This inspection took place on 25, 26 April and 5 May 2017 and was announced. The last inspection of this service was carried out in February 2016.

Direct Care & Support Team (Hartlepool) is a domiciliary care service which provides reablement (short term support usually after people are discharged from hospital), 'telecare' services (technology to help people live at home longer) and emergency respite care for family carers to over 3000 people in the Hartlepool area. At the time of this inspection, 21 people were receiving personal care and reablement support for a period of up to six weeks.

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 our last inspection of this service in February 2016, we gave the service a rating of 'requires improvement' and asked the provider to take action to make improvements. This was because we found the provider had breached Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that time we found the provider did not have accurate records to support and evidence the safe administration of medicines. We found gaps and inaccuracies in medicines records. Some staff had not completed up to date training in key areas, staff supervision records were not up to date, and direct observations of care did not happen regularly. The provider did not have audits in place for medicines and care plans.

During this inspection we found the provider had made significant improvements in all of these areas and was now meeting all of the regulations that we inspected against.

Medicines were managed safely. Medicine administration records were completed correctly. Prescribed creams were recorded as administered on topical medicines application records and body maps to highlight where staff should apply creams and ointments were in place. Increased checks on medicines had been effective in identifying areas for improvement and reducing the risk of further errors.

People told us they felt safe when receiving care and support from staff at the service. Staff had a good understanding of safeguarding procedures and how and when to report concerns. Thorough recruitment and selection procedures were in place to check new staff were suitable to care for and support vulnerable adults.

People and relatives we spoke with felt there were enough staff to meet people’s needs. The service used a 'call confirm' system which enabled supervisors to check staff were on time and to track the duration of people's care visits. This was an accurate and effective system. People received their calls as scheduled.

Risks to people’s health and safety were assessed and reviewed. Accidents and incidents were recorded and dealt with appropriately and analysed to look for trends.

People and relatives we spoke with said they felt staff had the right skills to provide the care they needed. Training records showed staff members had completed up to date training in areas such as moving and assisting, emergency first aid and food hygiene since the last inspection. Staff were supported with their professional development through regular supervisions, annual appraisals and direct observations of their care practice.

People told us staff were caring, friendly, helpful and respectful. They described how staff respected their privacy and promoted their independence. People were given a service user guide when they began to receive care. This contained information about how to make a complaint and how to access independent support and advice.

People’s care plans contained guidance for staff about how to support people with their care needs. Their needs were reviewe

The inspection took place on 10, 16 and 17 February 2016. This was an announced inspection. The last inspection of this service was carried out in March 2014. The service met the regulations we inspected against at that time.

Direct Care & Support Team (Hartlepool) is a domiciliary care service which provides reablement (short term support usually after people are discharged from hospital), ‘telecare’ services (technology to help people live at home longer) and emergency respite care for family carers to over 2000 people in the Hartlepool area. At the time of this inspection, 29 people were receiving personal care and reablement support.

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.

We found the provider had breached Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records to support and evidence the safe administration of medicines. We found gaps and inaccuracies in medicines records. Some staff had not completed up to date training in key areas, staff supervision records were not up to date, and direct observations of care did not happen regularly. The provider did not have audits in place for medicines and care plans.

You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives spoke positively about the service, and told us there was enough staff to carry out visits. One person who used the service said, “The service is first class. The staff are excellent.” Another person who used the service said, “They helped me stay in my own home which is fantastic.”

Feedback to the provider from people who used the service was 100% positive, across all areas, in the last 12 months.

The service used an effective ‘call confirm’ system to monitor staff attendance at scheduled visits to people’s homes. The majority of visits were on time and lasted for the allocated duration. Supervisors used this system to monitor visits on a daily basis so potential issues could be responded to promptly.

Staff knew how to report safeguarding concerns and were able to describe various types of abuse. Staff said they felt any concerns they had would be taken seriously. Safeguarding concerns, accidents and incidents were recorded and dealt with appropriately. They were also analysed so lessons could be learnt to prevent recurrence.

The service worked closely with health professionals to ensure people didn’t stay in hospital longer than necessary. People were supported to attend medical appointments and social activities.

Staff had access to clear guidance about how to provide care and support to people, according to their individual needs and wishes. This guidance was set out in people’s care plans which were reviewed and updated when people’s needs changed.

People knew how to make a complaint, although all of the people we spoke with said they had never had to make a complaint. People told us if they had a concern they would speak to care staff or supervisors who were based in the registered office. People were confident their concerns would be dealt with appropriately.

Staff told us they felt supported by the management team and felt able to voice any concerns they may have. Staff told us there was a positive and open culture at the service.

People who used the service said it was well organised and they would recommend it to others.

The Direct Care and Support team provided telecare, intermediate and re-enablement services to over 1500 people in the Hartlepool area. At the time of the inspection, of this group of people we found that the intermediate and re-enablement team provided personal care services to 19 people. We spoke with 50% of these people and several relatives.

All of the people we spoke with were extremely complementary about the staff and the support they were offered. However, a number of people said they found it difficult not knowing which carer was going to visit each day. We spoke with the manager who told us this was an issue they had recently become aware of and he outlined the measures they were taking to improve this aspect of the service.

People said, "I find the staff are always really pleasant and really do a good job", "The staff make me feel at ease", "The staff are very friendly and polite," and "I find the staff are very sensitive and seem to really care".

We found that the manager and supervisors were skilled at planning the delivery of care and organised the staff so people received the care they needed. The staff we spoke with were very knowledgeable about the people using the service and passionately explained how they made sure people received a good service.