This inspection took place on 11 October 2017 and was announced. We gave the provider 24 hours’ notice to ensure someone would be available at the office.

Care Link Northern Limited provides domiciliary services and support to people living in their own homes. The service also provides care under supported living arrangements for adults with a learning disability, so they can continue living in their own homes and communities. At the time of our inspection visit the service provided care and support to 35 people.

The service had a registered manager who was also the provider. We met with the registered manager and the office manager during the course of our visit. 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.

On our last visit to Care Link Northern Limited in August 2016 we rated the service as Requires Improvement. At that visit we found breaches of the Health and Social Act 2008 (Regulated Activities) Regulations 2014 in relation to the recruitment of staff and quality assurance and records. At this visit we found improvements had been made and we rated the service as Good.

People were protected by the service’s approach to safeguarding and whistleblowing. People and their relatives told us they could raise concerns if they needed to and were listened to by staff. We saw that concerns were listened to and acted on straight away by the management team and outcomes were recorded in safeguarding records we saw. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and said that management listened and acted upon staff feedback.

People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support package met their needs. People who used the service told us that they had a team of staff, who were reliable and arrived when expected. Staff confirmed that they were not rushed and had time to provide the care people needed and expected.

Our conversations with people who used the service and their relatives during the inspection showed us that people who used the service were supported in their own homes by sufficient numbers of staff to meet their individual needs and wishes.

We looked at the recruitment process and found that relevant checks on staff took place before they started work and this process was safe. The office manager had implemented a checklist to ensure the appropriate recruitment checks were in place for prospective employees.

We saw that people’s prescribed medicines and topical medicines were recorded when administered. We looked at how medicines records were kept and spoke with the registered manager and office manager about how staff were trained to administer medicines and we found that the medicines administering, recording and auditing process was safe.

The service had introduced systems to ensure staff were appropriately trained and supported. Staff had received supervision, had observations carried out on their practice and we saw appraisals were all scheduled to take place in December 2017.

The care records we looked at included risk assessments, which had been completed to identify any risks associated with the person’s environment and delivering the person’s care.

From looking at people’s support plans we saw they were person-centred. ‘Person-centred’ care is about ensuring the person is at the centre of everything and their individual wishes and needs and choices are taken into account. The support plans made good use of personal history and described individuals care, treatment, wellbeing and support needs. These were in the process of being reviewed by the care co-ordinator and t

Care Link Northern Ltd provides personal care and support to people living in their own homes. At the time of our inspection there were 45 people using the service including four people who live in a supported living setting who require 24 hour care.

This inspection took place on 17 August 2016 and was unannounced. We last inspected this service in February 2014, at which time we found them to be compliant against all the regulations that we inspected.

The service had a registered manager in post who was also the registered provider. 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 found the safety of staff recruitment was not robust. Personnel records were missing essential evidence which would verify a person was suitable to work with vulnerable adults. We discussed this with the office manager who told us she would arrange for the collection of the necessary documentation.

The service had risk assessed aspects of people’s daily living to ensure their safety, but some wider aspects, such as behaviours which may challenge the staff and people accessing the community, had not been considered. We have made a recommendation about this. The company policies and procedures had been recently reviewed and updated. We discussed the implementation of additional policies with the office manager to ensure the service was more robust in areas such as recruitment, social media and use of mobile phones.

Medicines were administered safely and in line with safe working practices. People and relatives told us they had no issues with medicine support and care workers told us they felt competent with this task, we found that formal medicine competency checks were not being carried out with care workers. The office manager told us she would ensure these checks took place in future.

Staff received an induction and had been trained upon commencement of employment; we found that refresher training was not up to date. For example, two of the four staff files we examined belonged to staff who had been employed for a long time. There was no evidence of refresher training for these two care workers.

The service had supervision and appraisal policies in place but staff told us and records confirmed that formal supervision sessions had not taken place for over 12 months. The office manager told us staff often visited the office to discuss and resolve any issues they may have although these had not been formally recorded as supervision sessions. There was also no appraisal documentation in two files of long standing employees. The registered manager told us she monitored staff competence daily by working with the care workers and had no concerns about them. We have made a recommendation about this.

The office manager maintained a diary to record actions to take, however formal audits of the quality and safety of the service were not being undertaken. Formal observational quality checks of staff practice had not been completed since March 2015.

The registered manager told us that she regularly worked shifts as a care worker which enabled her to have oversight of the service. People and staff told us they had a good relationship with the registered manager and were able to approach her with any feedback.

People told us they felt safe living at home with support from their care workers. Staff understood their responsibilities to report any safeguarding concerns to the office manager or registered manager. People and staff told us they felt there were enough staff employed to provide a reliable and consistent service. We confirmed this through records.

There had been a low number of accidents and incidents; these were recorded as appropriate. There was evidence

People told us that they were happy with the care provided by this service. Comments made to us included “Very kind, very courteous, can’t do enough for me”, “I like the consistency I’m getting now” and “Really fantastic, very person centred, they ask and explain everything.” Arrangements were in place to assess people’s care needs and plan their care.

Arrangements were in place to help people take their medication safely. Staff had received medication training, including more specialist training where this was appropriate.

People who used the service and their relatives told us that the service’s staff were professional and competent. Comments made to us included “They are very good actually” and “Very professional.” Arrangements were in place to provide staff with training and support, to help them do their jobs.

Arrangements were in place to provide appropriate training and support to staff. People were asked if they were satisfied with their care during satisfaction surveys, reviews and visits by senior staff. People told us that they had regular contact with the manager and senior staff, and would feel able to raise any concerns that arose.

Improvements had been made to people’s care records since our last visit, although the provider needs to ensure that all care plans are regularly kepy under review.

We spoke to five people who used the service and the relative of one person. They all reported they were happy with the service they received. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. For example, one person said, "The staff talk to me about my care plans. The care that I get is the care that I want." Another person said, "I get what I need, but if not I can always ask them to change what they do."

The people we spoke with said they thought they received the care they needed and that the provider was able to respond as their needs changed. For example one person told us, "I wouldn't go anywhere else. They do all the right things. All the things that I like. If anyone is going to be late, I always get a call to let me know."

From what we witnessed and were told we found that people who used the service were protected from the risk of abuse.

The provider had carried out appropriate pre-employment checks to ensure the suitability of staff.

Although the people we spoke with were happy with the service, we found that records about the care planning and assessment of people's needs lacked detail. There was a risk that important information contained in people's care records could not be retrieved promptly when required.