Castle Rock Recruitment Group Stockton (CRG) is a domiciliary care agency which provides care and support to people living in Stockton-On-Tees and Redcar-In-Cleveland. The service provides personal care to people living in their own houses and flats. It provides a service to older adults who live with a dementia, to young adults and older people with physical or mental health difficulties and younger adults living with a learning disability and autism.

This service also provides care and support to people living in specialist ‘extra care’ housing in Stockton-On-Tees. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care [and support] service.

At the time of the inspection there were 311 people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager had been in post since 7 March 2016, however they had not been working at the service for at least one month. During the interim period, the regional manager was based at the service and an acting manager was in place. 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 last inspection on 31 May 2017, we found improvements were needed to the quality of record keeping at the service. Records relating to the care and treatment of people using the service were not always accurate or updated when people’s needs changes. Audits had not identified these concerns. After the inspection, the provider supplied an action plan, which was dated 21 August 2017 which said, all of the required improvements would be completed by 31 October 2017.

At this inspection, we found these improvements had not been made. In May 2018, the provider had accepted a significant number of new care packages. Local authority commissioners had raised a number of concerns around the operation of the service. The provider agreed as part of the serious concerns protocol, to a voluntary embargo on accepting new care packages in some aspects of the service. After inspection feedback, the provider placed their own embargo across all aspects of the service.

At this inspection, we found staff were not responsive to risk and safeguarding alerts had not always been raised when needed. Accidents and incidents were not routinely recorded and systems had not been in place to ensure lessons were learned. Risk assessments were not always in place. Those in place lacked information about how to reduce the risks to people. Medicines were not always managed safely for people and records had not been completed correctly. There were gaps in recruitment and there were insufficient staff in all areas of the service to meet the needs of people. Infection prevention and control procedures were not routinely followed.

Staff had not been supported through their induction. Supervision, appraisal and training were not up to date. Staff lacked understanding about people’s nutritional needs, as a result there was a lack of oversight. People were supported to make and attend healthcare appointments, however guidance from health professionals was not routinely available in care records. People were not always supported to have maximum choice and c

The inspection visit took place on 31 May 2017. We gave the registered manager 48 hours' notice of our inspection because we needed to be sure they would be available.

Castlerock Recruitment Group (CRG) provides personal care and support for people in their own home. At the time of our inspection 32 people were receiving personal care and support from the service. At the last inspection, in May 2015, the service was rated good. At this inspection, we found the service requires improvement.

People continued to receive safe care and support. They were protected from abuse and avoidable harm by staff who knew their responsibilities to follow the provider's procedures. Risks to people's well-being were assessed and monitored. However the registered manager did not always provide guidance to staff to help people to remain safe.

Where people required assistance with their medicines, this was undertaken safely by staff who knew their responsibilities. However medicine records were not always correct.

The provider had safely recruited a sufficient number of staff to meet people's care requirements. Staff files were inconsistent with items missing. We found these items were waiting to be filed.

People continued to receive care from staff that had the necessary skills and knowledge. Staff were trained and received on-going support so that they understood their responsibilities. People were offered food and drink based on their preferences and supported to maintain good health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service provided guidance in this practice.

People continued to receive compassionate care from staff members who protected their dignity and privacy. Staff knew the people they supported and could easily explain people's life history and background, however not all this information was recorded. People were involved in decisions about their care and their independence was promoted wherever possible so that they retained their skills.

People continued to receive care and support based on things that mattered to them. People’s care plans did not reflect people’s current needs. Staff we spoke with were fully aware of any updates however these had not been recorded. When care plans were reviewed and people's needs had changed the care plans were not updated to reflect these changes.

People and their relatives knew how to make a complaint and there were clear procedures in place to handle them should one be received.

Staff we spoke with said the registered manager had an open ethos that encouraged feedback. Staff were supported well by the registered manager and received feedback on their work. The registered manager was aware of their responsibilities.

The registered manager carried out a range of quality checks to make sure the service was delivering a high quality service. However the quality checks did not reflect the lack of updated records.

Further information is in the detailed findings below. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

People who used the service and their relatives told us that staff treated them with respect and made sure that their privacy and dignity were maintained.

People who used the service and their relatives had no concerns about the care the service delivered. They thought that staff were knowledgeable and made sure that people were safe. Pre admission assessments and risk assessments had been carried out and care plans had been written to ensure staff knew how to keep people safe.

The provider had systems in place to reduce the risk of abuse and staff had undergone training make sure they were aware of their responsibilities if they had concerns that abuse was taking place. Some staff weren't aware of how safeguarding concerns were investigated outside the organisation or that the Local Authority lead safeguarding investigations.

People who used the service were supported by staff who had undergone a recruitment process which ensured that pre-employment checks were carried out and that staff were suitable to work with vulnerable adults.

The provider had systems in place to check the quality of the care it delivered however during our inspection we were only able to find limited evidence that all of these checks had been carried out regularly and frequently.

Castlerock Recruitment Group support people to remain as independent as possible in their own homes. It is registered to provide personal care to people living in the Stockton, Middlesbrough and Redcar areas. Castlerock Recruitment Group also provides other services such as staff to provide sitting services, psychological support, cleaning and to do shopping as well as agency staff for care homes. CQC do not regulate agency provision, social support or domestic services.

We completed the announced inspection from 28 February to 30 March 2015 in order to have the opportunity to speak with a representative group of people who used the service and staff. We spoke with seven (55%) of the people who used Castlerock Recruitment Group domiciliary care services.

We completed an inspection 8 January 2014 and found that systems for overseeing the performance of staff and the effectiveness of the service needed to be improved. This was because the manager had recently left their post and the remaining staff were unable to locate any audits. Office staff had not been able to log on to the previous manager’s computer where they were all stored. Although the provider had a number of ways of monitoring the quality of care delivered, we only found evidence that two audits had been carried out by the Stockton service.

We had found that Castlerock Recruitment Group was not meeting the requirements of regulation 10 (monitoring and assessing the service).

Following our last inspection the provider sent us an action plan outlining their plans to improve. We carried out this inspection to check that improvements had been made and found that action had been taken to ensure Castlerock Recruitment Group complied with the Health and Social Care Act 2008 regulations.

Following the last inspection, commissioners identified that the domiciliary care services were not performing to a satisfactory standard.

In December 2014 a new manager came into post they became the registered manager 27 February 2015, however, they have now left. 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 is in the process of recruiting a new manager.

Currently a care coordinator oversees the domiciliary care service and we found they alongside the management team had been instrumental in making improvements to the service.

People we spoke with who received personal care felt the staff were caring, knowledgeable, skilled and the care package met their needs. Staff understood how to safeguard people.

We heard how last year there had been a range of problems with the service such as staff not being allocated sufficient travelling time, which led to people having their allocated time cut short. However people told us that since December 2014 this poor practice had stopped.

The staff undertook the management of medicines safely and in line with expectations.

People told us when they previously raised concerns these were not listened to but since December 2014 this had improved significantly. People told us they now felt confident that should concerns be raised these would be dealt with appropriately.

We found the provider had reviewed the performance of the whole service and this had led them to making significant changes to the senior management team since the last inspection. The changes we found had improved the operation and delivery of the personal care services.

The staff we spoke with told us they had attended training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances.

The care coordinator had introduced systems to ensure staff were appropriately recruited, trained and supported. They had also ensured that people who used the service were contacted on at least a two-monthly basis to check if the package of care they received met their needs.