This was an announced inspection which took place on 18, 23, 24 July and 15 August 2018. We gave the provider 24 hours' notice to ensure someone would be available at the office.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

At the last inspection in May 2017 the service was not meeting all of the legal requirements with regard to regulation 17, governance, regulation 9, person-centred care and regulation 12, safe care and treatment.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe care and treatment, person-centred care and governance to at least good.

At this inspection we found improvements had been made and the service was no longer in breach of regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

South Tyneside Homecare Ltd is a domiciliary care agency. It provides personal care to older people in their own home. At the time of inspection 100 people were using the service supported by 50 staff members.

A registered manager was 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 and their relatives told us the service kept them safe. They trusted the workers who supported them. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Policies and procedures were in place to safeguard people from abuse. People's medicines were managed safely. The provider and registered manager monitored staffing levels to ensure enough staff were deployed to support people safely. The provider's recruitment process minimised the risk of unsuitable staff being employed.

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. Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. There were other opportunities for staff to receive training to meet people's care needs.

Staff were aware of people's nutritional needs and made sure they were supported with eating and drinking where necessary. People's health needs were identified and staff worked with other health care professionals to ensure these were addressed.

People praised the kind and caring approach of staff. Staff were respectful and explained clearly how people's privacy and dignity were maintained. Staff understood the needs of people and care plans were person-centred. People and their relatives spoke very positively about the care provided.

People were provided with opportunities to follow their interests and hobbies. They were supported to contribute and to be part of the local community.

Staff said the management team were supportive and approachable. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up-to-date about any changes in people's care and support needs and the running of the service.

People had the opportunity to give their views about the service. There was consultation with people and family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

This inspection took place on 24 and 30 May 2017 and was announced. We gave 48 hours’ notice of this inspection because the service is a domiciliary care agency and we needed to be sure there was someone in the office available to assist with the inspection. We last inspected South Tyneside Home Care on 17 May 2016 and found the provider had breached three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014.

At the last inspection we identified concerns in respect of the safe care and treatment of people using the service. Care plans were not person-centred and did not demonstrate any clear involvement of the person or their relatives. Care plans did not always contain detailed information on how to support them. Risk assessments lacked sufficient information to enable staff to support people consistently and safely. Risk assessments were not reviewed appropriately. The provider’s quality assurance system did not include managerial oversight resulting in a lack of knowledge on how the service was performing and what areas were in need of development and improvement.

We undertook this inspection to check that the provider now met legal requirements. We found the provider continued to breach regulations.

We found care plans were being updated to include more personalised information for staff. However some plans did not contain detailed information on how to support people with specific needs.

Risk assessments were in place and had been updated, however not all risk assessments contained sufficient information to enable staff to support people consistently and safely.

The quality assurance process had been reviewed and the registered manager was routinely checking audit results and actions. Care file audits had not identified any of the issues or concerns we found at this inspection.

You can see what action we told the provider to take at the back of the full version of the report.

South Tyneside Home Care is an employee owned social enterprise that is registered with the Care Quality Commission for the regulated activity of personal care. The service provides domiciliary care and support for people in South Tyneside. The workforce are the owners of the agency and they participate in the decision making process about the direction of the agency by making provisions for appointed employees to serve on the board.

The service had a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like provider’s, 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 provider had developed a more structured approach to quality assurance. A new post of compliance officer had recently been filled with an operations manager post soon to be advertised. Documentation was being reviewed to be more standardised across all locations and a new risk assessment process being implemented to provide more detailed information for staff. This meant the provider was proactively working to improve the quality assurance process in order to drive improvements.

Medicines were managed by staff who were appropriately trained. Checks were in place to ensure staff remained skilled and competent. MAR charts were completed correctly with no gaps or anomalies.

Medicine administration records (MAR) we reviewed did not contain information for staff to follow when people were prescribed topical medicines (used on the skin) as to which specific area of the body the cream or ointment was to be applied. We found the assistant manager had identified this concern and had developed body maps to be issued with people’s MAR setting out where topical medicines were to be applied.

Recruitment practices at the service were thorough appropriate and safe so only suitable people

The inspection took place on 17 May 2016 and was announced.

South Tyneside Home Care is an employee owned social enterprise that is registered with the Care Quality Commission for personal care. The service provides domiciliary care. At the time of this inspection the service provided support to 139 people who resided in the South Tyneside.

The service had a registered manager. 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.

During this inspection we found the registered provider had breached regulations 9, 12 and 17 of the Health and Social Care Act 2008.

We found people’s daily support plans did not always contain detailed information on how to support them. Where risks were identified through assessments, control measures to mitigate risk were not detailed in daily support plans.

The provider’s quality assurance process for care records was not robust. The audit tool covered a document check, not the content of the document. We found where spot checks had been carried out and reviews of support had been completed, these had not identified the lack of information provided for staff. The registered provider did not have a process to develop the service that could be reviewed and monitored to drive improvement.

The registered manager did not always submit statutory notifications. Statutory notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

We saw the process for the recording and management of safeguarding was not effective. The service had failed to submit statutory notifications regarding allegations of abuse where relatives were involved. The service did not submit the required statutory notifications regarding the death of someone using the service.

You can see what action we told the provider to take at the back of the full version of the report.

Everyone we spoke to told us that they felt safe or their relatives were safe with their carers. One person told us, “They are kind and respectful.”

The provider operated an effective recruitment procedure which included ensuring appropriate checks were undertaken before staff started work. Staff had completed mandatory training required to perform their role. Staff received regular supervision and annual appraisals.

Staff received training and were supported in their roles. Staff attended regular team meetings. One staff member told us, "I am always doing courses.” Training plans included dates for staff to refresh their knowledge.

People had a regular team of care staff. Relatives and people we spoke with were very happy with the service they received and everyone spoke warmly about their carers. Staff knew how to support people to access other health care professionals if necessary.

People who needed support with meals and shopping told us they were well supported. One person told us, “They know what I Iike, I enjoy my meals”. Another commented, “They always go through the receipt with me.”

The service provided people with information about the service they should expect including details of how to make a complaint about their care. We found concerns were acted upon straightaway and records kept in people’s files. Numerous compliments had been received from relatives and people who used the service.

People, relatives and staff said the service was well managed. They described the registered manager as “approachable”.

We looked at a selection of people’s medication administration records (MAR) and found these were completed correctly with no gaps or inaccuracies. Staff were trained in the administration of medicines and received competency checks.

The service had a system in place to capture people’s views