This was an announced inspection which took place on 03 January 2019.

Caremark (Wokingham) is a domiciliary care agency providing support and care for people living in their own homes in the Wokingham and Bracknell area. Caremark (Wokingham) is a franchisee of Caremark a national organisation supporting a large number of local care companies. Caremark (Wokingham) support people with diverse needs including dementia, learning disabilities, sensory impairment and physical disabilities. They are currently providing a service to approximately 70 people. However, this number fluctuates depending on the needs of the community.

At the last inspection, on 05 July 2016, the service was rated as good in all domains. This meant that the service was rated as overall good. At this inspection we found the evidence continued to support the 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.

At this inspection we found the service remained Good.

Why the service is rated Good.

People, staff and visitors were kept as safe as possible. They were protected from harm because staff had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood what action they needed to take if they identified any concerns. General risks and risks to individuals were identified and action was taken to reduce them, as far as possible. People were supported to take their medicines safely (if they needed support in this area) and medicines given were recorded accurately. People were supported by care staff whose values and attitudes had been tested and who had been safely recruited.

Staff were able to meet people’s needs safely and effectively. There were enough staff who were given enough time to meet their identified needs. The service did not accept care packages if they could not meet people’s identified needs.

People were assisted by care staff who had been trained and supported to make sure they could meet people’s individual needs. Care staff were effective in meeting people’s needs as described in plans of care. The service was worked closely with health and other professionals to ensure they could meet any specific, complex needs.

People were assisted to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The staff team remained committed to providing people with kind and compassionate care. Care staff were able to build good working relationships with people and met their needs. The management team and care staff were aware of people’s equality and diversity needs which were noted on plans of care. People were encouraged to be as independent as they were able to be.

People continued to benefit from a flexible and responsive service that could meet individual’s current and changing needs and preferences. People’s needs were reviewed regularly to ensure the care provided was up-to-date. Care plans included information to ensure people’s individual communication needs were understood.

The registered manager was described as very supportive, caring and flexible. The registered manager, provider and the staff team were committed to embracing diversity and did not tolerate any form of discrimination. The service assessed, reviewed and improved the quality of care provided. The service worked closely with the local authority to respond to the changing needs and expectations of the local community.

Further information is in the detailed findings below.

This inspection took place on 05 July 2016 and was announced.

Caremark (Wokingham) is a domiciliary care service which offers support to people in their own homes. The service supports approximately100 people with diverse needs who live in the community, predominantly in the areas of Wokingham and Bracknell. Services include a wide variety of support packages from 15 minute medicine administration visits to providing 24 hour live in carers.

There is a registered manager running the service. 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.

People were kept as safe as possible by staff who had received the appropriate training so they knew how to recognise and deal with any form of abuse or risk of harm. Staff understood and followed safeguarding and health and safety policies and procedures to protect people, themselves and others. Any significant risks were identified and managed to keep people and staff as safe as possible. The service’s robust recruitment procedure ensured that staff were safe and suitable to provide people with care. If people needed support to take their medicine, the service made sure they did this safely.

Care staff understood the importance, to people, of consent and making decisions for themselves. People’s capacity to make decisions was recorded, if appropriate and necessary, and relevant paperwork was included in care plans. People’s rights were protected by staff who understood the Mental Capacity Act (2005). This legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision

People were treated respectfully at all times. Staff understood how to maintain people’s privacy and dignity. Care staff made sure they provided people with care that met their individual needs, preferences and choices. People’s diversity was understood and people’s care reflected any special needs they may have had.

The service was well-led by a registered manager who had been in post for approximately two years. The management team was described as open, approachable and supportive by staff. The service monitored and assessed the quality of care they offered. Any shortfalls or improvements needed were identified and acted upon, as far as possible.

The inspection team consisted of one adult social care CQC inspector. On the day of our inspection the registered manager told us 120 people used the service. We spoke with the registered manager, managing director, administration staff and two care workers during our inspection. After our inspection, we spoke with a further four care workers. We also spoke with nine people who use the service, and three relatives of people who use the service.

We considered all the evidence we had gathered under the outcomes we inspected, which related to involving and respecting people, people’s care and welfare, safeguarding people from harm, staff recruitment, and assessing and monitoring the quality of service provision. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found.

Is the service caring?

All the people and relatives we spoke with told us care workers were caring. One person told us “They [the care workers] are excellent. I don’t have a bad word to say about any of them. They are perfect in every way”. Another told us “X [the care worker] is very nice, I could adopt her”.

Care workers spoke of the people they supported with respect and fondness. They told us they listened to what people wanted. One care worker explained “I respect people’s choices”.

We looked at eight care plans. Each of these was personalised, noting the person’s needs and wishes. The plan of care was agreed with the person. It provided guidance for staff to follow to ensure they provided care that met people’s needs whilst respecting their preferences.

