The inspection took place on 1, 8, 14 and 23 June 2017. We gave 48 hours-notice to the provider as we needed to be sure someone would be available to facilitate our inspection. Caremark (Redcar & Cleveland) is a domiciliary care service that provides personal care, companionship and support to people living in their own homes. The service covers the Redcar and Cleveland areas as well as parts of North Yorkshire and Middlesbrough.

At the time of our inspection there were over 300 people using the service with 204 of these people receiving personal care.

The staff team have worked as a part of Redcar and Cleveland rapid response team (which is where staff attend a person’s home if they activate their call alarm) for the last two years. Over the last three years the provider manages two extra care schemes and they are providing one-to-one support for people in supported living schemes. In addition the provider has piloted a drop-in service for people with learning disabilities, which offered relaxation activities, crafts, hobbies and IT sessions as well as having a gym and café on site.

Our last inspection of this service took place on the 24 April 2015 and we rated the service as ‘Good’ overall but we found improvements were needed to ensure staff received regular training. At that time we found the service to be in breach of Regulation 18 (staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our last inspection the provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the service.

At this inspection we found that the provider and manager had spent time reflecting on the measures that could be taken to improve staff completion of training. They had developed a training department, which was based at the location. The staff within the training department operated a constant rolling programme of induction and mandatory training. Staff were provided with comprehensive training including specialist training, which was delivered both in-house, via online resources and from external trainers. Staff told us they received regular supervision and competency assessments as well as annual appraisals.

There was a registered manager in post at the time of our inspection who had worked as the manager at the service since 2013. 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.

Within this vibrant, dynamic and innovative service there was the strong sense of leadership, commitment and drive to deliver a service which improved people’s lives. The culture embedded in the service was one where all the staff were committed to deliver a service that was focused totally on each person and responsive to their needs, which relatives and people described as defining what outstanding care looked like. They were committed to providing excellent person-centred care. Person centred is when the person is central to their support and their preferences are respected.

We found that the provider and manager had encouraged staff to constantly think about improvements and how to make the care delivery more effective. The management style had led to constant constructive review of the service and continuous improvement.

We found that following comments people who used made the service about their preference for continuity of care the provider and manager organised the staff into teams who were allocated to people. The small teams provided sufficient cover for holidays and absence but meant that the same staff worked with people over each week. For emergencies they had a floating field care supervisor who could step in at short notice.

We saw that the pr

We undertook an announced inspection of Caremark (DCA) on 24 March 2015. We told the provider two days before our visit that we would be inspecting. Caremark (DCA) provides personal care services to people in their own homes. At the time of our inspection 204 people were receiving a personal care service.

Caremark (Redcar & Cleveland) offer domiciliary care and support services, including 24 hour live- in to people within their own homes. Support can be provided to people living in Redcar and Cleveland, North Yorkshire and Teesside.

The service had a registered manager who had been registered with the Care Quality Commission since April 2013. 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 were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staff said they were able to accommodate last minute changes to appointments as requested by the person who used the service or their relatives.

The registered provider had policies and procedures in place which were there to protect people from abuse. Staff we spoke with understood the types of abuse and what the procedure was to report any such incidents. Records showed staff had received training in how to safeguard adults. A whistleblowing policy (where staff could raise concerns about the service, staff practices or provider) was also in place. Staff we spoke with again demonstrated what process to follow when raising concerns.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005. Mental capacity was assessed by either social work or healthcare professionals and this information was shared with the registered provider who used them to develop care plans for people. Where people lacked capacity, decisions were taken in their best interests. Care plans

included instructions on how they should be supported and included their needs, likes and dislikes.

Social workers or healthcare professionals assessed the dependency level of people who used the service. They then decided the correct staffing needed to provide effective support to people. Records showed the registered provider had sufficient staff in place to meet people’s needs.

Staff supported people to attend healthcare appointments and liaised with other healthcare professionals as required if they had concerns about a person’s health.

Assessments were undertaken of risks to people who used the service and staff. Written plans were in place to manage these risks. There were processes for recording accidents and incidents. However no analysis was made of accidents and incidents to see if there were any trends or patterns, to enable them to learn from them.

We looked at the finance records for people who the service did shopping for, it was difficult to confirm the receipts due to each month not being separated or not collected from the persons home. We were told that the supervisors visit the home regularly to check on finances, but these visits were not recorded.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers and we saw evidence that a Disclosure and Barring Service (DBS) check had been completed before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults. To help employers make safer recruiting decisions and also to minimise the risk of unsuitable people working with children and vulnerable adults.

