This inspection took place on 3 and 4 July 2018 and was announced. We gave the provider 48 hours notice of the inspection to ensure we could meet with staff and people using the service in their own homes.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. It provides a service to older adults and younger disabled adults. On the day of our inspection there were 47 people receiving the regulated activity of personal care.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection in June 2017 we rated the service as ‘Requires Improvement’ as we wanted to see sustained evidence of improvement following an inspection in February 2017 where we found the service in multiple breach of regulations and rated it as ‘Inadequate’. We saw at this inspection considerable improvements had been sustained and we now rated the service as 'Good'.

People told us they felt safe with the staff from Castle Care Teesdale Limited. The registered manager and team leaders understood their responsibilities with regard to safeguarding and staff and managers had received updated training in the protection of vulnerable adults.

The provider had an effective recruitment and selection procedure in place. People who used the service and their family members said staff usually arrived on time and stayed for the agreed length of time.

Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff. The service demonstrated it learnt from accidents, incidents and safeguarding issues and shared this learning with the staff team to drive improvements.

There was a safe system in place for the management of medicines and medicines administration records were completed accurately.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. We saw that the management team and staff were committed to supporting people to remain in their own homes with support and worked with district nurses, G.P’s, occupational therapy, physiotherapists and other specialist services as and when needed.

People who used the service and family members we spoke with were complimentary about the standard of care provided by the staff at Castle Care Teesdale Limited. People said their privacy and dignity were respected and they enjoyed positive relationships with the care staff.

Care records showed that people’s needs had been assessed before they started using the service and care plans were written in a person centred way. This meant that their preferences and wishes were respected.

People who used the service and family members were aware of how to make a complaint and people told us issues raised had been addressed by the management team.

Staff told us they were supported by the registered manager, assistant manager and care co-ordinator and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. People and family members told us the management and office staff were approachable. We saw some recent concerns from people and relatives regarding communication with the office had been addressed by the management team.

This inspection took place on 19 June 2017 at the registered location office and was unannounced. We subsequently carried out interviews with staff and spoke with people via telephone on 23, 26 and 28 June 2017. Castle Care Teesdale Limited provides personal care to people living in their own homes in and around the Barnard Castle area. There were currently 40 people receiving personal care.

At the last inspection in February and March 2017 we rated the service as ‘Inadequate’ and the service was placed into ‘Special Measures’. The service has not been compliant with regulations since our inspection in 23 and 28 July 2015 and October 2016. People who use adult social care services have the right to expect high-quality, safe, effective and compassionate care. Where care falls below this standard and is judged to be inadequate it is essential that the service improves quickly for the benefit of people who use it. Special measures will give people who use the service the reassurance that the care they get should improve .

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and they are no longer rated as inadequate overall or in any of the key questions. Therefore, this service has now been taken out of Special Measures.

The provider has worked on improvements with the Care Quality Commission, Durham local authority and through their own consultants brought in to assist them since our last visit. At this inspection we found the provider had worked hard to meet all required regulations but needs to complete the improvement work they have started and to sustain the improvements long term.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

At our last inspection in February 2017 we saw that not all people had a list of medicines in their dosette boxes so staff knew what they were supporting people to take. Not all staff had been trained in the safe administration of medicines. This put people at risk of not receiving their medicines safely. On this visit we saw all policies and procedures had been revised and shared with staff in relation to medicines and all staff had been trained in the safe handling of medicines. Robust checks were now in place to ensure medicine records were safe and we saw actions taken by the service in response to issues found by audits. The service was carrying out competency checks with staff which observed staff carrying out medicine administration as well as recording their response to scenarios that may occur. We did find some gaps in the medicine administration records (MARs) we looked at. We could see that some staff had recorded their administration in the daily notes of the person rather than on the MAR and this did not contain the detail of the exact medicines that had been given. We asked the provider to explore the gaps we saw and they carried out an investigation and returned the findings to us including actions they were taking to ensure staff improved in this area.

