This inspection took place on 29 May, 30 May and 5 June 2018 and was announced. This was to ensure someone would be available at the office to speak with us and show us records.

Hartlepool Care Services Limited is a domiciliary care agency and is known locally as ‘Carewatch’. It provides personal care to adults living in their own houses and flats in the community.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

On the day of our inspection there were 324 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 last inspected the service in May 2016 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’ however some statutory notifications had not been submitted to CQC. We are dealing with this matter outside the inspection process.

People told us they felt safe with the staff at Hartlepool Care Services Limited. Some people told us staff did not always arrive on time. The provider was aware of this and was implementing a new call monitoring system.

There was an effective recruitment and selection procedure in place and relevant vetting checks were carried out. Staff were suitably trained and received regular supervisions and appraisals.

Accidents and incidents were appropriately recorded and risk assessments were in place. Safeguarding procedures had been correctly followed and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

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 were protected from the risk of poor nutrition and care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Hartlepool Care Services Limited.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were protected from social isolation.

The provider had an effective complaints procedure in place and people who used the service were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team. People who used the service and staff were regularly consulted about the quality of the service via meetings and surveys.

The inspection took place on 7 and 9 March 2016 and 13, 21 April 2016 and was announced. We last inspected the service on 22 September 2015 and found the registered provider met the regulations we inspected against.

Hartlepool Care Services provides domiciliary care and support to people in their own homes. At the time of our inspection the service provided support to over 300 people.

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.’

People told us they received their care from kind staff who treated them with dignity and respect. One person commented, “They are worth their weight in gold, I have regular carers and they are wonderful.” Another person said, “They are very kind when they are here. The regulars are excellent, they stay as long as they should. I have a regular care worker who comes to take me out, she’s very good.”

Care workers had a good understanding of safeguarding adults including how to report concerns. They were also aware of the whistle blowing procedure and said they would not hesitate to use the procedure if they had concerns.

People received their medicines from trained staff. Medicines administration records (MARs) we viewed were accurate and fully completed. Regular checks were carried out to help ensure people received the medicines they needed in a timely manner.

People were cared for by well trained and knowledgeable staff. Staff said they were supported to carry out their role. One staff member said, “We have supervision every three months. [Manager] is approachable, she would help.”

The registered provider followed the requirements of the Mental Capacity Act (MCA). Information was available to guide staff as to how to support people who lacked capacity with making day to day choices. People received the care they had consented to. One person commented, “They are very nice to me, they do what I want.”

Most people told us they received an inconsistent service due to frequent last minute changes to rotas. In particular, people said staff often turned up at different times and sometimes different care workers to those they expected to see.

New care workers were only employed following the completion of an effective recruitment process, including receiving references and checks with the disclosure and barring service (DBS).

Care worker supported people to meet their nutritional needs. One person told us, “They make my breakfast and see that I get a snack lunchtime, I make my own tea but it’s in the oven so I time it for when they come so they can put it on the tray.” Another person said, “They do my meals, I buy microwave meals and they do them for me.”

People’s needs were assessed shortly after they started using the service. However, assessments were generic and did not capture details of people’s specific needs and preferences. People had care plans and service user profiles in place which detailed the care and support they wanted from the service.

There was a complaints procedure for people to access if they had concerns. People told us they knew how to complain and would do so if they had concerns. One person told us, “I would just ring the office if anything was wrong.” The complaints log showed individual complaints had been investigated and action had been taken.

The registered provider had a range of checks in place to check on the quality of people’s care. People were sent questionnaires in order to provide feedback about their care. Most feedback received was positive.

We found the inconsistency of staffing was a feature throughput our inspection as negative feedback about this was apparent in complaints, service user reviews and consultation. The re

We carried out an announced comprehensive inspection of this service on 8, 16 and 22 December 2014. A breach of legal requirements was found because medicines were not being managed in the right way and staff were not receiving regular one to one supervision. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations relating to the management of medicines and supervision of staff.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hartlepool Care Services Limited on our website at www.cqc.org.uk.

We found the assurances the provider had given in the action plan had been met. The registered provider had met with staff specifically to discuss the quality of medicines management. Only trained and competent staff administered medicines. A nominated person was now responsible for checking the quality of medicines administration records (MARs) each week. The registered manager said, “The checks are more consistent now.” A further quality check was carried out at the end of each four weekly medicines cycle. These checks had been successful in identifying issues.

Supervision records confirmed all staff had received a one to one supervision since the last inspection. We also viewed the minutes of a team meeting where staff support was discussed.

