We carried out an announced inspection of the service on 11 and 12 June 2018. This was the provider’s first inspection from the date of registration in 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own homes within and around Ashfield and Mansfield in North Nottinghamshire. It provides a service to older adults and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Direct Health (North Notts) receives regulated activity; 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 our inspection, 278 people were receiving personal care as part of their care package.

There was a registered manager at the service. 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.

Risks associated with people’s needs showed information provided to staff to manage known risks varied in detail or had not been completed. Risks associated with the environment had been assessed and information recorded to inform staff.

Shortfalls were identified in the management of medicines; best practice guidance was not always followed. Improvements were required in the deployment of staff. Some people had experienced missed and late calls and weekends were identified to be the most likely times this occurred. Safe staff recruitment checks were in place and followed.

Staff had received training in infection control and food hygiene.

People’s nutritional needs had been assessed but these needs were not always sufficiently supported and effectively managed.

People had an assessment of their needs and care plans were developed to instruct staff of how to support people. When people’s needs changed, this was not effectively managed and people experienced a delay in their needs being reviewed.

Staff were aware of their responsibilities to protect people from avoidable harm and abuse. Accidents and incidents were recorded, reviewed and monitored and action was taken to share any learning. Staff received an induction and ongoing training and support.

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 supported this practice.

People’s healthcare needs were monitored and action was taken when changes occurred such as informing the person’s relatives and representatives or health and social care professionals.

Staff treated people with respect and kindness, they were caring and compassionate in their care and approach. Independence was promoted and privacy and dignity respected. People had access to information about independent advocacy services.

People knew how to raise a concern or make a complaint. Whilst some people had experienced a positive outcome to a complaint, others were less confident to raise any complaints.

People received opportunities to share their feedback about the service. The provider and registered manager had met their registration regulatory requirements.

The provider had systems and processes in place to regularly review the quality and safety of the service people received, but these had not identified the shortfalls identified during this inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.