About the service: Caremark (Cheshire West and Chester) is a domiciliary care agency registered to provide personal care to people who live in their own homes. At the time of the inspection the service was providing personal care to 40 people most of whom were older people living with age related conditions.

People’s experience of using this service:

People received a consistently good service. People received safe and effective care from kind and caring staff. Staff knew people well and had a good understanding of their personality traits as well as their health and social care needs.

People and their relatives had been fully involved in the assessment and planning of their care before they started using the service. A care plan had been developed with each person detailing their likes, dislikes, preferences and care needs.

Consent had been sought before any care had been delivered in line with legal requirements and people were supported to have maximum choice and control of their lives.

Staff treated people and their relatives with kindness, dignity and respect. People’s privacy was protected and confidential information was stored securely. People were supported and encouraged to remain independent and do as much as possible for themselves. People were supported to maintain contact with people that mattered to them. The provider had organised and invited people who used the service to social events to help prevent social isolation.

Steps had been taken to make sure people were safe. Risks to people had been assessed and minimised in the least restrictive way. Staff had access to protective clothing such as gloves and aprons and had completed training in infection control.

Staff were safely recruited and well trained and they had a good understanding of people’s needs. Staff felt supported by the management team. Management and staff worked in collaboration with other stakeholders such as health and social care professionals and people’s relatives.

A complaints procedure was in place for people to follow. There was a system in place for recording complaints and outcomes.

The service met characteristics of Good in all areas more information is in the full report.

Rating at last inspection: Good (report published 31 August 2016).

Why we inspected: We inspected the service as part of our inspection schedule methodology for ‘Good’ rated services.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 15 and 18 July 2016 and was announced. The inspection was announced to ensure someone would be available at the office. Caremark (Cheshire West and Chester) is a domiciliary care service that provides personal care to people living in their own home. On the day of the inspection 45 people were supported by the service with their personal care and support needs.

The service had 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.

During our inspection we observed staff within the office who were welcoming and there was a pleasant atmosphere. All the information we requested was supplied promptly, records were clear, easy to follow and detailed. People, relatives and staff all spoke positively about the service. Peoples comments included, “Staff are absolutely fantastic”, “Continuity of care is essential, and that’s what I get” and “[Name] is a credit to the service”.

People told us they had developed good relationships with staff and they valued these. People said they felt valued by the staff and office team. One person said, “All the staff are caring and friendly”. A relative commented, “The registered provider has gone above and beyond to support us as a family”.

People told us they felt safe. All staff had undertaken safeguarding adults from abuse training and put their knowledge into practice. Records showed staff had raised concerns and these had been managed promptly and where required, investigations had been undertaken to protect people. People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults before they started their employment.

People were supported to take their medicines by staff that had undertaken medicines training and completed competency assessments. People were supported by staff that received training appropriate to their role. Staff put their training into practice and delivered good care.

People and relatives were fully involved in the development of the person centred care plans. People’s preferences acknowledged and followed. Staff responded quickly to emergencies and people’s changes in need.

People’s risks were fully anticipated, identified and monitored. Risk assessments were very detailed and specific to the individual. Staff managed risk appropriately and supported people’s personal decisions. Risks were regularly reviewed and updated promptly following any changes in need.

Staff had a good appreciation and understanding of how to respect people’s privacy and dignity. Staff supported and encouraged people to remain as independent as possible.

People and their relatives knew how to raise complaints and confirmed they had received information about how to do this and to whom. People and their relatives who had raised concerns confirmed they had been dealt with promptly and resolved to their satisfaction.

Staff described the management to be very approachable and understanding. Staff were positive when speaking about their roles and the people they supported. People told us they benefitted from having regular staff visiting them that got to know them well. They highlighted the importance of continuity. Staff said that visiting people regularly allowed them to develop positive working relationships and to fully understand the person’s individual needs and preferences.

The service had effective quality assurance systems in place. Actions were highlighted and promptly addressed. The service sought to highlight and address areas for improvement. Changes had been made to help ensure the service moved forward and continually improved.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with three people using the service, a relative and three members of staff as well as the registered manager and responsible person who were both Directors of the service. We reviewed records relating to staff training, appraisal and supervision, care files and quality audits.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. People’s care and support needs had been assessed with their involvement and every person using the service had a care plan. People consented to the care they received and had signed a service agreement. Carers who supported people with dementia had received appropriate training and training for all staff about mental capacity was planned. When equipment was required to care for people in their homes, this had been maintained and serviced safely. All staff had received training in the use of equipment such as hoists and standing aids. This meant that people were cared for safely. New carers had all received an induction to the service and completed the standards common for care. Staff had received an annual appraisal and regular supervision.

