This inspection took place on 23, 24, 29 and 31 January 2019 and was announced. The 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 February 2018. At that time, we identified a breach of our regulations in relation to medicines management, risk assessments and good governance processes. We took action by requiring the provider to send us action plans setting out how they would improve in these areas.

When we returned for this latest inspection we saw that that improvements had been made in relation to risk assessments. However, we found that medicines were still not managed safely. The provider’s quality assurance processes had not identified these issues. These were a continuing breach of our regulations.

This is the third time the service has been rated requires improvement.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community It provides a service to older adults, people with learning disabilities or autistic spectrum disorders and people with mental health conditions. At the time of our inspection 73 people were receiving personal care from the service.

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 also one of the owners and registered providers of the service.

Risk assessments had improved but further and sustained improvement was needed. Accidents and incidents were monitored to see if lessons could be learned and action taken to improve people’s safely. People were safeguarded from abuse. Policies and procedures were in place to promote good practice in infection control. Plans were in place to support people in emergency situations that disrupted the service. The registered manager and provider ensured sufficient staff were deployed to provide safe support. The provider’s recruitment policies minimised the risk of unsuitable staff being employed.

People's health and social needs were assessed to ensure the service could provide effective support. Staff worked collaboratively with external professionals to maintain and promote people’s health and wellbeing. Staff were supported with training, supervisions and appraisals. People were supported with managing food and nutrition as part of their support package. 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.

People and relatives spoke positively about the support they received. People were treated with dignity and respect. People said they were empowered by the support they received and had used this to improve their overall quality of life. Policies and procedures were in place to support people to access advocacy services.

People received personalised support based on their assessed needs and preferences. The provider had systems in place to ensure information was accessible to people. The provider supported people to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service and the leadership provided by the registered manager and provider. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken. Feedback was sought from people, relatives and staff and was acted on.

This inspection took place on 7, 13 and 15 February 2018 and was announced. The 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 September 2016. At that time we identified a breach of our regulations in relation to good governance processes. There were gaps in care plans and risk assessments. Supervision and appraisal records contained limited information. Staff recruitment records did not always show if post-recruitment reviews had been carried out. There were also gaps in meeting minutes and action plans where issues were identified. Quality assurance procedures had not highlighted the concerns we had during that inspection. We took action by requiring the provider to send us action plans setting out how they would improve in these areas.

When we returned for this latest inspection we saw that that improvements had been made in relation to supervisions and appraisals and post-recruitment reviews. However, we found that risk assessments were still limited or not in place for people with specific health conditions. The provider’s quality assurance processes had not identified these issues. This was a continuing breach of our regulations. We also found that medicine records were not always completed accurately.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community It provides a service to older adults, people with learning disabilities or autistic spectrum disorders and people with mental health conditions. At the time of our inspection 57 people were receiving personal care from the service.

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 also one of the owners and registered providers of the service.

Accidents and incidents were monitored to see if lessons could be learned to improve the service. The provider had a business continuity plan in place to provide guidance to staff on supporting people in emergency situations that might disrupt the service. Policies and procedures were in place to safeguard people from abuse. People and their relatives said people were supported by stable staffing teams. The provider’s recruitment processes minimised the risk of unsuitable staff being employed. Policies and procedures were in place to support staff to maintain good infection control practice.

Supervisions and appraisals were taking place regularly. Staff received a range of mandatory training in order to support people effectively. 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. People were supported to manage their food and nutrition and to access external professionals to maintain and promote their health.

People and their relatives spoke positively about the support they received at the service, describing staff as kind and caring. People and their relatives said staff treated them with dignity and respect. Staff promoted people’s independence and encouraged them to do as much as possible for themselves. Policies were in place to support people to access advocacy services where this might be needed.

People received personalised care based on their support needs and preferences. Some people received support with accessing activities and the wider community as part of their support plan. Policies and procedures were in place to respond to and learn from complaints. At the time o

This announced inspection took place on 27 September 2016. This meant the registered provider and staff knew that we would be attending. This was the first inspection of the service which had registered with the Commission on 5 April 2016.

At the time of inspection, the service provided personal care to 22 people living in their own homes. People were supported by 29 staff who worked within specific postcode areas within Middlesbrough. The office was located in a residential area within Middlesbrough.

The registered manager had been registered with the Commission since 23 February 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.

Care plans and risk assessments did not contain the detail needed. The concerns we found had not been identified by the service's own qualities assurance processes in place. Minutes of staff meetings had not always been recorded and there were a lack of action plans in place following audits.

There were gaps in supervision and appraisal records and staff induction records. We could see these meetings had taken place however records had not been fully completed. Staff told us they felt supported by the management team.

There were some gaps in training; however planned dates had been put in place

A small number of complaints had been made. Records in place showed the nature of these complaints and the action taken to resolve them including an outcome.

People, their relatives and staff spoke positively about the registered manager. Staff told us they felt able to discuss any concerns with them and felt supported by them.

Safeguarding alerts and accidents and incidents had been recorded and were analysed to identify any patterns and trends which may have occurred. This allowed the registered manager to take action to reduce any future risks of harm.

Notifications had been submitted to the Commission when needed.

Safeguarding alerts had been made when needed. All staff understood the procedure which they needed to follow.

Staff understood the risks to people; however identification of these risks were not always followed with risk assessments. We could see that staff addressed these risks despite any gaps in the care records.

On-going recruitment was in place because there had been a high turnover of staff. Robust recruitment procedures were in place.

People and staff confirmed there were enough staff on duty to provide safe care and support to people.

Good procedures were in place for the management of medicines. We highlighted gaps in medicine administration records and topical cream records and these were addressed on the day of inspection.

Staff understood the procedures they needed to follow for people who were at risk of malnutrition and dehydration. Staff also made sure people had access to provisions such as bread and milk.

People were supported by staff when they experienced deterioration in their health and well-being. This included making appointments to see health professionals.

Staff understood the procedures they needed to follow for obtaining consent from people. Where they were any queries about whether people had capacity to make their own decisions, staff told us they would also seek support from the registered manager.

People spoke positively about the care and support they received from staff at the service. We could see people and staff had good relationships with each other and people told us they communicated well with staff.

People’s privacy and dignity was respected and maintained. People told us they received a good standard of care from staff and felt involved in any decision making about their care.

We found one breach in the Health and Social Care Act 2008 (Regulated