This inspection took place on 9, 11 and 17 January 2019 and was announced. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the office to assist with the inspection.

The service was last inspected in July 2016 and was rated good. When we returned for this inspection we identified issues with staff training and the provider’s quality assurance processes. The rating of the service deteriorated to requires improvement. This is the first time the service has been rated required improvement.

This service is a domiciliary care agency. It provides personal care to people under the age of 18 who live with a physical or learning disability.

Not everyone using South Tees Home Support Service receives regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection eight people were receiving personal care from the service.

The service operated in line with the Registering the Right Support guidance. These values include choice, promotion of independence and inclusion. People using the service could live as ordinary a life as any citizen. Although the service had not been originally set up and designed under the Registering the Right Support guidance, they were continuing to develop their practice to meet this and used other best practice to support them.

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. The registered manager was registered in 2011. The registered manager had been absent on planned leave and had returned to work the day before our inspection began. During that time the service had been managed by an interim manager, who also assisted with this inspection.

Training was taking place but the provider’s governance systems were ineffective at monitoring and recording this. The provider did not have systems in place to assess, monitor and improve the quality and safety of the service.

Risks to people were assessed and steps taken to reduce them. The provider had effective infection control policies and procedures in place. People were safeguarded from abuse. Plans were in place to support people in emergency situations. The provider monitored staffing levels to ensure people were supported safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed. Policies and procedures were in place to provide support with medicines if needed.

Staff were supported with regular supervision and appraisal. A detailed assessment was carried out before people started using the service to ensure the appropriate support was available. The service worked closely with other healthcare professionals to ensure people received effective support. 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 supported with food and nutrition.

Relatives we spoke with told us staff were caring and kind. External professionals also spoke positively about the support provided by staff. People were treated with dignity and respect. Staff were passionate about their roles and committed to supporting people to live full and happy lives. Staff were knowledgeable about issues surrounding equality and diversity and were clearly committed to treating people as individuals. Policies and procedures were in place to support people to access

This inspection took place on 11 July 2016. This was an announced inspection because we needed to be sure that staff would be at the service. We previously inspected the service on 5 December 2013 and found that the service was meeting all of the regulations which we inspected.

South Tees home support provided care and support to people under the age of 18 who lived with a physical and / learning difficulty. People had very limited communication difficulties; this meant we were unable to speak with people during inspection. Staff assisted people's parents to make sure people received the care and support needed. This included helping people get ready for school, assistance with personal care and mealtimes, providing activities and taking people out into the community. At the time of inspection, they were 21 people using the service. All staff provided care and support to people in their homes; however the service did have an office located in a residential area of Middlesbrough.

The registered manager had been registered with the Commission since 2011. 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.

Staff supervision was carried out, however this was not in line with the registered provider’s policy for supervision. There were some gaps in supervision and appraisal records.

All staff participated in training. We identified a number of gaps in training; however the registered manager had started to take action to address this.

All staff were supported through an induction programme which included training, shadowing more experienced staff and developing relationships with the people and their families whom they would be working with.

People were supported with their nutritional and hydration intake. Staff worked closely with people’s families and followed any recommendations put in place by health professionals.

The service took action to keep people’s care records up to date about each person’s health. Records showed the health and social care professionals involved in each person’s care and staff supported people to attend health appointments if needed.

All staff followed and understood the guidelines set out in the Children’s Act 2004. The service sought consent from parents who held parental responsibility for each person. Staff told us they did observe for non-verbal cues to make sure people were happy with the care and support they were providing.

The service worked closely with social workers and child protection teams to keep people safe. Care and support and care plans were updated when required to reflect any new or increased risks. All staff told us they felt confident in raising any concerns which they had about the people they cared for.

Detailed risk assessments were in place and where needed were followed up by a care plan. Robust procedures were in place to keep people safe. Risk assessments also included information about people’s understanding of risk and any further measures which staff needed to take into consideration.

People’s parents were responsible for their prescribed medicines and staff did not have responsibility for this. Staff were trained to dispense emergency epilepsy medication. Protocols and emergency health care plans were in place for this.

People’s parents spoke positively about the care and support their children received from the service. From speaking with staff we could see they enjoyed caring for these people.

Privacy and dignity was maintained at all times. People's parents told us they felt involved in people's care and felt able to make decisions on their behalf which staff respected.

Person-centred care plans were in place which reflected people’s individual needs, wishes and preferenc

At the time of the inspection the service was providing personal care and support to 125 children and young people aged from 0 to 18. As part of the inspection we spoke with the parents of five children / young people who used the service. We also spoke with the manager, two senior home support workers, a home support worker and the service manager.

Parents told us that they were well supported. We were told that the agency provided a reliable service. One person said, “It took me a long time to trust anyone to look after him / her but they do a great job.” Another person said, “He / she has a small team that work with him / her. I’m given the rota in advance. They never send bank staff. Someone always steps in to cover sick leave."

Children, young people and parents were supported by, suitably qualified, skilled and experienced staff. We found that the provider had effective recruitment procedures and that relevant checks were carried out on staff to ensure that they were suitable to work with children and young people.

We saw that there was sufficient staff with the right knowledge and experience to support people.

We found that appropriate systems were in place to deal with comments and complaints.

We found that records were stored securely.

We spoke to relatives of two people who use the service, who told us about their experiences. They told us “it’s an absolutely first class service”, “I’ve always been very impressed with them” and “they’ve been a bit of a lifeline really”. People told us that they were always involved in any care planning with the service and felt able to give their views and have an input into the service they received.

We looked at the care plans for three people who used the service. These showed that the service had carried out sufficient assessment of the needs of each person, and as an ongoing review, to enable appropriate care and support to be given.

We spoke with three of the agencies’ care staff, the manager, and a social worker for one person who used the service. Staff told us that they “loved their jobs,” enjoyed working for the agency, were well trained and supported by management, and thought that the agency provided a good service.