This inspection took place on 9 October 2018 and was announced.

Human Support Group is a domiciliary care agency that provides care and support to people in their own homes. At the time of the inspection the service provided care and support to 41 people.

The service had a registered manager in post. 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 in February 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and in line with their agreed care visits. A number of recruitment checks were carried out before staff were employed to ensure they were suitable.There were arrangements in place to protect people from risks associated with the management of medicines and the spread of infection.

We have made a recommendation about the timings of medicine administration.

Care and support were based on detailed assessments and care plans, which were reviewed and kept up to date. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. 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. Where appropriate, people were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and occupational health.

Care workers had developed caring relationships with people they supported and knew people well. People were supported to take part in decisions about their care and treatment, and their views were listened to. Staff respected people's independence, privacy, and dignity.

People's care and support considered people's abilities, needs and preferences, and reflected their physical, emotional and social needs. People were kept aware of the provider's complaints procedure which would come into place if any complaints were received.

Effective management systems were in place to monitor the quality of care provided and to promote people's safety and welfare.

We have made a recommendation about collecting feedback from people who use the service.

We inspected Human Support Group Limited Middlesbrough on 5 February 2016. This was an announced inspection. We informed the registered provider at short notice that we would be visiting to inspect. We did this because the service did not have a registered manager and we wanted other senior management to be present on the day of the inspection.

Human Support Group Limited Middlesbrough provided assessment, rehabilitation and reablement services for people in their own homes to promote their daily living skills and independence. This service is provided to people for up to six weeks and then the person is reassessed and their ongoing needs determined.

The service did not have 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. The registered provider was actively recruiting for the position of registered manager. In the interim the area manager of the service was acting as manager. The area manager told us they were going to apply to be registered manager with the Care Quality Commission.

The acting manager told us audits were completed of care records and medicines; however we were not able to see these as they had been put into storage.

Appropriate systems were in place for the management of medicines. However, medicine records only contained one staff signature to confirm it had been checked and was correct. The MAR should be checked and countersigned by another staff member when they next visit.

The service had a call monitoring system which meant the care co-ordinator was able to monitor if staff were running late or had been held up.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Staff were aware of how to keep people safe. This meant that staff had the written guidance they needed to keep people safe.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of the action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

We saw that staff had received supervision on a regular basis. Supervision is a process, usually a meeting, by which an organisation provides guidance and support to staff.

The service was registered in March 2015 which meant staff had not worked at the service for a year. We asked the acting manager about the annual appraisals for staff. An annual appraisal is a review of performance and progress within a 12 month period. They told us they had commenced appraisals and had a plan in which to ensure all staff received an appraisal within the coming weeks.

People told us they were cared and supported to regain their independence by experienced and knowledgeable staff. People told us staff were reliable. Staff had been trained and had the skills and knowledge to provide support to the people. There were enough staff employed to meet the needs of people who used the service and if there was to be an increase in demand.

The acting manager told us all people who used the service would need to have capacity. The service did not cater for people with advanced dementia as they would not benefit from the service provided. Staff we spoke with understood their obligations with respect to gaining consent and ensuring people had choice. People and their relatives told us they were involved in discussions about their care.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before