Careline Homecare (Newcastle) is a domiciliary care service providing personal care and support to people living in their own homes, in Newcastle and Northumberland. The service provides social care and support. At the time of our inspection there were 285 people using the service. The service supports people who are funded by the local authority or privately.

We previously inspected this service in August 2015 when we identified the service required improvement. At that time, the provider continued to breach Regulation 12 of the Health and Social Care Regulations relating to management of medicines from an earlier inspection in February 2015. We also issued the provider with a fixed penalty notice for failing to display their previous CQC performance rating. Following the inspection, the provider sent us an action plan which detailed how they planned to address the areas of improvement and the date of when they would be compliant. This inspection took place on the 30 December 2016 and 4 January 2017 and was announced.

The service had a new 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 registered manager had a history of managing domiciliary care services and the staff we spoke with told us they found her supportive and approachable. The registered manager had a clear vision for the service and had been moved to this service in April 2016 by the provider from another of their services to implement the improvements required. There was a friendly office culture and we observed care workers calling into the office to speak with their supervisors.

We looked at how the service now managed medicines. We found considerable improvements had been made in this area. New robust procedures had been introduced which had significantly reduced the amount of medicine errors and improved recording and monitoring.

Care workers wore a uniform and used other personal protective equipment to reduce the risks associated with cross infection. Gloves and aprons were changed regularly between personal care and meal support to ensure any cross contamination was avoided.

People spoke highly of all the staff who supported them to live at home. They told us they felt safe and comfortable with the care workers who visited their homes and that they trusted the provider to deliver a good service. Policies and procedures were in place to safeguard people from harm and staff understood their responsibilities. Records were kept regarding concerns of a safeguarding nature and investigations had taken place in a timely manner. The registered manager had reported all incidents of a safeguarding nature to the relevant local authority’s safeguarding adults team as required.

Staff supported people to manage health and safety in their home and care records showed that risks associated with individual care needs such as moving and handling, medicine and accessing the community had been assessed and were monitored. Person-centred care plans were in place to support care workers provide a service that was personalised to each individual. There was evidence to demonstrate that regular reviews were carried out of the service people received and the information was passed onto the care workers and other agencies when necessary.

Most staff told us they felt there was enough staff employed by the service to manage it effectively and to meet people’s assessed needs. People told us the staff didn’t rush them and sometimes have time for a chat before they left. People said the service was consistent and their regular care workers were rarely late. Staff records showed the recruitment process was robust and staff were safely recruited. Training was up to

We spoke with relatives of four people who were using this service. Most relatives told us they were happy with the care and support given. They told us, “I can’t really fault them at all, they’ve been excellent,” ”I’m pleased with it” and “I think it’s fine, good.” One relative was not always happy with the service. They told us, ”It’s not 100 per cent. They change times of visits without telling us.”

In relation to the care and support provided, we found the provider had suitable arrangements in place to obtain, and act upon, consent from people, and those acting on their behalf. One relative said, “I was given information about what care was available and I have signed care plans.”

We viewed care records of four people and found that care was not always planned and delivered in a way which met people’s individual needs, nor did it always ensure their welfare and safety.

Where people required assistance with their medication, we found there were arrangements in place to ensure this was provided in a safe and suitable manner.

We viewed recruitment documentation relating to five staff employed in the six months prior to our inspection. We found the provider did not always operate effective recruitment procedures.

We viewed a complaints policy and procedure in place which detailed how complaints would be dealt with. We concluded that complaints would be investigated and responded to appropriately.

This was a follow up inspection to check that issues identified at our inspection of the service on 30 July 2011 had been addressed. At that inspection on 30 July people told us that they had been involved in their assessments of need and in their care plans. They said that they were happy with their care and with their care workers.

They said that they were given choices as to how their care was delivered, and one person told us, “The carers always listen to what I want”.

Another person said that he couldn’t fault his care workers, and that he would give them “ten out of ten”.

People said that their care workers were friendly but respectful, and were flexible and reliable.

People told us that they feel safe when their care workers are with them. They also told us that they thought their workers had been well trained.

