Caremark is a home care provider which offers domiciliary care services and personal support, it provides care and support for people of all ages within their own homes. The service provides assistance with personal care, medication, nutrition and hydration, pressure area care and accessing the community. At the time of our inspection there were 45 people using the service.

At our last inspection in March 2016 we rated the service overall as ‘Good.’ We rated the domain of ‘Well-led’ as ‘Requires Improvement,’ this is because the service did not have a registered manager in post. We have now improved the rating to ‘Good.’ The service had a registered manager in post who was appointed in 2017. A registered manager is a person who has registered with 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.

At this inspection we found the evidence continued to support the overall rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found people were kept safe by the use of appropriate risk assessments and provision of care by staff who were familiar with their needs. Any accidents and incidents were reported and recorded appropriately.

Staff’s suitability to work with vulnerable adults at the service had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken.

Staff had received training which equipped them with the knowledge and skills to ensure people received adequate care. Some staff had received more specific training to meet the needs of people living with specific health conditions, for example, training in dementia, mental health and PEG (percutaneous endoscopic gastrostomy) care. Medication was managed safely and was administered by staff who were competent to do so. People who wished to self-medicate were supported by staff to do so safely, this helped to promote their independence.

Care records contained information to identify people’s requirements and preferences in relation to their care and there was evidence to show that they had been consulted about decisions. People we spoke with told us their choices and preferences around their care and support were respected.

People were supported by staff to attend health care appointments. This helped to maintain people’s health and well-being.

Quality assurance processes were in place to seek the views of people using the service. This helped to drive improvement.

Although all of the people using the service were able to consent to their care and treatment, staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA). The MCA is legislation which protects the rights of people to make their own decisions.

We asked both people using the service and staff about how they thought the service was managed and their feedback was positive.

We carried out an inspection of Caremark Sefton on 9 March 2016. The inspection was unannounced.

Caremark Sefton provides domiciliary care services to 32 people living in their own homes.

At the time of the inspection a registered manager was not 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.

We asked people about the safety of services. Each of the people that we spoke with told us that they felt the service they received was safe.

The provider had a range of systems and procedures in place which allowed people using the services, their relatives and staff to raise any concerns. Evidence of these systems was made available during the inspection.

The care files that we saw showed clear evidence risk had been assessed and reviewed regularly.

Incidents and accidents were subject to a formal review process which included; the production of a report, a meeting with any staff involved and an analysis that was shared with the manager.

Staff had been recruited and trained to ensure that they had the rights skills and experience to meet people’s needs. Staff were required to complete an induction programme which was aligned to the Care Certificate.

People were supported to maintain good health through regular contact and review with a range of healthcare professionals.

We were unable to observe the delivery of care, but people spoke positively about the way in which care was delivered. The staff that we spoke with knew the people that they cared for and their needs in detail. The care records that we saw used language which was respectful when describing people and the care provided.

People were given choice about the gender of their care staff and the times when staff provided care.

People using the service and their relatives were encouraged to provide feedback to the organisation through informal and formal mechanisms.

The staff that we spoke with enjoyed working for the organisation and felt supported. Staff were encouraged to give feedback on their experiences and make suggestions for development.

In this report the name of a Registered Manager appears who was not in post and not managing the regulatory activities at the location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We gathered evidence against the outcomes we inspected to help answer our five key questions;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

The inspector gathered information from people using the service by telephoning them.

Below is a summary of what we found. The summary is based on speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard people they supported.

People told us that they felt their rights and dignity were respected.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helps the service to continually improve.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The provider set the staff rotas and took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

Recruitment practices were safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them, and they told us they were involved in writing their plans of care. We saw that their care plans were up to date and reflected their current needs.

Is the service caring?

We spoke with two people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; “The staff are always on time”, “They do what I ask them, sometimes it may not be in my care plan”, “I feel I can talk to my staff about anything”, “I don’t feel rushed by the staff when they are working with me”.

When speaking with staff it was clear that they genuinely cared for the people they supported and knew their needs.

People using the service and their relatives completed a telephone monitoring survey every three months as well as receiving quality assurance visits every three months and individual three monthly care reviews. Where shortfalls or concerns were raised these were taken on board and dealt with.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

The service has a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the agency and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We visited one person who received care and support in their own home and spoke with another on the telephone, to gather their views and experiences of the service provided. The people we spoke with told us they were happy with the way staff supported them and the tasks they carried out for them. They told us they received the same care workers which provided consistent support.

We looked at two care records in the office. We found them to contain relevant and current information about the person’s needs. People who received a service told us the staff knew what support they required and did everything that was needed for them.

Staff we spoke with told us they had received the training required for their job.