This inspection took place on 14 and 15 March 2018 and was announced. The expert by experience contacted people and a relative by phone from 19 – 23 March 2018. We gave the provider 48 hours’ notice because staff provide support to people in their own homes and we wanted to ensure there would be someone at the service office when we called.

Cheviot Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older and younger adults living in Wooler and the immediate surrounding area. At the time of the inspection the service was providing care and support to 22 people. CQC only inspects the service being received by people provided with ‘personal care.’ Personal care involves help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. Cheviot Care Limited also provided other services such as housework and enabling, which CQC does not regulate.

At our previous inspection in December 2016, we identified three breaches of the regulations relating to safe care and treatment, staffing and good governance. An effective system to manage medicines was not in place; there was limited evidence that recent training had taken place; care records were not always detailed or available and formal documented audits to monitor the quality and safety of the service were not completed. We rated the service as requires improvement. We requested an action plan describing what actions the provider was going to take to improve. This was not provided .

The service had a registered manager in post who had been registered with the CQC since July 2011. 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 service was co-ordinated from a small office in the registered manager’s own home.

Cheviot Care Limited consisted of three full time members of staff, including the registered manager. All three were directors of the service. Two part-time staff were also employed. All staff, including the registered manager delivered care and support. People told us there were sufficient staff deployed. We accompanied the registered manager and one of the directors on visits and saw that they carried out care and support in a calm unhurried manner.

We found continuing shortfalls with the management of medicines. An effective system to manage medicines was not in place. Risks were not always assessed or documented.

People told us they felt safe with the staff who supported them. We raised a safeguarding alert regarding the management of one person’s medicines and another concern which was not related to the care and support provided by staff at Cheviot Care Limited.

Staff told us there was sufficient training and felt supported. We found that further training had been carried out. However, records were not always available to demonstrate this. In addition, an effective system was not fully in place to monitor and review staff training.

The registered manager was aware of the Mental Capacity Act (2005). She said no one using the service was subject to any restrictions placed on them by the Court of Protection.

People and relatives told us that staff were very caring. They said their privacy and dignity was respected during the delivery of personal care and support. People told us they felt involved in their care and said the service kept their relatives up to date with any issues.

We found that care records still lacked detail. This did not affect the responsiveness of staff, because people were supported by the same small group of staff who knew them very well.

There was a complaints procedure in place. No formal complaints

This inspection took place on 19 December 2016 and was announced because the service provides support to people in their own homes and we wanted to ensure there would be someone at the service office when we called.

Cheviot Care Limited provides home support and personal care to people living within the local community in Wooler. At the time of the inspection 26 people were being provided with services, although this figure will fluctuate due to the nature of the service.

The service had a registered manager in post who had been registered with the CQC since July 2011. 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 found issues with the management of medicines and medicines records at the service. There were several unexplained gaps in the recording of medicines and some medicines detailed on the medicine administration records (MARs) were not complete or sufficiently detailed. Care plans to support people with their medicines were not specific and lacked detail.

The service had recruited one additional member of staff since the last inspection. Whilst there was evidence of an application and interview process the provider had failed to follow and secure references for the staff member. A Disclosure and Barring Service (DBS) check was in place. People told us they were well supported by staff and there were never any missed calls.

People told us they felt safe when receiving care. They told us they trusted the care workers who supported them and looked forward to them visiting. The registered manager told us there had been no safeguarding events in the last 12 months. Not all care records contained an up to date risk assessment.

There was limited evidence staff had received recent training or refreshing of skills. The registered manager told us the service had recently contracted with Sunderland College to provide future training. She told us supervisions and appraisals had been undertaken but documentation was not immediately available as it was being assessed as part of her own management training.

The registered manager was aware of the Mental Capacity Act (2005). She said no one using the service was subject to any restrictions placed on them by the Court of Protection. She was aware of one relative having formal Lasting Power of Attorney on behalf of a person who used the service.

People were also supported to maintain their well-being, as staff supported people to contact their general practitioner or other services, when necessary. People told us staff supported then to access sufficient meals and drinks throughout the day. Staff also supported people with shopping.

People told us they found staff caring and supportive and praised the staff highly. They said their privacy and dignity was respected during the delivery of personal care and support. People told us they felt involved in their care and said the service kept their relatives up to date with any issues.

Copies of the local authority assessment documents were available in people’s care records, although there was limited documentary evidence that the service had carried out its own assessment of needs. Daily living plans contained some highly personal and individual information to help staff to support people. However, there was a lack of detail in other areas, such as the support people required with medicines. Care plans were not always formally reviewed. Although there was evidence in staff meeting minutes that changes to people’s care needs were discussed.

