The inspection took place on 23 November 2016 and was announced. The provider was given notice because the location was a domiciliary care agency (DCA) and we needed to be sure that someone would be in. After the office visit we followed this up with phone calls on the 9 December 2016 to people and staff to ask them about the service.

Caremark (Rother) DCA provides a personal care service to people living in their own home. On the day of the inspection 16 people were supported by the agency with their personal care needs. Caremark (Rother) is a franchise to Caremark Ltd.

The service had a registered provider in post who is currently in the process of applying to be the registered manager. 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 said; “Very, very, happy with the service.” Another person said; “They are so kind to me and really look after me. Staff said; “Great company to work for.”

People’s individual care records contained personalised information which described what staff needed to do to provide care and support. Staff responded quickly to people’s change in needs. When required, relatives and health and social care professionals were involved in identifying people’s needs. People’s preferences, life histories, disabilities and abilities were taken into account, communicated and well documented.

People’s risks were monitored and well managed. The agency had policies and procedures in place which were understood by staff to help protect people and keep them safe.

People were kept safe and protected from discrimination. Staff had completed safeguarding from abuse training. Staff displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm.

People who required assistance with meals were supported and encouraged to maintain a varied and healthy balanced diet.

People’s medicines were managed safely and people told us they were given the prompts required to help ensure they received their medicines as prescribed.

People and staff were encouraged to be involved and help drive continuous improvements in the way the service was provided. This helped ensure positive progress was made in the delivery of care and support provided by the service.

The registered provider sought feedback from people and encouraged individuals to share their concerns and complaints. The registered provider confirmed they would investigate any complaints or concerns thoroughly and used the outcome as an opportunity for learning to take place.

The registered provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

The registered provider and staff had completed training on the Mental Capacity Act. They understood the requirements of the act, and knew how to put this into practice should the need arise.

There were sufficient staff to meet people’s needs. Staff were trained and had the correct skills to carry out their roles effectively. For example staff had completed infection control training. The registered provider followed safe recruitment practices to help ensure staff were suitable to work with vulnerable adults. Staff described the management as open, supportive and approachable. Staff spoke positively about their jobs and felt motivated to provide good quality care.

There were effective quality assurance systems in place to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.

Our inspection team was made up of one adult social care inspector. The focus of the inspection was to follow up on compliance actions issued at our last inspection in October 2013 and to answer five key questions; is the service safe, effective, caring, responsive and well-led? At this inspection, we looked at: is the service safe? and is the service responsive?

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

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were protected from the risks associated with medicines. We saw that the care plans for medicine administration were in place detailing the level of support required from the staff. Medication administration records had been audited regularly and appropriate action taken when errors identified.

Staff had all received medication training and competency assessments.

Is the service responsive?

Staff knew the people they supported in the community well. They were able to tell us about the care and support people required and their preference for care delivery. The care plans and daily notes viewed reflected the information that staff had told us and the care delivered. This meant that people's personal records were accurate and provided appropriate and up-to-date guidance for staff in meeting people's needs in a way each person preferred and required.

In this report the name of one of the registered managers appears as Wendi Furnell. This person was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with seven people who used the service and three relatives. Five people told us that the service that Caremark (Rother) provided was reliable, staff arrived on time and they provided a good standard of care. One person told us, “I look forward to (my care workers) coming. I don’t know how they do it all. I couldn’t manage without them.” One relative told us, “This agency is better than others we have used. Staff are on time and they are really happy and caring.”

We spoke with five staff. They told us they enjoyed their work and were well supported to do their job. We found that there were robust systems in place for the recruitment of new staff.

People told us that staff asked for their permission before carrying out any tasks. They told us they felt safe and had their needs met in the way they wanted. We found that care documentation was not always up to date.

We examined the procedures for the management of medicines. We found that there were inadequate arrangements in place to manage the risks associated with medicines.

There were quality assessment processes in place which demonstrated that Caremark (Rother) continuously reviewed its systems and procedures.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

For the purposes of this review we spent time with the manager and with four care staff who worked for the agency. We visited three people who used the service in their own homes. In addition we spoke to five people and two relatives on the telephone.

People told us, ”The three girls that come are very good”. One said, ”You don’t have to tell her, show her once and she remembers”. Another told us, “The staff are flexible; they do what I need them to do”. Another said, “No two days are the same for me, but she always helps me with everything I want her to”.

One relative said that the care workers had only just started and it was thought best that the services were gradually introduced so that the person could get used to it. They said “It’s strange having people you don’t know in your home, so we are getting used to it gently, which is a good thing”.