At our last inspection in February 2017 risk assessments were not in place to ensure people were kept safe. People who required restrictive equipment such as bedrails did not have specific risk assessments in place. This meant staff did not always have the guidance in place to help them mitigate the risks to people using the service. On this visit we saw in the four files we viewed that risk assessments were in place and had been reviewed. We saw a variety of risk assessments were in place including for mov

This inspection took place on 8 and 16 February 2017 at the registered location office and we subsequently carried out interviews with staff and spoke with people via telephone on 3 and 6 March 2017. We also visited people in their own homes on 21 February 2017. Castle Care provides personal care to people living in their own homes in and around the Barnard Castle area. There were currently 72 people using the service.

At the last inspection on 16 and 19 September 2016 we rated the service as “Requires Improvement.” The service has not been compliant with regulations since our inspection in 23 and 28 July 2015. We had issued a warning notice to Castle Care Teesdale Limited on 13 October 2016 where the service was required to be compliant with regulations by 31 January 2017.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service had a registered manager in post. 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.

We checked to see if people were given their medicines in a safe manner and found there were gaps in the Medicine Administration Records (MAR). We saw that not all people had a list of medicines in their dosette boxes so staff knew what they were supporting people to take. Not all staff had training in the safe administration of medicines. This put people at risk of not receiving their medicines safely.

Risk assessments were not in place to ensure people were kept safe. People who required restrictive equipment such as bedrails did not have specific risk assessments in place. This meant staff did not always have the guidance in place to help them mitigate the risks to people using the service. We saw one person had a serious incident with a bedrail that was not followed up or reported to the relevant authorities by the registered provider.

There was not a systematic method of recording incidents. We found incidents had not been reviewed in sufficient detail to ensure people who used the service were kept safe. CQC requires registered services as a part of their registration to notify the Commission when there are incidents of a safeguarding nature, people rece

Castle Care Teesdale was last inspected on 23 and 28 July 2015 and we issued a number of requirement notices in relation to breaches of regulations relating to medicines, consent, care plan reviews, supervision and appraisal of staff and ensuring feedback from people about the service provided. The registered provider had sent us an action plan detailing how they would address the requirements identified. This had not been fully completed when we carried out our latest inspection.

The service is registered to provide personal care to people in their own homes. At the time of our inspection the provider gave us a list of 100 people who used their service, 60 of whom were in receipt of personal care.

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. At the time of our inspection there was a registered manager in post.

We found new medicine administration records had been implemented but we saw gaps in recording which had not been identified through a robust audit process which meant people may be at risk of not receiving their medicines in a safe way.

There was a recruitment procedure in place to protect people from care being delivered by unsuitable staff but the service had not ensured appropriate references were sought in the case of one recently recruited staff member.

The registered provider had in place clear guidance to staff regarding gifts and gratuities which helped prevent people from being placed at risk of financial abuse.

People’s written consent had not been obtained by the provider to deliver care. During the course of our visit the assistant manager devised a new format to implement in people’s care plans to record their consent.

The service had considered people’s food and fluid intake and put in place specific plans to meet individual people’s needs.

We found staff did not receive recorded support through supervision and appraisal meetings although staff told us they felt supported and could raise issues at any time with the service’s management team.

People, their relatives and other professionals told us the service was caring.

The service supported people to attend local groups and day centres to help prevent social isolation.

The registered provider had in place a statement of confidentiality and staff we spoke to understood the statement.

The registered provider had in place arrangements to gather information about people before they visited to assess their needs before delivering care.

We found care plans had not been formally reviewed but feedback and discussion took place between staff and people to confirm care was still appropriate. This meant there was a risk that people’s needs had changed but staff did not have up-to –date written information to guide their practice.

We found training records were not up to date but saw a new programme of training was scheduled with a new training provider. Staff told us they had received training in moving and handling, dementia, administering medicines and first aid.

