This inspection took place on 13, 14, 15, 20, 27 June and 3 July 2017. The first day of the inspection was unannounced. We made arrangements with staff to visit people in their own homes throughout the inspection.

Our inspection was carried out at this time because of concerns we had due to the notifications we received from the service. Notifications are changes, events or incidents the provider is legally required to let us know about. The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

We planned to carry out a focussed inspection to consider the incidents detailed in the notifications, but due to the evidence we gathered and the improvements made in the service we changed this inspection to a comprehensive inspection to more accurately reflect our findings.”

The service provides support to over 160 people living in their own accommodation. There were four regional managers in post who line managed supported living services grouped by local authority areas. A supported living service enables people to live in their own home and receive care and/or support in order to promote their independence. People who live in such services have a tenancy agreement in place for their accommodation and are provided with support by a provider who is independent of their accommodation provision. In each area services had been clustered together for management purposes and each cluster was managed by a service lead. At the time of our inspection there were 17 clusters across 10 local authorities.

At our last inspection in August and September 2016 we found the service was in breach of the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Regulation 12 Safe care and treatment

Regulation 17 Good governance

Regulation 18 Staffing

We asked the provider to take action to make improvements. Following the inspection the provider submitted an action plan to tell us how they intended to improve the service. We found during this inspection the provider had made improvements in each of these areas.

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 taken the decision that the four regional managers should apply to become registered managers. Each registered manager would then be responsible for services in a defined geographical area. At the time of the inspection two managers had their applications to become registered accepted by CQC and two managers had begun the process to become registered.

Staff were supported through induction, training, supervision and appraisal to carry out their duties. Checks were in place in the provider’s recruitment practices to ensure people employed in the service were suitable for their roles.

Staff had received training on how to administer people’s medicines. They were then observed giving people their medicines and assessed as competent. We found people’s medicines were administered in a safe manner.

People were protected from the risk of abuse because the staff understood how to keep people safe and what actions they needed to take if they were concerned a person may be at risk of harm.

We found there were sufficient staff on duty to meet people’s needs.

Staff had identified and assessed risks to people and actions had been put in place to mitigate the risks. We saw where accidents had occurred these were reviewed and risk assessments were updated to prevent future occurrences.

The service was in a period of transition from introducing a new format

We inspected this service on 16, 17, 19, 24, 25 and 31 August 2016 and was unannounced. We gave feedback about our inspection findings to the regional director and a regional manager on 15 September 2016 when we received further information about the service.

Community Integrated Care is a domiciliary care service that provides personal care and support to people with a range of needs, including learning difficulties, physical disabilities, complex needs (including dual diagnosis), mental health concerns, sensory impairments and autistic spectrum disorders. These people live in their own homes and supported living services. The service is provided across Newcastle, North Tyneside, Gateshead, South Tyneside, Sunderland, Middlesbrough, Stockton, County Durham and Northumberland areas.

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 the registered manager was absent from the service and one of the regional managers was covering the duties of the registered manager.

At the last inspection in July 2013 we found the registered provider was meeting the regulatory requirements.

Staff had received training in safeguarding. We found staff understood what actions to take if they thought people were unsafe.

There was robust oversight of accidents and incidents by the management team to ensure the risks of any accidents re-occurring would be reduced.

Staff employed by the registered provider had undergone a number of checks to ensure they were suitable to work in the service.

Where people lived with others in joint homes we found the arrangements for fire safety to between the landlord and the registered service to be at times unclear. People had not been able to practice emergency evacuations.

Staff were not always up to date in their medicines training and some assessments of them to determine their competency to give people their medicines were not up to date.

Staff had not received regular support through supervision and training to enable them to care for people. The service had introduced a new system for giving support to people through supervision meetings with their manager. This had yet to be fully implemented.

The service adhered to the requirements of the Mental Capacity Act. This meant people’s capacity to make decisions had been assessed. Where required we found decisions had been made in people’s best interests involving their family members and other professionals.

People were able to choose the food they wanted to eat and were supported to eat and drink when required.

The service had introduced a new system for people’s care planning. We saw the implementation of the system was at different stages. Staff saw the advantages of the new system.

We found that people’s care plans had not always been reviewed in a timely fashion. This meant that any changes to people’s care plans identified in the reviews had not been carried out.

People were supported by staff to participate in a range of activities of their own choosing. We saw people had in place regular visits to places where they enjoyed going.

We found regional managers fed back to the registered manager at monthly meetings about the regulated activity and updated the registered manager on events which had taken place in the service.

We found that some staff were unclear about which of the provider’s registered office location they were accountable to. The office arrangements were clarified for us and the regional director explained there may be some further review of these to ensure the service is working in the most effective way.

During our inspection we found a number of breaches of the Health and Soc