This announced inspection took place over three days. We gave the service 48 hours’ notice of the inspection visit because we needed to be sure that someone would be in the office.

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 younger adults, working age adults and older adults living with a physical disability, mental health condition or learning disability.

At the last inspection of the service on 22 December 2016, we rated the service as Good.

At the time of this inspection, 105 people with physical and mental health conditions including people living with a dementia and learning disabilities were receiving care and support. One person received 24 hour support from a small team of staff and everyone else received a range of planned calls which included personal care, domestic care and social support.

The registered manager has been registered with the Care Quality Commission since 2 September 2016. 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 this inspection we found that improvements were needed to improve the quality of the service.

Core risk assessments were in place for people, such as for the environment and for falls however they had not been reviewed regularly. Risks outside of these core risk assessments such as alcohol abuse, safeguarding concerns and behaviours which challenge had not been appropriately risk assessed and information relating to these kind of risks had not been included into people’s care plans. This meant we did not know how the risks to people and to staff were safely managed. We found these risks put staff and people at increased risk of potential harm.

Risks to people and staff were not appropriately assessed when candidates were recruited with previous criminal convictions. We found there was a lack of information about these convictions because accurate information had not always been shared or appropriately investigated. One criminal conviction had not been accurately recorded on an application form. Records did not show that all criminal convictions had been fully discussed during interview and no risk assessment had been carried out before an offer of employment was made.

Medicines were not managed safely. People had not always received their medicines as prescribed and records of medicines had not been kept up to date. The medicines policy did not reflect current practices in place at the service.

Staff knowledge of the Mental Capacity Act 2005 was limited. Staff assumed that people who were living with dementia did not have capacity and were not able to consent to their own care. Care records wrongly stated that people did not have capacity and relatives had been asked to sign consent records and care plans even though people had the capacity to sign these records themselves. This action meant that people were not always supported to have maximum choice and control in their lives.

Staff did not receive appropriate support to carry out their roles by way of regular reviews during induction, supervision and training. The provider and registered manager did not have robust oversight of the service. An ineffective auditing system was in place which had not identified the concerns raised during this inspection. The provider had not submitted a statutory notification when required to do so.

Staff understood their role in protecting people from abuse and safeguarding notifications had been submitted when needed. Accidents and incidents had been reported and recorded and there was evidence that lessons had been learned to minimise the risk of reoccurrence. There were sufficient staff on duty and people

This inspection took place on 21 and 22 December 2015. The registered provider was given 48 hours’ notice prior to inspection because the service provided domiciliary care services. This meant we could be sure that the registered manager and people’s care records would be able for inspection. This also gave the registered provider time to gain consent from people who used the service for us to speak to them by telephone.

Meadowvale Healthcare Ltd provided domiciliary care services for people living in Redcar and Cleveland. The registered provider’s office was located in Boosbeck, a small village in the Redcar and Cleveland area. At the time of our inspection there were 15 people using the service. The registered provider employed an operations manager, registered manager and eight staff.

Meadowvale Healthcare Ltd had been running for less than one year. This meant all of the staff and the management team were fairly new in post. Because of the demands for the service, the registered provider was currently advertising for staff. The registered manager had been in place since the registered provider had set up 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.

All staff had received up to date safeguarding training. Staff had a good understanding of the signs and symptoms of abuse which people using their service could display. They were able to provide detailed information about the procedures which they needed to follow if they suspected abuse. Safeguarding procedures had been followed and appropriately recorded. All staff told us they would whistle blow [tell someone] if they needed to.

The service did not provide care or support to anyone who had a Deprivation of Liberties (DoLS) Safeguard in place. All staff had received training in DoLS and understood about the procedure they needed to follow if they suspected that someone may not be able to make decisions about their own health and well-being.

Risk assessments for people’s needs and the day to day running of the service had been carried out. People did not have a personal emergency evacuation plan in place; however the registered provider told us they would action this straight away. When action was needed to respond to people’s health conditions, we could see staff acted appropriately.

There were enough staff employed to provide care and support to people using the service. People we spoke with told us that staff attended their homes on time, were not rushed and stayed for the agreed length of time. The registered provider was in the process of recruiting further staff to meet increased demand for their service. They told us that they would not take on new people until suitable staff had been recruited. We could see that people had been recruited safely and two references had been checked and a disclosure and barring services check had been applied for before starting work at the service.

Medicines were managed appropriately and staff were trained to dispense medicines. Each staff member had been observed supporting people to receive their medicines. This meant the service could be sure that staff were competent to manage medicines safely following their training.

People had the equipment they needed to help them stay in their own homes. This meant the service was not responsible for the monitoring of wheelchairs or hoists for example, however they told us they would report any fault with them to the appropriate service. Safety certificates for the day to day running of the service were up to date, where they had expired, we could see appointments had been made with the appropriate professionals.

All staff undertook a thorough induction prog