This inspection took place on 16, 23 and 25 May 2017 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 in to assist us.

Comfort Call Middlesbrough is a domiciliary care service which provides personal care to people in their own homes. The service supports people in Middlesbrough, Redcar and Cleveland and North Yorkshire. At the time of the inspection 517 people were using the service.

At our last inspection in February 2016 the service was rated Good. At this inspection we found the service remained Good.

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. At the time of our inspection a new manager had been appointed and the service was in the process of registering them with the CQC so that they would become the new registered manager. They will be referred to as ‘the manager’ throughout this report.

People and their relatives told us the service kept them safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Policies and procedures were in place to safeguard people from abuse. People’s medicines were managed safely. The provider and manager monitored staffing levels to ensure enough staff were deployed to support people safely. The provider’s recruitment process minimised the risk of unsuitable staff being employed.

People told us staff had the skills needed to support them effectively. Staff were supported with regular training, supervision and appraisal. People’s rights under the Mental Capacity Act 2005 were protected. Some people received support with their food and nutrition. Where this was the case their nutritional needs and preferences were recorded in their care records. The service worked with external professionals to maintain and promote people's health and wellbeing.

People and their relatives spoke positively about the care they received, describing it as kind and caring. People and their relatives told us staff treated people with dignity and respect. Staff helped people to maintain their independence. Policies and procedures were in place to arrange advocates for people should this be needed.

People told us they received personalised care based on their assessed needs and preferences. Care plans were reviewed every two months to ensure they reflected people’s current support needs and preferences. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service and also spoke positively about the manager. People we spoke with also said the manager was available to speak with if they wished to raise any concerns or feedback. The manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was sought from people and their relatives. The manager had informed CQC of significant events in a timely way by submitting the required notifications.

This inspection took place on 9 February 2016 and was announced. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in to assist us. A second visit took place on 26 February 2016, and was announced.

Comfort Call Middlesbrough is a domiciliary care service which provides personal care to older people in their own homes. The service supports people in Middlesbrough, Redcar and Cleveland and North Yorkshire. At the time of the inspection 360 people were using the service.

Risks to people were assessed and regularly reviewed, and steps were taken to minimise the chances of them occurring. People were supported to access their medicines, and clear records were kept to show when they had been administered.

Staff were alert to safeguarding issues, and felt confident to raise any concerns they had to management. Staff and the people they supported thought that there were enough staff employed to support people safely and without rushing care. Checks were made before staff were employed to ensure they were suitable to work with vulnerable people.

Staff had easy access to personal protective equipment (PPE) such as gloves and aprons, to minimise the risk of infection control. During visits to people’s homes we saw staff using PPE where appropriate.

Staff received a wide range of training, and felt they could request additional or specialist training if they wanted it. Staff were supported through regular supervisions and appraisals, which allowed them to raise any issues or support needs with management.

Staff had a working knowledge of the principles of the Mental Capacity Act 2005, and could describe how they obtained people’s consent to deliver care and support.

Where people were supported with food and nutrition, they told us they were free to choose their meals. Staff described how they supported people on specialist diets.

The service worked with other professionals to support and promote people’s health and wellbeing, including receiving specialist training from external professionals where needed.

People told us that staff maintained their dignity and promoted their independence.

People and their relatives said that staff were kind and caring, and that the support they delivered made a positive contribution to people’s lives.

Where necessary, the service had procedures in place for organising advocates to support people.

Care plans were detailed and reflected people’s preferences on how they wanted their care delivered. They were reviewed to ensure they met people’s current needs. People said they received the care they wanted.

Procedures were in place to investigate complaints to the service, and people were informed of the outcomes.

Staff felt supported by the registered manager, and felt involved in how the service was managed.

The registered manager carried out a number of quality assurance checks, and used the results to maintain and improve standards at the service. The registered provider also sought people’s feedback on the service.

The registered manager understood their role and responsibilities, and was able to describe the notifications they were required to make to CQC.

We carried out this inspection to check that improvements had been made in respect of shortfalls in the management of medicines and quality of care records identified on our last inspection on 10 and 14 October 2013.

During this inspection we spent time speaking with the registered manager and director. We also spoke with two people in their homes and spent time observing people and staff. We looked at records that related to the administration of medicines, staff training and the care plans of eight people. We found that improvements had been made and that there was a robust system in place to ensure that people were protected from risks to their health, safety and welfare. A person said, "The staff are all lovely. I know what to expect from them but they always go the extra mile anyway." We saw evidence from our observations with staff and people that staff had a good understanding of the needs of people and that this was reflected in people's care plans.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

At the time of our inspection the agency was providing support to approximately 380 people. The agency provided personal care to the majority of people and also provided support relating to general cleaning, shopping and other household tasks. We received feedback from people who used the service and their relatives/carers. People were satisfied with the care and support they received.

One person told us, "The carers are nice.” Another person told us, “They are lovely girls.” A relative we spoke with told us, “They always treat mum well, speak to her properly, they adapt to her moods, we are absolutely delighted with the service.”

All the people we spoke with said they were treated with dignity and respect by the staff.

Effective systems were in place to reduce the risk and spread of infection.

We found processes for the administration and management of medicines were not being followed.

We found that there were systems in place to monitor the quality of service delivery.

There was a complaints procedure in place and this was accessible to people.

We found that care records needed further improvement due to gaps and the need for additional information.