Mears Care Limited Wallsend provides personal care to mainly older adults in their own homes. At the time of inspection there were 130 people using the service.

We previously inspected Mears Care in September 2017, at which time the service was in breach of regulations 9, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the previous inspection we rated the service as requires improvement. At this inspection, we found there had been improvements in all areas and the service had improved to good. The service was no longer in breach of the regulations.

There was a registered manager in place with suitable experience and knowledge of 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.’

The registered manager had ensured a range of improvements had been made, specifically with regard to the implementation of the electronic call monitoring system and rota planning system. We found instances of missed or delayed calls had been significantly reduced.

People who used the service felt safe and had confidence in the service.

There were risk assessments in place to ensure staff knew how to keep people safe. These were regularly reviewed. Some risk assessments would benefit from more personalised details.

Where staff administered medicines they had been appropriately trained. Staff competence in this regard was regularly checked and reminders shared with all staff where common errors or poor practice were identified.

Staff were aware of their safeguarding responsibilities and understood the risks people faced. They also understood the risks of lone working and were well supported by the provider in this regard.

No concerns were raised with us by external professionals regarding the service.

Rota planning was effective and well managed. Out of hours on call arrangements were in place. Staff mobile phones were used to log in and out of calls and this system was working well.

There was effective liaison with external professionals to ensure people’s needs could be reviewed and met.

Staff were well supported by way of induction, ongoing training and support and staff meetings.

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.

Continuity of care was generally good particularly given the higher volume of shorter calls the provider undertook.

Staff treated people in a dignified way and feedback was consistently strong in this regard.

The registered manager had sent surveys to all people who used the service, reviewed responses, responded to people and put a plan in place to address any concerns.

Care files were well-ordered and logical and contained sufficient person-centred detail.

People’s changing needs were well met. The service had provided end of life care previously and worked well with external nurses to ensure people were supported in a consistent, dignified way.

The management of complaints had improved since our last inspection. All people who used the service and their relatives knew how to raise concern. Complaints were comprehensively addressed.

The registered manager was receptive to feedback and was aware of aspects of best practice.

The culture was one of meeting people’s care needs well, whilst also trying to ensure this was done in a positive, person-centred way, rather than a task-focussed way.

The registered manager had ensured the required improvements to the service had been made.

The inspection took place from 25 September 2017 to 4 October 2017 and was announced. The service had been registered in January 2016. This was the first inspection since registration and the first time the service has been rated Requires Improvement.

Mears Care Limited Wallsend is a domiciliary care agency. It provides personal care to mainly older people living in their own homes. At the time of our inspection 161 people were using the service.

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.

We found that the staffing capacity, rostering and monitoring of visits were not sufficiently robust in ensuring people always received a reliable service. A number of people and their relatives reported a lack of continuity in staff and problems with the timings and duration of their care visits. There were also times, which the service had not identified, when staff had failed to turn up and people had not been provided with the care they needed.

Although new and longer standing staff were trained and supervised, people and their relatives had wide ranging views about whether the care they provided met their needs. Some were satisfied and others told us their support was affected by staff not having the necessary skills and rushing people’s care.

People using the service praised the caring approach of staff, how they engaged with them and respected their privacy and dignity. However, negative opinions were expressed about how the service was managed, people’s contact with office based staff, and complaints not being resolved.

Whilst more care staff had been recruited, there were on-going pressures which compromised the management resources of the service. There was a vacant co-ordinator post and at times the registered manager, co-ordinators and seniors directly provided care, removing them from their usual roles.

Feedback from people about their satisfaction with the service had been obtained through surveys, but other communication and quality assurance methods were not well structured. The electronic system for monitoring whether staff visited people at the right times did not give a fully accurate picture. There was limited documented evidence of how issues communicated to, from and within the office were captured and responded to. An overview of the frequency and findings of internal quality audits was not kept and there was no recorded action plan for how the service intended to improve following the last quality review.

We judged that improvements were required to the governance of the service, safeguarding and in ensuring people always received a consistent service with appropriate care. We have made a recommendation about the management of complaints.

Measures were taken to reduce risks to people’s personal safety. Suitable arrangements were in place to assist people with their prescribed medicines. Where needed, people were supported in accessing health care services and meeting their dietary needs.

The implications of mental capacity law in upholding people’s rights were understood. People and their families were involved in and agreed to their care plans.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing, safeguarding, person-centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.