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Inspection carried out on 18 July 2018

During a routine inspection

The inspection took place on 18 July 2018 and was unannounced. The last comprehensive inspection of this service took place on 7 August 2017 when we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to fit and

proper persons employed and good governance. On 4 October 2017, we carried out a focused inspection to check if the provider had made the necessary improvements and found that they had met the requirements.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to a range of people, including older adults, some of whom were living with the experience of dementia, younger adults with a learning disability and children. At the time of the inspection the service was supporting 28 people, including one child who were all receiving personal care support. Not everyone using Caremark (Hillingdon) received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, support with medicines and eating. Where they do we also take into account any wider social care provided.

The previous registered manager left their role in May 2018 and the provider was currently managing the day to day running of the service. They had recruited to the post of manager and this person was applying to become 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.

Risk assessments for people’s home environment and individual risks had generally been carried out and plans put in place to minimise the risks occurring. However, risk assessments had not always been updated in a timely manner and we identified one occasion where a risk assessment had not been completed about one person’s particular needs. This was addressed by the provider both during and shortly after this inspection.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). The provider was aware of what to do and who to contact if they had concerns that people lacked capacity to make certain decisions. The provider needed to be sure if a person had a deprivation of liberty order placed on them so that they were satisfied people were not being restricted unlawfully.

There were quality assurance systems in place to monitor the quality of the service provided. This included understanding the experiences of people who used the service and identifying any concerns. The audits did not always identify when records were incomplete or out of date.

People and relatives said people were being cared for safely by the care workers. Policies and procedures were in place for safeguarding people from the risk of abuse.

The care workers told us they felt supported. They took part in individual and group meetings to discuss their roles, the service and good practice was praised and rewarded. The provider had not been providing an annual appraisal of the care worker’s performance and confirmed they would introduce this.

There were sufficient numbers of care workers employed to meet people's needs.

Care records provided staff with information about the care and support each person required. At the time of our inspection there was no-one receiving end of life care support.

People were supported to manage their medicines in a safe way. Staff responded quickly to changes in people's health and worked with other health and social care professionals to meet their needs.

The provider had arrangements to help protect people from the risk of the spread of infection as the care workers wore protective equipment, such as gloves and aprons, w

Inspection carried out on 4 October 2017

During an inspection to make sure that the improvements required had been made

This inspection took place on 4 October 2017 and was announced. We told the provider two days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people and we wanted to be sure someone would be available to assist with the inspection.

The last inspection of this service took place on 7 August 2017 when we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The issues were relating to fit and proper persons employed (Regulation 19) and good governance (Regulation 17). At the previous inspection we found that there was missing information in the recruitment checks carried out. Also the quality assurance systems were lacking because they had not included carrying out checks on people's care records or staff employment files.

Following the inspection in August 2017 the provider sent us an action plan in which they told us that improvements would be made by 11 August 2017. At this inspection we reviewed the actions identified in the action plan and we found improvements had been made.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ' Caremark (Hillingdon)' on our website at www.cqc.org.uk.

Caremark (Hillingdon) provides a range of services to people in their own home including personal care. People using the service had a range of needs such as learning and/or physical disabilities and dementia. The service offered support to people over the age of 18 years old. At the time of our inspection 23 people were receiving personal care in their home. The care had either been funded by their local authority or people were paying for their own care. Some people had care workers living with them 24 hours a day.

Since the last inspection the provider had implemented monthly audits in relation to the information in staff files, which included their recruitment checks. The monthly audit also looked at a sample of people's care records which identified there were no issues with the information held about people using the service. This helped to ensure that people were safely supported with their needs.

The registered manager confirmed that all staff files had been checked following the August 2017 inspection. Following on from the last inspection, we saw a sample of staff files had been audited by both the registered manager and registered provider. No issues were noted and these continuous checks enabled them to ensure everything was up to date and that staff were recruited appropriately and supported once they started working in the service.

Following the inspection in August 2017 the service was rated Requires Improvement overall with the key questions, ‘Is the service safe?’ and ‘Is the service well–led?’ rated as Requires Improvement. Following the inspection in October 2017 the ratings for the Safe and Well-led key questions have been changed to Good and the service had also now been given an overall rating of Good.

