The inspection of Caremark (Cheshire North East) took place on 24,25,26,27 April 2018 and was announced.

At our last inspection in June 2017 we found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. These breaches related to the service not following the principles of the Mental Capacity Act 2005 to assess if people did have capacity to consent to their care and the service not notifying The Care Quality Commission (CQC) about significant events that they are required to notify of by law.

Following that inspection we asked the provider to complete an action plan to identify what they would do and by when to improve the key questions- Is the service effective and well-led.

At this inspection, we found that all the required improvements had been made.

The action plan submitted identified the service had followed the principles of the Mental Capacity Act 2005. Mental capacity assessments were being carried out if it was felt that some people did not have capacity, or had fluctuating capacity. The registered manager had systems in place to ensure they notified CQC about significant events that they are required to notify by law.

Caremark (Cheshire North East) is a domiciliary care agency based in the Handforth area of Cheshire. It provides personal care to people living in the community. The services provided include care and support provision for older people, people with a physical or learning disability, people living with dementia, children and end of life care. At the time of our inspection, the service offered care and support to 42 people who lived in the area.

There was a manager in post who had submitted his application to CQC to become registered as a manager of the service. A registered manager is a person who has registered with the 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.

Systems were in place to check the quality and safety of the service. The manager also sought feedback from people informally on a regular basis and on a formal basis annually. All the feedback we viewed was positive. Spot checks and observations were carried out with staff to ensure that the standards of care were maintained.

People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and knew how to respond to and report any concerns they may have.

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.

Care records had been updated and contained personalised information about people's needs which helped ensure that staff had access to up-to-date and accurate information around people's individual needs and choices. This helped ensure that people received the correct level of support.

Medication administration records (MAR) sheets held details of types of medication and the times they were to be given.

There were clear lines of responsibility within the service and the manager and managing director worked positively with the local authority and other professional services in order to develop and drive improvement.

The manager had the ratings displayed in the office from the last CQC inspection.

The office inspection took place on 5 June 2017 and we gave the provider 48 hours’ notice. This was to ensure that someone would be available in the office as it is a domiciliary care service. We spoke with the people who used the service, their relatives and staff after this. The service had been previously inspected in 2015 and rated Requires Improvement. At the time of this inspection there were approximately 28 people using the service with a range of support needs such as people with a physical disability and older people.

There was a Registered Manager in post at the time of our inspection. 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 this inspection we identified breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one of the Care Quality Commission (Registration) Regulations 2009. You can see what action we asked the provider to take at the back of this report.

The principles of the Mental Capacity Act 2005 were not always being followed. Mental capacity assessments were not being carried out if it was felt that some people did not have capacity or had fluctuating capacity. Evidence had not always been sought to verify that representatives had Lasting Power of Attorney or that people had given permission for their relative to sign consent on their behalf.

The registered manager had not always notified CQC about significant events that they are required to notify us of by law.

Reviews of care plans had not always identified that some lacked personal detail and information was not consistent throughout the care file. The registered manager told us they would review files to ensure they contained more personalised information.

People told us they felt safe and we saw risk assessments and plans had been put in place to keep people safe. When an incident had occurred, action had been taken to protect the person and to reduce the likelihood of another incident occurring.

Medicines were managed safely. People told us they received their medicines and there was clear guidance available for staff to follow.

There were appropriate amounts of staff to care for people and people told us staff were generally on time. Staff were aware of their responsibilities to safeguard people from abuse and referrals had been made if there had been an incident.

Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.

Staff had sufficient training to support people effectively and staff were able to refresh this training when required.

People had access to other health professionals in order to maintain their health and wellbeing.

Most people we spoke to could prepare their own food or were supported by relatives to make their meals throughout the day. Of those who were supported by staff, they felt staff did this appropriately.

People felt staff were caring and that they were treated with dignity and respect and people were encouraged to maintain as much independence as possible.

People felt they were supported appropriately by staff and had regular staff they were able to get to know. We recommend that plans are reviewed to ensure that they are all person-specific and details of life histories so staff can continue to get to know people.

People and relatives were able to complain if they needed to and it was recorded that this feedback was acted upon. We saw that complaints were recorded, investigated and responded to.

People were asked for their opinion about their care and staff were able to have team meetings. Staff felt supported in their role and had confidence in the registered manage

We carried out an unannounced comprehensive inspection of this service on 8 December 2014. A second day of the inspection took place on the 9 December 2014 in order to gather additional information.

We found that the service was not always safe or well led as double-up calls (visits that should be undertaken by two staff) were sometimes being undertaken by one carer. Furthermore, some people did not have risk assessments on specific areas of need such as pressure care or nutrition and the agency did not have a comprehensive medication audit in place to monitor and identify issues with medication promptly. Some concerns were also raised regarding a lack of continuity of care staff deployed by the agency. There was no management information in place to enable us to analyse the frequency of events such as the reason why double up calls had not been completed or the action taken by the manager in response to such incidents.

