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 Activities) Regulations 2014 in relation to the premises and equipment and records. You can see what action we told the provider to take at the back of the full version of this report.