Caremark (Croydon) 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 older adults and younger disabled adults. At the time of our inspection 35 people were using the service.

Not everyone using this service 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.

This inspection took place on 12 and 15 October 2018. At our last comprehensive inspection in December 2017 we gave the service an overall rating of ‘requires improvement’ in the key questions of safe and well led. This was because people told us staff were often late and the provider did not let people know or provide alternative care. This had previously been an issue during our inspection in October 2015. We found the provider was not always effectively monitoring, assessing and improving the service and as a result there was a breach of regulation under the key question of well led. After our inspection in December 2017 the provider wrote to us to tell us how they would make improvements to meet the regulations.

At this inspection we found the provider had used the learning from the previous inspections to make improvements at the service. Systems were in place to reduce staff lateness and to let people know if staff were running late. Where possible care staff worked in the same areas to help reduce travel time and the agency had employed more care staff that could drive. This helped when people using the service were not near public transport links.

People’s and their family members trusted staff and felt safe when staff supported them. There were systems in place to help make sure people were protected from the risk of abuse and staff were aware of safeguarding procedures and understood how to safeguard the people they supported.

Staff helped make sure people were safe and knew the risks people faced each day. They took steps to reduce those risks while still encouraging people's independence.

There was a 24-hour call system in operation. This ensured support and advice was always available for people and staff.

People were cared for by staff who received appropriate training and support to do their job well. Staff recruitment made sure only suitable staff were employed to work at the service. Staff felt supported by managers through regular supervision and team meetings.

People and their family members were involved in making decisions about their care, treatment and support and the care records reflected this.

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.

People and their family members liked their regular staff and thought they were caring. Staff respected people’s privacy and dignity. When required, staff supported people with their activities and interests, both in their own home and in the community.

People were asked about their food and drink choices and staff assisted them with their meals when required.

People and their family members said they would complain if they needed to and knew who to complain to.

People were contacted regularly to make sure they were happy with the service and spot checks helped review the quality of the care provided.

We have made a recommendation about the management of some medicines.

Further information is in the detailed findings below.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older adults and younger disabled adults. There were 42 people using the service at the time of our inspection.

When we last visited the service on 9 and 12 October 2015 the service was meeting the regulations we looked at and was rated Good overall. However, we rated the service Requires Improvement in the key question ‘Is the service Safe?’ This was because sometimes people did not feel safe with inexperienced care staff. In addition, the provider did not always tell people when staff would be late and what time staff would arrive, or which staff would be coming.

At this inspection we rated the service Requires Improvement.

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.

People experienced late visits and the provider did not always inform them staff would be arriving late. We identified these same issues at our previous inspection in 2015. This meant the provider had not improved in light of our previous inspection findings. In addition, the provider did not have an effective system to monitor the time staff cared for people and the provider had not identified the on-going issues relating to lateness which people and relatives were dissatisfied with. These issues were a breach of the regulation relating to Good Governance.

Most people and relatives we spoke with felt the service was not well-led due to the issues relating to lateness and the lack of communication from the service relating to this. People did not always know in advance who would be caring for them and some people did not receive consistency of care from the same people.

People were protected from the risk of abuse as the provider had systems in place such as training staff to recognise and respond to abuse.

Risks relating to people’s care were also reduced as the provider identified, assessed and managed risks. The provider managed people’s medicines safely.

The provider carried out recruitment checks on staff to check their suitability to care for people.

People received care in line with the Mental Capacity Act 2005 although the provider told us they would review their processes when we identified some improvements could be made.

The provider assessed and reviewed people’s care by gathering their views and consulting any relevant professional reports. People were involved in decisions regarding their care.

People were supported to maintain their health and were supported in relation to eating and drinking by staff.

Staff received suitable induction, training, supervision an annual appraisal to help them in understanding and delivering care to people. The service worked well with other services in providing care to people.

People were supported by staff who knew their needs and preferences. People were supported to be as independent as possible. Staff treated people with dignity and respect and maintained their privacy. People’s care plans contained sufficient detail about people to be reliable to staff in caring for people.

The provider had a suitable complaints procedure in place and investigated and responded appropriately to any complaints.

The service had a registered manager in post who had a good understanding of their role and responsibilities and leadership was visible and capable at all levels. The director implemented incentives to retain staff such as company cars and bonuses. The director often spoke about care-related topics at events and mentored other directors in the franchise.

The service supported people to integrate into their community

This inspection took place on 9 and 12 October 2015 and was announced. This was the first inspection of this new service.

Caremark (Croydon) is a recently registered service that provides personal care for people in their own homes. At the time of our inspection 16 people were receiving a personal care and support.

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.

People and their relatives told us they felt safe with their regular care staff and that staff treated them well. There were processes in place to help make sure people were protected from the risk of abuse and staff were aware of safeguarding vulnerable adult’s procedures and understood how to safeguard the people they supported.

People were not always told which care staff would be coming or if they were running late. Systems had been put in place to improve communication for people who used the service and this will be checked again during our next inspection.

Staff had completed their induction and they were in the process of receiving additional training this included specific ongoing training for people’s complex needs. The service followed appropriate recruitment practices.

People’s individual risk was assessed to help keep them safe. Care records and risk assessments were regularly reviewed. Staff supported people to liaise with their GP and other healthcare professionals to help meet their health needs.

When required people were asked about their food and drink choices and staff assisted them with their meals. People were supported to take their medicine when they needed it.

People and their relatives thought staff were caring and respectful. Staff knew the people they were supporting and provided a personalised service for them. Staff explained the methods they used to help maintain people’s privacy and dignity.

People and their relatives told us they would complain if they needed to, they all knew who the manager was and felt comfortable speaking with her about any problems.

People were contacted regularly to make sure they were happy with the service. Senior staff carried out spot checks to review the quality of the care provided.