The registered manager told us there had been no formal complaints within the previous 12 months. People we spoke with told us they had not raised any complaints and were happy with the service.

The register

The announced inspection took place on 6 May 2015. We last inspected Cheviot Care Limited in September 2013. At that inspection we found the service was meeting all the regulations that we inspected.

Cheviot Care Limited provides home care and housing support for people living within the local community in Wooler. At the time of the inspection 30 people were being provided with services, although these figures will fluctuate due to the nature of the service.

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.

People told us or communicated that they felt safe. Risks were identified and generally managed effectively so that people were kept safe, without compromising their independence. Staff knew how to protect people from abuse because of appropriate training received and safeguarding procedures that were in place.

Emergency procedures were in place to ensure that people continued to receive care and support from the provider, for example in poor weather conditions. The provider also had systems in place to ensure staff sickness and holidays were covered.

There were enough staff to meet people’s needs. Staff support was provided at the times people needed it and managed flexibly so people’s individual wishes could be accommodated. Staff had been vetted before they were employed to ensure they were suitable to work with vulnerable people.

People told us they got their medicines at the times they needed them and staff supported them well with this. We have made a recommendation to the provider to ensure best practice in managing medicines is followed.

The provider had ensured the staff were trained to provide the care people needed. This included basic training in the fundamentals of care, as well as more specialised training using healthcare professionals when required.

The registered manager understood the requirements of the Mental Capacity Act 2005 and had taken action where necessary, when concerns were identified about people’s capacity to make their own decisions.

Where staff supported people to eat and drink, this was done effectively.

People got the support they needed to maintain good health and obtain additional medical support if the need arose. There were effective systems in place to monitor people’s health and wellbeing.

Staff were very kind and considerate when providing care and support to people. They supported people to express their views and were skilled at listening and communicating with people. It was apparent people got on well with their care workers. They told us, “I like the workers.” Staff understood the importance of promoting people’s privacy and dignity when they provided care to them.

Care plans were in place to guide staff as to how care should be provided, although these needed to be reviewed to ensure detailed information was recorded and we have made a recommendation to the provider. It was clear from our communication with people, they had been involved in planning their care. As a consequence, the support provided to people reflected their wishes and aims. This meant people got the support they needed and wanted. For instance, people were able to get out into the community if that was part of their support package. This showed the service provided the personalised care people wanted.

People understood how to make a complaint or raise any concerns about their care. The registered manager had checked to make sure people understood how to do this. Documents about making a complaint were available to people who used the service.

The registered manager provided good leadership to the staff team and managed the service well. Both she and the staff team were well known to people in the local area.

The staff team promoted a positive culture, which meant both people using the service and staff, had ample opportunities to discuss their views about the service. People’s views were taken into account which meant the service was provided in a flexible way to meet people’s needs, wishes and choices.

There were systems in place to check on the quality of care being delivered including regular meetings with people who used the service and staff.

We spoke with two people who received a service and with two relatives of people. They told us staff provided a very good service. Relatives said staff provided a consistent service and they were prompt in coming to their homes. They said they knew the staff who provided their service and that this was important to them. One person said, “The staff are brilliant and we are very satisfied with the service.” Another person said, “They come to suit our needs and we always know who is coming. That is the nice thing about having a local service.”

We found people were treated with respect and were involved in making choices about their care.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Systems were in place to protect people from the risk of infection because the provider had followed appropriate guidance.

Staff were well supported by the provider and had appropriate opportunities to access training relevant to their roles.

We found people had their comments and complaints listened to and acted on, without fear they would be discriminated against for making a complaint.

This review was carried out to check improvements made following our visit on the 1st November 2011. We did not speak directly with users of the service regarding this outcome.

People told us that they were very satisfied with the service they received. They said the staff know what they need help with. One person said " They are all very good, they come when they are supposed to and they are very kind."

People told us they were happy with the care they received. They said staff treated them with dignity and respect.

We found people's needs were assessed and care was planned in line with their needs. One relative told us, “We are very happy with the support we receive. The carers are really good and always arrive on time.” Care plans were regularly updated and contained clear information about individuals' care.

We found care workers were aware of infection control policies and procedures. All staff had completed relevant training.

We were satisfied the provider had effective recruitment systems in place to safeguard people who used the service. People told us the care workers were experienced and skilled at their jobs.

People's personal records were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.