.

People’s independence was promoted and people were encouraged to make choices. Staff treated people with kindness and compassion. People’s communication needs were identified and supported. Dignity and respect for people was promoted.

The care needs of people had been assessed. Staff had a clear understanding of their role and how to support people who used the service. People contributed to the planning and reviewing of their care.

People and staff felt that the registered manager was approachable and action would be taken to address any concerns they may have. People and staff were kept informed of changes to the service and their feedback was sought.

There were a range of audit systems in place to measure the quality and care delivered so that improvements could be made.

For this follow up inspection we did not speak with people who used the Caremark Charnwood service. We visited the office to review the care plan records that were held there and we spoke to staff who worked in the office and to the field care supervisor.

Care plan documents had been reviewed in recent months and updated at regular intervals. The information was well detailed and explained people's individual care and support requirements and their preferred routines. Staff confirmed that the care plan records were up to date and accurately reflected peoples' current needs.

These care plan documents also included information about the medicines people took, including the name of the medicine, the dose and frequency. This meant that people were protected from the risks associated with unreliable administration of medicines.

Prior to our inspection visit we contacted the provider to announce our inspection. This was to allow for the opportunity to meet with people who used the service. The provider arranged for us to accompany a member of staff on visits to two people.

During our inspection we met two people who used the service, one with their relative present. We also spoke by telephone with four other people using the service and two relatives of people using the service.

We met with seven of the care staff employed by Caremark and spoke in detail with four of these and with the manager of the service.

The local authority had recently been supporting the provider by offering advice and expertise to them to help make improvements to the service.

Care plans showed that people’s needs had been assessed and their views taken into account. The plans were not always as up to date as they needed to be to reflect recent changes in people’s circumstances. Overall, the people we spoke with told us that they were satisfied with the support they received. One person explained this to us, “It is all very good. The staff come on time. They are very nice and very reliable.”

Information in medication care plans and risk assessments gave useful information but arrangements for recording the administration of medication indicated people did not always have their prescribed medicines when they should.

Staff received support from senior staff and attended regular training to help keep their skills and knowledge up to date.

The provider asked people for their views on the quality of the service. Unannounced spot checks took place to observe staff and provide feedback on their performance.

People using the service who we spoke with were unfamiliar with the formal complaints policy but felt they would be able to raised concerns with staff, should they have the need to. One of the people we spoke with told us, “I have no complaints whatsoever. If I did I would let them know.”

We carried out this inspection in response to information of concern we received. During our inspection we spoke by telephone with four people who were using the service. We also spoke with two staff who employed by Caremark Charnwood.

Staff received computer based induction training when they commenced their employment and worked alongside colleagues to help learn different aspect of the job. There were no formal arrangements in place to support and monitor staff and to help ensure that they had the appropriate skills and knowledge to carry out their duties safely.

During our inspection we spoke with four people using the service and one person whose relative received support from Caremark Charnwood. These people told us that they were satisfied with the care and support they received. They felt staff were reliable and treated them well.

Assessments were completed prior to people using the service and information was gathered to help plan the care and support people needed. People were involved in this process by sharing information about their likes, dislikes and preferred routines.

Staff understood the potential risks to people’s safety and wellbeing and knew how to raise concerns if they felt a person was at risk of harm or abuse.