Staff who were new to the service underwent an induction period although this was not always well recorded. This included staff shadowing other more experienced staff members to learn about people’s needs and how they liked their care to be delivered.

The service had sought people’s views on the quality of the service they received but needed to ensure this linked to an improvement / action plan so that the service could demonstrate it had followed up any suggestions, comments or feedback.

The service worked in partnership with key organisations to support care provision and to ensure people's healthcare needs were met.

During our inspection we found a number of breaches of the Health and Social Ca

We saw people were supported to take appropriate risks to promote their independence and were involved in decisions about their care and support needs.

We spoke with four people who used the service. All said they were very satisfied with the support they received. One person told us, "The service is first class, I am never rushed and they always have time for a chat." Another described the service as,"Excellent."

We saw evidence how the provider co-operated with other health care professionals to protect the health, welfare and safety of people who used the service.

The relationships people had with the staff who supported them were good. All personal support they received protected their privacy and dignity. This was confirmed when we spoke with people who used the service.

The recruitment records demonstrated all appropriate checks were in place before an employee commenced work at the agency.

We found suitable arrangement were in place for handling concerns and complaints.

We carried out this inspection in order to complete our inspection cycle at this location for 2012/2013. Each year we check compliance with a minimum of five of the Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. During this inspection we focused on consent to care and treatment, as well as the care and welfare of people who use services.

We found Castle Care had 42 staff who provided care to around 110 people in their own homes in the Barnard Castle area and its surrounding villages.

We spoke with 4 people who used the service. All were highly complimentary of the care, treatment and support they received. One person said “They’re wonderful! They are so very good and they know exactly what they are doing.” Other comments included “Very professional. I couldn’t fault them in any way” and “I’m well looked after. My son says I couldn’t be in better hands.”

We spoke with 3 care workers. They all said they felt very well supported by the provider and thought they gave a good quality of service to people. One staff member said “It’s about engaging with the clients; being a little ray of sunshine in their lives.” Another said “You become part of your client’s family.”

This was a follow up responsive inspection to look at improvements made following our last inspection in December 2012. Therefore, we did not visit people who used the service on this occasion.

We inspected this service on 23 and 28 July 2015. The inspection was announced. This meant we gave the provider 24 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

Castle Care Teesdale was last inspected on 28 January 2014 and was found to be compliant with the required regulations.

The service is registered to provide personal care to people in their own homes. At the time of our inspection the provider gave us a list of 100 people who used their service, 60 of whom were in receipt of personal care.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. At the time of our inspection there was a registered manager in post.

We found arrangements were not in place to ensure people were given their medicines in a safe manner.

There was a robust recruitment procedure in place, reducing the risk of an unsuitable person being employed to work with vulnerable people.

The provider had in place clear guidance to staff regarding gifts and gratuities to prevent people from being placed at risk of financial abuse.

People’s consent had not been obtained by the provider to deliver care.

The service had considered people’s food and fluid intake and put in place specific plans to meet individual people’s needs. Relatives were confident people were receiving the required nutrition.

We found staff were not receiving appropriate support through supervision and appraisal where they could discuss any concerns as well as their training needs.

People, their relatives and other professionals told us the service was caring.

The service supported people to attend local groups and day centres to prevent social isolation.

The provider had in place a statement of confidentiality and staff we spoke to understood the statement.

We found the provider did not have in place arrangements to review people’s care plans.

We found families were involved in their relatives’ care and had acted as natural advocates for their family members. The provider had responded to their role as advocate, listened to what was said and as a result care plans were put in place to support people’s needs.

The provider had in place arrangements to gather information about people before they visited people to assess their needs before delivering care.

We found training records were in place which demonstrated staff had received appropriate training. Staff told us they had received training in moving and handling, dementia, administering medicines and first aid.

Staff who were new to the service underwent an induction period. This included staff shadowing other more experienced staff members to learn about people’s needs and how they liked their care to be delivered.

The service worked in partnership with key organisations to support care provision, service development and joined-up care.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.