They said they knew how to make a complaint, if necessary, and were confident that any concerns that they raised would be taken seriously and responded to promptly by the agency.

People told us that they had been involved in their assessments of need and in their care plans. They said that they were happy with their care and with their care workers.

They said that they were given choices as to how their care was delivered, and one person told us, “The carers always listen to what I want”.

Another person said that he couldn’t fault his care workers, and that he would give them “ten out of ten”.

People said that their care workers were friendly but respectful, and were flexible and reliable.

People told us that they feel safe when their care workers are with them. They also told us that they thought their workers had been well trained.

They said they knew how to make a complaint, if necessary, and were confident that any concerns that they raised would be taken seriously and responded to promptly by the agency.

This inspection took place on 5, 12, 14 and 19 August 2015 and was announced. We announced the inspection prior to our visit to the provider’s head office, to ensure that the office was accessible and we were able to meet the registered manager or a senior member of the service. By announcing the inspection, the manager was able to facilitate our requests to speak with staff and organise visits and telephone calls for us to see and speak with people and their relatives.

Careline Homecare (Newcastle) provides personal care and support to people in their own homes in the Newcastle area. At the time of our inspection, the service provided care and support to 450 people.

At the previous inspection in February 2015, we issued a warning notice related to medicines management. We identified breaches in a further three regulations; staffing; care and welfare and assessing and monitoring the quality of service provision. Following this inspection, the provider sent us an action plan telling us what actions they were going to take to improve.

At this inspection, we found that improvements had been made, although we still found shortfalls in medicines management.

There was a registered manager in place who had been in post since December 2014. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

Some people, relatives and staff told us that more staff were required to support people, especially in the Gosforth, Kenton and Newbiggin Hall areas. The manager informed us that more staff had been recruited and more were in the “pipeline to start.” Safe recruitment procedures were followed.

Most people told us that they felt safe with the staff who visited them in their homes. One person raised concerns about her care and support and we received an anonymous concern about two people’s care and support. We referred these concerns to the local authority’s safeguarding adults team.

Staff told us that there was sufficient training available. This was confirmed by training records which we examined.

We checked how the service followed the principles of the Mental Capacity Act 2005 (MCA). The MCA governs decision-making on behalf of adults who may not be able to make particular decisions. The manager was aware of the Supreme Court judgement in relation to deprivation of liberty. She was liaising with the local authority to ascertain what implications this ruling had on people who used their service.

People’s nutritional needs were met. Healthcare professionals such as the GP or district nursing service were contacted if there were any concerns with people’s health care needs.

We found that staff were knowledgeable about people’s needs and they demonstrated a caring approach whilst supporting people.

People and relatives told us that they were involved in their care. They told us that they generally saw the same care workers or the same small team of care workers. The number of missed calls had reduced from 13 to seven since our previous inspection.

There was a complaints procedure in place and people told us that they could raise any issues or concerns with staff. Some people, relatives and staff told us that they felt the office staff needed to be more efficient in responding to telephone enquiries. Regular surveys were carried out to obtain the opinions and views of people and their representatives. We noted that 176 people were “very satisfied” with the service, 127 were “satisfied,” 49 were “neither satisfied nor dissatisfied,” six were “very dissatisfied” and nine people had just started using the service and could not comment.

Services are now required by law to display their CQC ratings at their premises and on their website. We discovered that the provider had not displayed their rating from the February 2015 inspection on their website.

We received mixed views from staff about working at Careline Homecare (Newcastle). Some staff told us that they did not feel valued or supported in their work. Other staff told us that they enjoyed their jobs and felt supported by their line manager. We considered improvements were required to ensure that there was a positive culture within the service.

There were continued issues with the Electronic Call Monitoring System. This meant that late or missed calls were not always identified in a timely manner.

During our inspection of the service, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to ‘Safe care and treatment’ in relation to medicines management and the ‘Requirement to display performance assessments.’ You can see what action we told the provider to take at the back of this report.

We issued a fixed penalty notice which related to the failure to display their CQC performance rating which the provider has accepted and paid in full.