Is the service effective?

The service was effective. People told us that they were happy with the care they received and felt their needs had been met. Staff that we spoke with showed us that they understood people’s care and support needs and that they knew them well. One person told us that the service was, “Really good.” We saw the results of an annual survey showed that everyone who responded was happy with the care they received. One person had commented, “I receive consistent care, I really feel I can rely on them.” The people that we spoke with said they would not hesitate to recommend the service to others. Carers had received training to meet the needs of people using the service.

Is the service caring?

The service was caring. We spoke with carers who knew people’s needs and the manner in which they talked about the people that they supported showed us that they cared about their wellbeing. One person said that their carers, “Really care very much.” They also said that the supervisors and manager seemed, “Genuinely interested in how I am” and that they felt the whole staff team cared about what was happening to them and how they were managing. Another person said that all of the carers they had met were, “Very kind, very caring. Everyone is very nice.”

Is the service responsive?

The service was responsive to people’s changing needs and to comments and suggestions made by people using the service and staff. A person said that carers always, “Ask me what I want and if they can help me.” Another person said that they needed more care now than a few years ago and this had been discussed and gradually increased as it was needed. A person said that, “The supervisor is very good and always responds to messages and accurately records new instructions.”

Telephone calls to the service office were answered promptly. Calls were logged and included details of the response made and any follow up action required. A manager reviewed the call log each day to ensure that appropriate responses had been made.

Is the service well led?

The service was led by a registered manager and the registered responsible person who were the Directors of the service. They were both highly qualified health professionals who were actively engaged in maintaining and improving the quality of the service. They were supported by a care co-ordinator and three supervisors. The service had a system in place to monitor and assess the quality of the service. Results of audits, quality surveys and annual surveys were fed back to other staff at a weekly meeting and in a newsletter. Staff that we spoke with all said that the managers were approachable and helpful. One also said that they were both, “Dedicated and knowledgeable.”

We spoke to seven people who used the service. All provided a positive summary of their experience of the support they received and comments included:

"I am really impressed with them, the care I get is the best I have ever received"

"All the carers are great and they meet my needs"

"I trust the staff"

"They go over and above what I need"

"They have a heart of gold"

"They are efficient and very good"

"I have not had to make a complaint but i know who to speak to"

"I am impressed with them"

Our visit found that the service promoted the wellbeing of people and involved them in their support. We found that people were protected from harm through the policies adopted by the service as well as the way staff are recruited. We found that the service monitored the quality of service it provided on a regular basis. The service had a robust complaints procedure and investigated complaints appropriately.

We asked people to tell us what it was like to receive services from this home care agency. We used telephone interviews to people who used the service and spoke with them to obtain their views on the service they received. We spoke with five people and visited the office and sampled a selection of records and spoke with the owners and manager of the service. We also spoke with four members of staff.

People who use the service spoke positively about the service and the staff who delivered the care. One person told us " the staff are wonderful, polite and caring" another person told us " they always accommodate me and any changes I want to make, I get the same people all the time"

We spoke to people who use the service and asked their views about how they and their representatives are involved in making decisions about their support.

People told us they have information about the service, which they keep in their home. They also told us that they are kept up to date with any new information by the staff that support them.

They felt the standard of care provided by the staff was very good. People using the service and their relatives/next of kin told us that staff support them well and treat them with respect.

People commented they were happy with the care they received and would tell someone if they were not. Everybody told us they would ask to talk to somebody in the office if they were not sure about the care and treatment received.

People who use the service made the following comments about the staff who supported them:

“The staff are very helpful, we have the same staff except for holidays but we are always introduced to any new staff covering.”

“The staff have been marvellous and have helped me walk again.”

”The staff keep me up to date with everything,”

“We are pleased with what’s happening with the agencies services.”

“ I have a care file and complaints procedure, I cant always read my file but I would like it all in large print they have already adapted invoices into large print for me.”

“The staff always ask how are relative is and they also send birthday cards, we’ve no complaints.”

“The staff always ask me what I want and if I want something special and different to eat, they always do what I ask.”

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no concerns or issues they were following up with the agency.