Furthermore, although systems were in place to seek feedback on the standard of service provided to people using the service, there was no action plan in place to demonstrate how the service planned to address constructive feedback to ensure the ongoing development of the service.

Following completion of the inspection in December 2014, the Care Quality Commission received information of concern from the relative of a person who had previously used the service. The person raised concerns regarding the agency, inspection process and the accuracy of some of the information contained within the inspection report.

A focussed / follow up inspection was therefore undertaken on 19 June 2015 in response to the information of concern received and to follow up on action taken since the last inspection. You can read a summary of our findings below.

This report only covers our findings in relation to this focussed / follow up inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Caremark (Cheshire North East)’ on our website at www.cqc.org.uk.

Caremark (Cheshire North East) is a domiciliary care service that is operated on a franchise basis and is part of a network of other branches of Caremark that operate in Great Britain.

The agency offers personal care to people with a range of needs within their own homes and in their local communities. Their office is based in Handforth, Cheshire and covers Handforth, Wilmslow, Alderley Edge and Knutsford. At the time of our inspection the service was providing the regulated activity of ‘personal care’ to approximately 54 people.

The agency’s registered manager has worked in this role for approximately 2 1/2 years. 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 our focussed / follow up inspection on 19 June 2015 we found that the provider had taken action to develop management information systems, improve the reliability and flexibility of the service and with the introduction of quality assurance, summary reports.

However there was scope for further development of risk assessments; medication auditing and records relating to Mental Capacity and Lasting Power of Attorney.

We also found a breach of the Care Quality Commission (Registration) Regulations 2009 regarding the reporting of notifiable incidents. You can see what action we told the provider to take at the back of this report.

During the course of our inspection, we spoke with four people who used the service and two relatives, seven staff members, the manager and the service provider. The registered manager had recently resigned her position and a new manager was in post at the time of our inspection. The new manager planned to submit her Registered Manager application to the Care Quality Commission.

People who used the service told us that they found the staff respectful and they were treated with dignity and their privacy was maintained. One person told us: “They turn up on time” and said: “In general now I have the same staff visit me, which is important to me.” They also told us that they felt that the staff: “Seem to be well trained and know what they are doing.” Another person told us: “I have no complaints; I think it’s a very good service.”

One relative told us: "The staff are kind and it's kindness we look for in the staff." They also said they were happy with the service provided and would recommend it to others.

We looked at staff recruitment files and saw that the agency had thorough recruitment and selection procedures in place.

We saw that the agency forwarded quality questionnaires/surveys to people who used the service and saw the comments people made, which were very positive. People who used the service told us that their views were listened to and any queries or concerns were responded to appropriately.

This inspection was unannounced and took place on the 8 December 2014. A second day of the inspection took place on the 9 December 2014 in order to gather additional information.

The service was previously inspected in March 2014. Two breaches of legal requirements concerning consent to care and treatment and records were identified. We found that improvements had been made during our inspection to address the breaches.

Caremark (Cheshire North East) is a domiciliary care service that is operated on a franchise basis and is part of a network of other branches of Caremark that operate in Great Britain.

The agency offers personal care to people with a range of needs within their own homes and in their local communities. Their office is based in Handforth, Cheshire and covers Handforth, Wilmslow, Alderley Edge and Knutsford. At the time of our inspection the service was providing the regulated activity of ‘personal care’ to approximately 54 people.

At the time of the inspection there was a registered manager at Caremark (Cheshire North East. 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.

Caremark (Cheshire North East) had a registered manager in place that had been in post for approximately two years. The registered manager was present during the two days of our inspection and was keen to engage in the inspection process together with the provider.

People were of the opinion that their care needs were met by the provider. Comments received included: ‘They have been coming to see me for some time and staff do what they can in the time they have” and “The care is fine.”

Staff had access to induction, mandatory and other training that was relevant to their roles and responsibilities. Staff spoken with also confirmed that they had received formal supervision at regular intervals.

Management and staff were aware of the need to promote people using the service to have a healthy lifestyle and to maintain hydration and good nutritional intake. Systems were also in place to liaise with family members and to arrange GP call outs and initiate referrals to health and social care professionals when necessary.

Systems had been established to obtain feedback from people using the service, their relatives and staff via annual surveys on the standard of service provided. Quality assurance telephone monitoring calls, spot checks and other audits were also undertaken throughout the year to review the standard of service delivered by the agency.

We found that the service was not always safe or well led as double-up calls were sometimes being undertaken by one carer. Furthermore, some people did not have risk assessments on specific areas of need such as pressure care or nutrition and the agency did not have a comprehensive medication audit in place to monitor and identify issues with medication promptly. Some concerns were also raised regarding a lack of continuity of care staff deployed by the agency.