This inspection took place on 3 and 5 July 2018 and was announced. This was the first inspection since the service was registered at this location in September 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and people with learning disabilities or autistic spectrum disorder. Not everyone using Helping Hands Middlesbrough receives a regulated activity. CQC only inspects the service being received by people provided with personal care. At the time of our inspection eight people were using the service who received personal care.

There was a registered manager 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.

People told us they were given their medicines appropriately however we identified a number of gaps in recording including on Medicine Administration Records (MARs).

People and their relatives told us staff employed by the service helped them to stay safe. Some risks to individuals, for example, around medicines, were documented but information was missing around other risks. This meant that staff did not always have the guidance they needed on how to manage identified risks and minimise the likelihood of harm.

The provider had continuity plans in place to ensure that people’s support needs would be still met in emergency situations. Infection control policies and procedures were followed to ensure the control of infection.

People were safeguarded from abuse and avoidable harm. Staffing levels were monitored by the registered manager to ensure sufficient staff were on duty to keep people safe. Recruitment policies minimised the risk of unsuitable staff being employed.

Staff received the training they required to help them keep people safe and were supported with regular supervision. Staff appraisals had not yet taken place due to the length of time the regulated service had been in operation. However, these had been scheduled to take place.

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 told us that they were supported with their nutrition.

People were supported to access external professionals to monitor and promote their health.

All of the people and relatives we spoke with said that the staff team were kind and caring. We were told by both people and their relatives that staff treated people with respect and promoted independence. Personalised care was planned and delivered based upon people’s support needs and preferences.

People and their relatives told us they knew how to complain. A complaints policy and procedure was in place. Staff understood and followed people's care and support plans. The provider had policies in place to support people with end of life care if needed.

Quality assurance checks had not always taken place regularly and those undertaken did not always pick up on the issues we found during this inspection. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 17 Good Governance. You can see what action we told the provider to take at the back of the full version of this report.

People, their relatives and staff informed us communication within the company was good. The staff we spoke with told us there was always someone to speak to if they needed guidance or support including out of hours.

Feedback from people, relatives and staff about the service was sought and analysed.

The registered manager promoted the service’s policies and procedures and moni