This inspection took place between 25 October and 1 November 2018. This was an announced inspection to ensure there would be somebody available in the office and so that people could be informed that we wished to contact them for their views.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to a wide range of individuals including older people, younger adults and children.

Not everyone using Carevisions@Home Ltd receives regulated activity; Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection 13 people were receiving support which included personal care.

We previously inspected the service in March 2016 and rated the service as good overall. At this inspection we found the service was no longer meeting all the required standards to retain this rating.

This is the first time the service has been rated Requires Improvement.

We visited the office location on 25 October 2018 to see the manager and office staff and to review care records and policies and procedures. After our visit to the office we made calls to people who used the service and their relatives. We also requested information from the local authority and asked external health professionals for their feedback.

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 recognised there were problems with the current delivery of care so, prior to our inspection had reduced the number of people being in an attempt to improve care delivery. However, people were still not always receiving support in a way they were happy with. People told us there were times when staff were not available to attend calls and call times could not always be changed to accommodate a change in circumstances. People and relatives told us they were not always supported by a regular team of staff and that communication with the office could be improved.

Medicine records did not contain all of the necessary information to guide staff on how to administer them correctly and safely. People were not always happy with the way their medicines were managed. Medicines audits were undertaken but had not picked up the issues we identified.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, decision specific capacity assessments were not always being undertaken.

Staff training was up to date and specialist training was delivered to meet the needs of the people being supported. Staff were happy with the training they received. Some people and relatives gave negative feedback about staff knowledge and we fed this back to the registered manager who planned to address this.

People were involved in their care planning and reviews. Care plans did not always include information about a person’s likes and dislikes. Some care plans included more detailed guidance to staff than others. Information was not readily available in an accessible format for people with a sensory impairment or learning disability. We have made a recommendation about this.

Audits and checks were conducted on a regular basis however they had not picked up on all of the issues we found.

The provider had systems in place to safeguard people from abuse. Staff completed safeguarding training and knew how to report any concerns.

People had individual risk assessments within their support files. Accid

We inspected Care Visions At Home, Middlesbrough on 4th March 2016. This was an announced inspection. We informed the registered provider at short notice (48 hours before) that we would be visiting to inspect. We did this because the service delivers domiciliary care and we wanted the registered manager to be present at the service on the day of the inspection. This meant they could provide us with the information that we needed.

The service is registered to provide personal care and nursing care to people living in their own homes. The service can provide care and support to adults, children and young people.

The service had a 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.

The service were providing care packages to 50 people at the time of the inspection and had 61 members of staff providing 12-1400 hours of care.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices. However some care plan records needed further detail to make sure care and support was delivered in a specific way for the person. The registered manager and branch manager were aware and had already taken steps to update care plans.

There were enough staff employed to provide support and ensure that people’s needs were met. However staff told us that at times rotas were changed at the last minute which meant people would also get last minute changes to staff who would be visiting. Staff also told us that they did not always get work near to where they lived which meant that sometimes they would be late due to travel time and this could impact on the call.The managers were aware of and addressing these issues.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what they would do if they witnessed any abuse..

Prior to the package of care commencing environmental risk assessments of the person’s home were carried out. Safety checks looked at among other things equipment to be used and general environment. This meant that the registered provider ensured the premises was safe for people and staff.

There were risk assessments in place for people who used the service. The risk assessments and care plans had been reviewed and updated on a regular basis. Risk assessments covered areas such as environment, medicines,finances and travelling. This meant that staff had the documentation and guidance they needed to help people to remain safe.

Systems were in place for the management of medicines so that people received their medicines safely. Care Records we reviewed contained detail of people’s medicines, how they should be administered and what time they should be taken.

Staff told us that the registered manager and case managers were available, approachable and supportive. Most staff had received regular and recent supervision and also spot checks to make sure they were doing their job correctly. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff.

Staff were up to date with training Staff told us they had received training which had provided them with the knowledge and skills to provide care and support to the people they visited. Robust recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included two references from previous employers to show staff employed were safe to work with vulnerable people.

The registered manager and staff we spoke with had an understanding of the principl