Information was regularly reviewed to ensure it remained accurate. Managers reviewed information with people to ensure they received the care they required and wanted. One person told us “They make regular checks to make sure we are ok”.

Is the service responsive?

We found the service was responsive to people’s needs and wishes. One person told us “Everything I’ve asked for they give, or have an answer [if they are unable to support the request]. They’ve been very good to me. I can‘t fault them in any way”. Another person said “They seem to listen to what I say”.

Staff told us they had opportunities to suggest changes to people’s care to meet changing needs. They told us they felt managers were supportive and fair. One care worker stated “They always consider your opinions”.

People’s care and support needs were assessed and reviewed. Information was documented in their care plan, which was kept at the person’s home. We saw care workers were reminded to document any changes to people’s care needs, and were supported to proactively engage with health professionals to promote people’s health and wellbeing.

When concerns were raised, the provider took steps to meet people’s expectations. One person told us “One [care worker] didn’t work out. I made a criticism, and they promptly put in a substitute”.

Is the service safe?

We found the service promoted people’s safety. One person told us “I feel very safe with them [the care workers]”. Staff we spoke with understood the provider’s safeguarding policy, and told us they were confident in recognising signs that indicated potential abuse. All staff attended safeguarding training during their induction to the service. This training was refreshed annually.

We saw care plans identified and assessed risks that may cause harm to people or others. Actions were taken to reduce the risk of harm. Staff respected people, and took account of their wishes and preferences. Where this potentially increased the risk of harm, we saw this was documented with appropriate guidance for staff. For example, one person identified at risk of falling declined use of a walking aid. Care workers were reminded to increase the level of support provided to reduce the risk of falls when this person moved around their home.

The provider completed appropriate checks before staff began work. Where it was appropriate, they recorded investigations they completed to verify the information supplied to them by applicants. This meant there were effective recruitment and selection processes in place.

Is the service effective?

We found the service was effective. One person told us “I was dreading having care, but I’m happy with how it’s been”. Another person told us the service was “excellent”.

People told us they were involved in reviews of their care and support needs. This meant they had the opportunity to raise issues or request changes promptly. Care plans detailed the tasks that care workers had to complete at each visit. Care workers told us they were informed of changes to people’s care needs to ensure they provided appropriate support and care. They listened to people’s comments to ensure they supported people as they wished. One person told us “They get in contact quite often. I feel I can always talk to them”.

Is the service well led?

We found the service was well led. One person told us “I am very satisfied with the care I get”, and another said “I can’t fault them”. The provider sought feedback from people and their relatives regularly, though visits, telephone monitoring calls and an annual survey. They used the information provided to review the care provided, and identify improvements that could be made.

Staff told us they felt supported to provide care with confidence. One care worker told us “It’s good to know I’m supported when I’m working alone”. Another said “There’s always someone I can contact in an emergency”. Care workers told us they felt appreciated by people and their managers. One care worker told us “We are praised for providing good care. It makes you feel good to be recognised for the good care we give”.

The provider had effective systems in place to ensure they maintained quality within the care provided. They promoted communication between office staff and care workers to encourage information sharing. Records were reviewed regularly to ensure people received the care they needed and wanted. The provider took pride in in the quality of the service provided.

People told us they were happy with the support they received. One person told us the service was "absolutely excellent" and another said the staff were "very, very good and very caring". People were involved in planning their care and making choices and giving consent for the care they received.

There were arrangements in place to protect people from the risk of infection. Staff were supported to deliver care as they received mandatory training in a range of topics and regular management supervision.

The provider had systems in place to monitor the quality of the service and the feedback from people who use the service. Complaints were monitored and acted upon in a timely manner.

The Registered Manager named in the section about the details of this location is no longer the manager of this service. A new manager has been appointed and began work at Caremark (Wokingham) on the day of our visit. The provider told us the new manager was currently in the process of registering as the Registered Manager of this location.

We telephoned seven people who used services provided by Caremark (Wokingham), to ask about their experiences of the care provided. People told us that they were treated with dignity and respect by staff who were competent and caring, as well as friendly. One person said that the care workers were “very polite, courteous and caring”. People said that they were satisfied with the care given and they said their needs were attended to with compassion. Another person told us “you can’t fault (them); if anything needs doing, they tell us and get on with it”. People also said that they appreciated that care workers found time to have a chat. People said that they were involved in their care arrangements and that communication was effective with staff in the office. They appreciated receiving a weekly schedule, showing the time when care workers would be calling and who would be attending. Most people commented that they thought care workers were not always given enough time to travel between clients, due to the geography of their route. They also said that even if they were a little late, care workers did not appear rushed and were always professional.