Caremark (Kingston) is a domiciliary care agency. This service provides personal care to people living in their own houses and flats. It provides a service to older adults some of whom have physical and learning disabilities, mental health needs and living with dementia. At the time of inspection 107 adults were receiving support with personal care from this service.

This inspection was carried out on 17 and 18 July 2018 and was announced. 48 hours before the inspection we contacted the service to let them know that we will be coming to inspect them. We wanted to make sure that the registered manager will be available on the day of inspection.

At the last inspection carried out on 29 February 2016, the service was rated Good. At this inspection we rated the service overall Good, with Requires Improvement in effective.

The service had a registered manager. 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.

Although new staff underwent a comprehensive induction training programme, the registered manager had not supported staff to ensure their knowledge and skills were regularly updated through ongoing training. We have made a recommendation about this.

Processes and procedures were followed as necessary to support people to stay safe from abuse and any incidents and accidents occurring. There were comprehensive risk assessments in place to protect people from a risk of fire. Staff had to undertake all the required pre-employment checks before they started working with people which ensured their suitability for the role. Staff were aware of people’s care needs and the support they required to take their medicines safely.

People had the necessary assistance to move around their homes which helped them to maintain their independence. Staff said the management team provided effective support to them which meant that staff were able to carry out their responsibilities as required. People’s health needs were adhered to when they required medical attention. The service monitored people’s ability to make decisions for themselves and provided support to people if they were unable to do that themselves as required by the Mental Capacity Act 2005 (MCA).

People spoke positively about the staff team and how well the individual staff members cared for them. Staff were kind, friendly and attended to people’s needs and preferences as required. People felt their dignity was enhanced which helped them to maintain their self-esteem. Staff were aware of people’s cultural needs and communicated to people in ways they could understand.

People’s care needs were assessed and monitored as necessary which provided staff with guidance on the support people required. People and their relatives were supported to raise concerns and complaints and felt confident to approach the management team for making changes to their care if necessary.

People, their relatives and the health professionals we spoke to felt that the service was well led which ensured safe care for people. Systems were in place to support and motivate staff in delivering good care for people. We saw audits being regularly carried out to check if people’s care records reflected their needs as necessary.

This inspection took place on 19 and 27 January 2016 and was announced. We told the provider one day before our visit that we would be coming. At the last inspection on 12 February 2014 the service was meeting the regulations we checked.

Caremark (Kingston) provides domiciliary care and support to 170 people of all ages, some of whom may have dementia or a physical or mental health need. Caremark (Kingston) is part of a franchise that delivers care to people in many areas of the United Kingdom. This includes personal care such as assistance with bathing, dressing, eating and medicines; home help covering all aspects of day-to-day housework, shopping, meal preparation and household duties. Of those 170 people 95% received personal care and the remainder receive only help in their home. We only looked at the service for people receiving personal care during this inspection as this is the part of the service that is regulated by the Care Quality Commission.

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 told us they felt safe with the support they received from staff. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service and staff how to report potential or suspected abuse. Staff we spoke with understood what constituted abuse and were aware of the steps to take to protect people.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe. The provider ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this. This training enabled staff to support people effectively.

Appropriate arrangements were in place in relation to administering and the recording of medicines which helped to ensure they were given to people safely.

The manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Records showed people were involved in making decisions about their care and support and their consent was sought and documented.

People were involved in planning the support they received and their views were sought when decisions needed to be made about how they were supported. The service involved them in discussions about any changes that needed to be made to keep them safe and promote their wellbeing.

Staff respected people’s privacy and treated them with respect and dignity. Staff supported people according to their personalised care plans.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner.

Staff gave positive feedback about the management of the service. The manager and provider were approachable and fully engaged with providing good quality care for people who used the service. They encouraged a positive and open culture by being supportive to staff and by making themselves approachable with a clear sense of direction for the service.

The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions and action plans were developed where required to address areas for improvements.