We spoke with five people, two relatives and seven staff at the inspection; including visiting people in their own homes and examining eleven care records.

The majority of people using the service were happy with the care and treatment provided and one person said, “Staff do everything I need them too.” One relative told us that they were not happy because staff had not attended their relative as they should have. Once we highlighted this matter, staff dealt with it immediately. We saw that full assessments, risk and care plans were in place for people using the service.

We saw that the provider co-operated with other services, including for example; community service teams and Healthwatch.

We heard staff speaking respectfully and in a gentle manner to people they were caring for and found that the provider had employed suitably skilled, qualified and experienced staff.

Staff had opportunities to develop their skills with additional training opportunities. One staff member said "We are encouraged to do training". Staff told us that they attended supervision and full staff meetings and that the provider now had an open door policy.

We found that systems were in place to monitor the service that people received.

This inspection took place on 8, 16 and 22 December 2014 and was announced. We gave the provider 48 hours notice of the inspection.

Hartlepool Care Services Limited is a large domiciliary care service. Hartlepool Care Services Limited provides personal care and support to people living in their own homes. At the last inspection on 12 December 2014 we found the provider was meeting all the regulations we inspected.

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 13 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found improvements were required to the management of medicines. Medicines were not always managed safely for people. Records had not been completed correctly and the current audit systems were ineffective in identifying gaps in medicines records.

Staff were not receiving regular one to one supervision with their line manager. One staff member said, “There is not enough of those [supervision], I have not had one for nearly four years. Feels like if and when.” Another staff member said, “Supervision, not very often.” Most staff we spoke with said they felt supported and confirmed there training was up to date.

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

Most people said they felt safe with the care workers who came into their home. However, two out of eight family members we spoke with told us they were not totally reassured to leave their relative.

People said they were not always told which care workers would be calling. They also said they were not told in advance of the frequent changes to their care workers or the time of their call. People and staff told us care staff were not allocated travelling time between calls. One person said, “Too much change.” Other people’s comments included, “They don’t stick to the rota”, “They send different ones”, and, “They don’t ring you to tell you if a different person is coming.”

The provider had undertaken recruitment checks on prospective new staff to ensure they were suitable to care for and support vulnerable adults.

People and family members were happy with the skills of the care staff. They also said the care staff were caring. Comments included, “Can’t fault them [staff]”, and, “Very good, like friends.” Another person said, “Staff know what they are doing”, and, “Can’t complain about [care worker’s name]. Another person said, “My carers are the best in the world.” People told us staff asked them for permission before delivering any care. One person said, “[Staff] always say what do you want?” Another person said, “[Staff] make me whatever I want.”

People were supported to make sure they had enough to eat and drink and to attend their health appointments. One person said, “[Staff] always have a meal ready at tea-time.” Staff told us about the support people they cared for needed with eating and drinking.

Staff had a good understanding of safeguarding and whistle-blowing procedures. They also knew how to report concerns. One staff member said, “I think the manager would be straight on to it.” Another staff member said, “The manager is good with things. She would deal with them.”

The provider undertook routine risk assessments which were generic to all people. Additional risk assessments were carried out where specific risks had been identified. This included risks to the person receiving care and environmental risks relating to the person’s home.

Most people who used the service had capacity to make their own decisions. For the very small number of people where there were doubts about capacity, the provider followed the requirements of the Mental Capacity Act (2005) (MCA).

People were asked about any particular preferences they had to maintain their dignity and these were respected. People confirmed staff treated them with dignity and respect. One person said staff, “Know exactly what to do for me.”

People had their needs assessed when they started using the service. The assessment was used to develop an action plan for each person. Action plans did not contain personalised information about how people wanted their care to be delivered. However, some people had a personal profile which included details of their preferences.

People told us they knew who to contact if they were not happy. One person said, “I ring the office if I am unhappy.” Another person said, “I know where to go if I’m not happy.” Most people we spoke with said they had contacted the office and found they had responded well.

People had opportunities to give their views about the provider and their care, including completing a survey or questionnaire. Other people had visits from a supervisor. They said, “Managers come and see if I am still satisfied.” Another person said, “The supervisor comes every fortnight to check how things are.”

Staff told us the registered manager was approachable. One staff member commented, “Brilliant, any problem I just phone straight up.” Another staff member said, “Really good, I have phone numbers and can ring anytime.” Some people told us the supervisor comes to introduce new staff. Others said this sometimes happens but not always.

There were systems in place to check on the quality of care being delivered. This included questionnaires, telephone reviews and spot checks. We found these were used to improve the quality of the care people received.