Not all staff had received the required training and only about only about 20 out of the 166 staff members had received specialist training in topics such as diabetes, pressure sores and challenging behaviour. The service had a training timetable to cover all the shortfalls. They were aware that training was needed so staff had the skills, knowledge and experience required to support people with their care and support needs.

Staff received regular supervisions and a yearly appraisal. The service also performed spot checks on staff every one or two months.

Staff we spoke with said they had access to plenty of personal protective equipment (PPE).

We found that medicines were administered safely.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People told us they liked the staff and looked forward to the staff coming to their homes.

People were supported to eat and drink. Staff encouraged people to access the community and this reduced the risk of people becoming socially isolated.

Staff were respectful of people’s privacy and maintained their dignity as well as encouraging independence.

The service had a system to log complaints and an outcome to the complaint was documented. The services policy stated that Caremark will produce an annual report on complaints, this will be shared with the management team within Caremark and will be used to review the service. We asked to see this report but at the time of our inspection there were no reports to view. The registered manager said this was something they were planning on starting.

The service had a system called ‘staff planner.’ When staff arrived at a persons home they would log in using a freephone number from the persons home if possible, this would alert the system they had arrived. The service had a screen up in the office which provided live data of each appointment. Unfortunately the system did not recognise mobile numbers, therefore if a staff member called from a mobile it would say they had missed an appointment due to lack of recognition. The registered manager was looking into a way around this. At the time of our inspection there were no analysis of late or missed calls, the registered manager was arranging to meet up with the company who provided ‘staff planner’ to find out how to run reports to monitor late or missed calls.

The registered manager along with the field care supervisors regularly checked the quality of the service provided to made sure people were happy with the service they received.

The registered manager kept records including; care plans, risk assessments and staff files. These were well maintained and fit for purpose. We saw they were stored securely.

We spoke with five people about their medicines. They all told us that they were happy with the level of support provided. One person said that they had no problems with their medicines and staff gave them their medicines when they needed them. One person said “I sometimes need painkillers and I get them quickly when I ask for them.” Another person told us “They look after my medicines well and I get them regularly.”

After visiting the domiciliary care agency we made appointments to visit three people in their own home. We made a telephone call to speak with another person who used the service.

People spoken with were generally happy with the care and support that they received. Comments made included:

"They are a brilliant care company. They are a lovely bunch of people. I can't praise them enough."

"I have used a lot of domiciliary care providers but Caremark is the best."

"It is important for me to have continuity and have the same carers because of my needs. Caremark have made sure that I get this, which has enabled me to build up a rapport."

"They visit me six times a day and they haven't let me down yet. They are always on time and I always get the same carers."

"I am involved in my care, I choose what I want to do and when I want to do it."

"The carers are very good at maintaining my dignity. They always cover me up with a sheet or towels when washing me."

"I don't always get the same carers. I don't always know who is coming."

"The carers I have are excellent they never rush me."

"Any concerns are dealt with straight away."

"If I had any concern I would just phone up the office."

Relatives and representatives told us that they were involved in making decisions about the care and support received and that they felt well supported by the agency.

We were told that people were happy with the care and support received and that the domiciliary care agency provided a reliable service. Relatives and representatives told us that staff supported an encouraged people to be independent, which enabled people to stay in their own home.

At the time of the inspection this domiciliary care agency provided care and support to 256 people aged 18 and above. As part of the inspection we spoke with 23 people who used the service, 12 relatives and visited seven people at their home. We also spoke with the provider, a field care supervisor and four care and support workers.

People told us that they were well supported. We were told that the agency provided a reliable service. We were told that staff supported and encouraged people to be independent, which enabled people to stay in their own home. One person said, “They’ve been great, I get the times I wanted on the days I wanted and they’ve never let me down.” Another person said, “I love the fact that they never seem to be rushed, of course I know they have loads of people to go to, but they make me feel quite special.” We saw that people had their needs assessed and that support plans were in place.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person said. “They’re very gentle with me and I really appreciate that, I depend on them for everything.”

We found that appropriate arrangements were not in place to ensure that medicines were recorded and managed safely.

We saw that there was sufficient staff with the right knowledge and experience to support people.

We found that records were accurate and stored securely.