About the service: Careline Berwick is a domiciliary care agency that was providing personal care to 180 older people at the time of the inspection.

People’s experience of using this service: People received good care from kind and considerate staff.

People told us the service was safe. Staff had a good understanding of safeguarding and the whistle blowing procedure; this included knowing how to report concerns. People were supported by punctual and reliable staff. The provider followed robust recruitment checks prior to new staff starting their employment. Medicines were managed safely. Incidents and accidents were fully investigated and action taken to keep people safe.

Staff confirmed they were well supported; they received regular one to one supervisions and appraisals. Training was up-to-date for all staff. Staff supported people to have enough to eat and drink where this was necessary. People were supported to access healthcare services when needed.

People’s needs had been assessed to identify the care they wanted; this was used as a baseline to develop personalised care plans. People knew how to raise concerns and felt confident to do so.

The provider had a comprehensive and structured approach to quality assurance. People and staff told us the service was well managed. People and staff had opportunities to provide feedback about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Good (the last report was published on 19 August 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule for services rated good.

Careline Berwick is a domiciliary care agency providing care and support to people in their own homes. It is registered to deliver personal care. At the time of the inspection the registered manager told us they supported around 200 people over the wider rural area of north Northumberland, including Berwick, Belford, Wooler, Seahouses and surrounding villages.

The last inspection of this service took place in February 2015 where the provider was found to be in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe management of medicines and the maintenance of effective records. At this inspection we found improvements had been made and the provider was no longer in breach of the aforementioned Regulations.

This inspection took place on 5 and 6 July 2016 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 in.

At the time of our inspection there was a registered manager in place. Our records showed she had been formally registered with the Care Quality Commission since July 2015. 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 told us they felt safe when being supported by staff and looked forward to them visiting. Staff told us they had received training in relation to safeguarding adults and records confirmed this. Appropriate processes were in place to recruit staff and to carry out checks to ensure they were suitably experienced to support people with their personal care needs. People told us staff could be sometimes late or unfamiliar staff called to support them. Staff told us covering calls in rural areas could sometimes be difficult. Supervisory staff said they worked additional hours to cover care work when care staff were not available. The provider told us they monitored the hours worked by care staff and supervisory staff. We have made a recommendation about staffing. The provider had an on-call out of hours system, manned by senior staff and care staff said managers could always be contacted for advice.

At the previous inspection we identified some shortfalls with the safe handling of medicines. At this inspection we noted there had been changes to how medicines were managed and improved systems were in place to ensure this was done safely.

People told us they felt staff had the right skills to support them. Staff told us they received training, although the majority was undertaken using workbooks. Some staff felt additional shadowing of experienced staff would be helpful, particularly for staff who had not previously worked in care. We have made a recommendation about training. Staff told us they received regular supervision and appraisals and records supported this. The manager confirmed no one being cared for by the service was subject to any orders from the Court of Protection under the Mental Capacity Act (2005). Specific questions were asked at assessment around any formal Power of Attorneys in place.

People were supported to maintain their well-being, as staff worked co-operatively with district nurses. Staff said they would raise matters with general practitioners or contact the office, if they were worried about people. People told us they were supported by care staff to access regular meals and drinks.

People told us that care staff were exceptionally caring and they looked forward to them calling. They said staff were supportive and flexible and would undertake additional duties for them. They felt involved in determining their care and said staff respected both their privacy and dignity.

At the previous inspectio

This inspection took place on 17, 19 and 12 February 2015 and was announced. This was the first inspection of the service under the current provider. The service was formally registered with the Commission in June 2014.

Careline Berwick is a domiciliary care agency providing care and support to people in their own homes. It is registered to deliver personal care. At the time of the inspection the acting manager told us they supported around 180 people over the wider rural area of north Northumberland, including Berwick, Belford, Wooler, Seahouses and surrounding villages.

At the time of our inspection there was no registered manager in place at the service, although our records showed that a person was still registered with the Commission. The regional manager told us the person had left some time ago and would follow this matter up. An acting manager was in place and she told us she was applying to become the registered manager. Our records showed that this application was in progress. 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 told us they felt safe when receiving care. They told us that they trusted the care workers who supported them and looked forward to them visiting. Staff told us they had received training in relation to safeguarding adults and would report any concerns. Appropriate processes were in place to recruit staff and to carry out checks to ensure they were suitably experienced to support people with their personal care needs and work with vulnerable people. People told us that staff attended appointments on time and although there were some late calls or missed appointments, these were kept to a minimum.

The provider had in place plans to deal with emergency situations through the use of an on call out of hours system, manned by senior staff and the provision of an adverse weather procedure to ensure people with key care needs could be supported if travel became difficult for care staff.

We found some issues with the safe handling of medicines. We found that care plans did not always reflect the instructions on the medicine boxes and that appropriate systems to ensure that people received the correct medicines were not in place. The acting manager told us that plans were in place to address these issues.

People told us staff had the right skills to support their care. Staff said they received training and there was a system in place to ensure this was updated on a regular basis. Staff told us they received regular supervision and appraisals and we saw documents that supported this. Staff told us they could not recall receiving dedicated formal training in relation to the Mental Capacity Act 2005 and how it related their work, although most staff were able to talk about best interests decisions and supporting people to make choices. People were supported by care staff to maintain appropriate intake of food and drinks.

People told us they found staff caring and supportive. They said they felt involved in their care and had their privacy and dignity respected during the delivery of personal care and support. People were also supported to maintain their well-being, as staff worked with district nurses or would raise matters with general practitioners, if they were worried about people.

People’s care needs were assessed and care plans detailed the type of support they should receive. However, we found that care plans sometimes lacked detail or did not reflect the type and range of care that was being provided. The acting manager and regional manager told us the care plan documentation was in the process of being changed to cover a wider range of issues and reflect in more detail people’s needs. We saw this new documentation was being introduced in some care record. The provider had in place a complaints procedure and dealt appropriately with any concerns raised. People told us they had few, if any, complaints and any issues raised were dealt with.

The provider had in place system to effectively manage the service and monitor quality. Senior staff undertook regular spots checks on care workers to ensure they were providing appropriate levels of care. People told us they were contacted to ask their views on the service and discuss any concerns. Staff told us there were regular meetings and information was provided to ensure they were up to date about any changes in systems. Records were up to date and stored securely.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.