Inspection carried out on 7 August 2017

During a routine inspection

We undertook an announced inspection of Caremark (Hillingdon) on 7 August 2017. We told the provider two working days before our visit that we would be coming because the location provided a domiciliary care service for people in their own homes and the manager and staff might be not be available to assist with the inspection if they were out visiting people.

Caremark (Hillingdon) provides a range of services to people in their own home including personal care. People using the service had a range of needs such as learning and/or physical disabilities and dementia. The service offered support to people over the age of 18 years old. At the time of our inspection 24 people were receiving personal care in their home. The care had either been funded by their local authority or people were paying for their own care. Some people had care workers living with them 24 hours a day.

The last inspection took place 23 October 2015 when we rated the five key questions we asked of services and the service ‘Good’.

There was 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.

The provider had not fully followed their recruitment policy and procedures as some care workers were working with only one reference obtained and these were not all from their most recent employer.

The provider had various checks and audits in place but these had not effectively identified that improvements needed to be made to ensure care and support plans were updated as soon as people’s needs changed and that care workers should start working with people using the service only once all the necessary recruitment information was obtained and checked.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to fit and proper persons being employed and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

The majority of people gave us complimentary comments about the service they received. Where there were comments that needed feeding back to the registered manager this was done so that they could act on any issues.

People needs were assessed and they were kept safe, because the provider had systems to help protect them. Risk assessments which outlined how care workers should help to protect people when caring for them were in place and regular reviews were held to ensure people’s needs had not changed.

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

Care workers received ongoing support through the induction, training and appraisal of their work. They gave us positive feedback about the service and how they were supported well by the registered manager.

People received the medicines they needed safely and regular checks on medicine administration records were carried out to ensure care workers recorded each time they administered medicines.

People were supported to eat and drink sufficient amounts and were assisted by the care workers to access healthcare services as and when needed.

People were encouraged to give feedback about the service. This included through meetings with the staff and completing satisfaction questionnaires.

Complaints were appropriately investigated and responded to.

Inspection carried out on 23 October 2015

During a routine inspection

This inspection took place on 23 October 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available. Caremark (Hillingdon) is a domiciliary care service providing a range of services including personal care for people in their own homes. This is our first inspection of the service since it was registered with us in October 2013. There were 48 people using the service at the time of the inspection with diverse needs such as dementia, older people, learning and physical disabilities.

There was 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 and were confident in the staff that supported them. People were safe because staff understood their role and responsibilities to keep them safe from harm. Staff had good knowledge of whistleblowing which meant they were able to raise concerns to protect people from unsafe care.

Risks to people had been assessed and reviewed regularly to ensure people’s individual needs were being met safely.

People received the appropriate support with their medicines as required from staff who had been trained in this area.

Recruitment processes were robust to make sure people were cared for by suitable staff. There were sufficient numbers of staff to meet people’s needs and to keep them safe from harm.

People were supported by staff that received regular training and support to help them provide effective care.

Staff understood the requirements of the Mental Capacity Act 2005 and their responsibilities to ensure that people who were unable to make their own decisions about their care and support were protected.

People were supported by staff that promoted their independence, respected their dignity and maintained their privacy.

People received care that was based on an assessment of their needs and preferences. They were fully involved in all aspects of their care and support and told us that staff were responsive to their individual needs. Staff knew people‘s needs and preferences and how they liked to be cared for.

There was an effective complaints system in place. People told us they were confident to raise any issues about their care and that they would be listened to and addressed.

People told us the service was well-led and managed by an effective and organised management team. People had confidence in the provider and staff were clear about their roles and responsibilities.

The culture in the service was open, inclusive and transparent. Staff were supported, felt valued and were listened to by the management team. Staff were confident to raise any concerns they had and bring forward ideas that could make improvements to the service.

There were effective systems in place to monitor and improve the quality of the service provided. Where improvements were needed, plans were put in place and action taken to make improvements.