We carried out an announced inspection of the service on 12 September 2018. Caremark (Gedling & Rushcliffe) is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It currently provides a service to older adults. Not everyone using Caremark (Gedling & Rushcliffe) 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 consider any wider social care provided.

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 the time of the inspection, 33 people received some element of support with their personal care. This is the service’s second inspection under its current registration. At the previous inspection, the service was rated as ‘Requires Improvement’ overall. At this inspection, they have remained at this rating and we identified one continued breach of the Health and Social Care Act 2008 (Regulated Activities).

You can see what action we have told the provider to take at the end of this report.

The risks to people’s health and safety had been assessed but the recorded assessments were not personalised and did not always reflect people’s individual care needs. Most people were satisfied with the punctuality of the staff, however records showed there were times when calls were regularly late. There had been a high turnover of staff however this had now stabilised and staff retention had improved. Staff were recruited safely and people were supported appropriately with their medicines. Staff were aware of how to reduce the spread of inspection. The registered manager investigated accidents and incidents; however, their decisions were not analysed and reviewed by the provider.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service did not always support this practice. People had care records in place. These were not always developed in line with current legislation and best practice guidelines. Staff received an induction and training programme, however some staff required refresher training which had not yet been arranged. People felt staff understood how to support them in their preferred way. Where needed, people were supported with their meals, however nutritional assessments were generic and not personalised to people’s needs. Other health and social care agencies were involved where further support was needed for people.

People felt staff were kind and caring, treated them with respect and ensured their dignity was maintained. People liked the staff and their independence was encouraged. People were involved with decisions about their care. People’s personal data was protected in line with the current legislation.

People’s needs were assessed prior to commencing with the service. This enabled staff to have the information needed to support them effectively. People’s records were person centred and informed staff how to support people in their preferred way. People felt staff responded to their complaints effectively, records viewed confirmed this. People’s diverse needs were discussed with them during their initial assessment. End of life care was not currently provided by the service.

Some improvements had been made to the quality assurance processes since our last inspection. However, they were still not fully effective in identifying areas of risk within the service. The registered manager received limited input from the provider to ensure they w

We carried out an announced inspection of the service on 28 July 2017. Caremark (Gedling & Rushcliffe) is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing the regulatory activity of personal care to 20 people. This was the service’s first inspection since registering with the Care Quality Commission.

On the day of our inspection there was a registered manager 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 when staff supported them and staff arrived on time for the majority of their calls. Risks to people’s safety were assessed for some people, but for people who were new to the service these were not always completed in a timely manner. Staff understood the process for reporting concerns about people’s safety to the appropriate authorities. Safe recruitment processes were in place. People’s medicine administration records were accurately completed however, more detailed risk assessments in relation to their medication were needed for some people.

People were supported by staff who completed an induction and training prior to commencing their role. Staff training was up to date and staff received supervision of their work. The registered manager was aware of the principles of the Mental Capacity Act (2005). Care and support was provided for people with their consent. People were supported to maintain good health in relation to their food and drink intake. People’s day to day health needs were met by staff.

People found the staff to be kind, and caring; they understood their needs and listened to and acted upon their views. People felt the staff treated them with dignity and respect with people enjoying their company. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible.

People told us they were happy with the way staff supported them and felt their individual care and support needs were respected. However, people did not always have detailed, person centred support plans in place. People had not felt the need to make a complaint, but felt confident that if they did, it would be acted on appropriately.

Current quality assurance processes were not effective in ensuring that risks to people’s health, safety and welfare were adequately assessed and planned for. A lack of administrative support for the registered manager had meant some tasks, such as the implementation of support plans were not always completed in a timely manner. The director agreed to address this immediately. People and staff spoke highly of the registered manager, who carried out their role in a caring and dedicated manner. The views of people and staff were welcomed to help improve and develop the service. Staff understood how to report serious concerns via the provider’s whistleblowing policy.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.