This inspection was carried out on 21 December 2016 and was announced. We gave the registered provider 24 hours’ notice as it was an extra care service and we wanted to make sure someone would be in.

The last inspection of this service was carried out in August 2015. At that time the provider was failing to meet the regulations relating to medicines management. The provider sent us an action plan showing how they intended to address these matters. During this inspection we found the provider had made improvements in all these areas.

Careline Homecare (South Tyneside) is registered to provide personal care to people living in their own homes. At the time of the inspection there were 350 people in receipt of a care service.

The service had a registered manager who had been in post since January 2016. 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.’

Staff had a good understanding of how to safeguard people and were confident in their role. The registered provider had an up to date whistle blowing policy which they ensured staff were aware of through staff meetings and supervisions.

People received their medicines in a safe way. All staff administering medicines had received up to date training and competency checks. Medicine administration records were completed and there were appropriate protocols in place for those people who required 'when required' medicines.

All risks to people's safety were assessed and monitored. All risk assessments had associated care plans in place to guide staff how to support people to manage those risks safely.

Staff rota systems had been changed to ensure they were more efficient in the deployment of staff, taking into consideration travel time, staff skill sets and history of support provision. The registered provider continued to recruit staff in a safe way, ensuring all appropriate checks were completed prior to staff commencing work.

Staff received regular supervisions and annual appraisals to discuss their personal development and success in their roles. Staff had received up to date training in a number of areas and the registered manager had an ongoing training plan to ensure staff training was kept up to date.

People were supported to meet their nutritional needs with staff supporting them when required. People had appropriate nutritional care plans and risk assessments in place if they required support to maintain a healthy balanced diet.

People had access to a range of healthcare professionals and staff supported them to access them in a timely way.

People's needs were assessed shortly after admission to the service and details of their life history were included in care records. People's care plans were personalised to each individual and included preferences, likes and dislikes. Care plans were reviewed regularly and updated in line with people's changing needs.

The registered provider had a number of quality audits in place to monitor service provision and inform ongoing development.

The inspection took place on 14 and 24 August 2015. This was an announced inspection. This was the service’s first inspection since Careline Homecare South Tyneside registered with the Care Quality Commission.

Careline Homecare South Tyneside is a large domiciliary care service, which provides support with shopping, domestic tasks and personal care to people living in their own homes.

The service did not have a registered manager. However, the person managing the service had applied to register. 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 provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not maintain accurate records to support the safe administration of medicines. We found gaps and inaccuracies in people’s medicines administration records (MARs). The registered provider also did not have systems in place to identify issues with medicines records effectively and in a timely manner. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe with the staff delivering their care. They said they received good care from trained and competent staff. One person commented, “They [staff] know what to do.” Another person said staff, “Definitely know what they are doing. You can tell they are well trained in how to care properly.” Other comments included: “Staff have been very good to the both of us. I cannot fault them. Lovely lasses all of them”, and, “The staff are worth their weight in gold. They visit me and [my relative] four times a day. They are lovely lasses and don’t half look after us. We have found them all to be very respectful and always willing to help us.”

Most people we spoke with said staff were either often or occasionally late. One person commented, “Staff are not always on time and it happens every week. Mind you their appointments do not allow any time for travelling. They may have to be at another appointment the time they finish with me but it is impossible. Because of this they leave 10 minutes early so they can get to their other appointment, as they may need to help other staff on other appointments.” Another person told us, “Staff have been late the odd time. For instance once a fortnight but I expect that because they have so many calls to attend and no time in between appointments.” Staff rotas confirmed care staff were not allocated travelling time between calls.

Staff confirmed people were asked for permission before receiving care. They said they would always respect a person’s right to refuse. Staff understood the requirements of the Mental Capacity Act 2005 (MCA). They had access to information about how to help people with making decisions.

People received support from caring staff who treated them with dignity and respect. One person said, “Mind you saying that I am more than happy with the staff who look after me. They are very polite and respectful.”

People had their nutritional needs assessed when they started receiving a service. This included identifying any eating and drinking preferences they had. Staff supported people to have enough to eat and drink, through making meals for people or leaving snacks. Where people were identified as at risk of poor nutrition action had been taken to keep them safe. People had access to a range of health professionals depending on their particular needs.

Staff understood safeguarding adults and the registered provider’s whistle blowing procedure. They told us they currently had no concerns but any concerns they had would be taken seriously. Staff said they were well supported in their role. The registered provider carried out recruitment checks before new staff started caring for people.

Staff described how they aimed to promote people’s independence so that they retained the skills they currently had. People were given information about how to access advocacy services.

People had their needs assessed shortly after they started using the service. Care plans identified goals for people to aim towards and the support required to achieve their goals. Care records showed care plans had been reviewed to take account of people’s wishes and their changing needs.

People knew how to complain if they were unhappy. They said they would contact the office if they were unhappy. However, people we spoke with were happy with care they were receiving. People had the opportunity to feedback their views about the support they received through an annual survey. Feedback from the most recent survey was mostly positive. Feedback in relation to consistency of staff was less positive.

The registered provider had systems in place to assess the quality of the care people received. This included unannounced spot checks on care practice and regular telephone reviews with people using the service. Action plans had been developed following audits to improve the care people received in the future.