This inspection was announced and took place on 11 and 12 October 2016. At the last inspection on 4 and 6 August 2015 we found that the provider had breached Regulation 17 associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA 2014). During that inspection we identified that the provider had ineffective auditing systems which had not identified that staff were not always receiving their refresher training when required. The provider had also not identified that staff were not completing and maintaining accurate records of the care and medicines people received.

We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulations. At this inspection we found that improvements had been made with regard to the breach identified.

The HCC North Hampshire Hub, also known as Community Response Team East, is a County Council run domiciliary care agency which specialises in providing a re-ablement service. This service provides short term personal care once people are discharged from hospital and their needs in the community are assessed. Care is provided for a period of up to six weeks. During this time people were continually assessed for their ability to manage independently once the time period concluded or whether they required longer term care provision and support from other care agencies. People who received this service included those living with a variety of chronic conditions such as Multiple Sclerosis and Parkinson’s disease.

At the time of the inspection 37 people were receiving this type of care from the HCC North Hampshire Hub which will be referred to as The HCC Hub throughout this report. The HCC Hub were also supplying care staff to support an additional 15 clients who were ‘hand back’ clients from local care agencies. Hand back clients were people originally receiving care from Hampshire County Council contracted care agencies however these agencies were not always able to meet people’s needs at the time they were required. As a result The HCC Hub were providing care staff to assist with people’s care provision until alternative care provision could be sourced.

The HCC Hub had a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the HSCA 2014 and associated Regulations about how the service is run.

Quality assurance processes were now effective in supporting the service to deliver high quality care. At our previous inspection in August 2015 auditing systems in place had not identified that care staff were not receiving their refresher training at the time intervals identified as necessary by the provider. During this inspection we saw that the action taken to address these concerns had commenced and staff were completing their refresher training as and when required.

People received their medicines safely. Care staff were trained to administer medicines and their competence was regularly reviewed. At our previous inspection in August 2015 we identified that People’s Record of Medicine Books (RoMBs) had not always been completed fully. As a result it had not always been easily identified whether people had received their medicines at the correct time and as prescribed. During this inspection we could see that positive action had been taken to address the shortfalls and RoMBs were being completed as required.

People were supported by care staff who had completed thorough recruitment processes. At our previous inspection in August 2015 we identified that care staff recruitment files did not always have the necessary information to allow the provider to make safe employment choices. During this inspection we saw that the action taken to address this concern and recruitment processes were robust and

The inspection was announced and took place on the 4 and 6 August 2015.

The HCC North Hampshire Hub, also known as the Community Response Team North East, is a county council run domiciliary care agency which specialises in providing a re-ablement service. This service provides short term personal care once people are discharged from hospital and their needs in the community are assessed. People who receive this service include those living with dementia and people with medical conditions such as dysphasia. At the time of the inspection there were 23 people using the service.

The agency had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the agency. Like registered providers they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the agency is run.

People received their medicines safely. Care workers were trained to administer medicines and their competence was regularly reviewed. Records showed that care workers were not always completely documenting in Record of Administration Books when people had received their medicine. However we could see that people were receiving their medicines in the way it was prescribed as this was documented in people’s daily care notes.

Quality assurance processes were not always effective in supporting the service to deliver high quality care. Auditing systems did not identify that care workers were not receiving their refresher training identified as necessary by the provider and that RoMBs were not accurately being completed.

Care worker recruitment procedures were completed so that people were protected from the employment of unsuitable care workers. One care worker profile failed to provide a detailed full employment history. This is an important way to ensure that care workers who have previously worked with adults who are vulnerable have any gaps in their employment suitably explained. Induction training and supervision processes were in place to ensure that people were protected from unsuitable care workers.

People using the agency told us they felt safe. Care workers understood and followed guidance to recognise and address safeguarding concerns. When a concern had been raised the registered manager evidenced that she understood her role and had liaised with the correct authorities so a thorough investigation could be completed.

People’s safety was promoted because risks that may cause them harm in their own homes had been identified and managed. People were supported by care workers who encouraged them to regain their independence. Appropriate risk assessments were in place and followed by care workers to keep people safe.

People were supported by care workers who had the knowledge and information available to be able to meet people’s needs effectively. However the provider did not have systems in place to ensure that care workers received refresher training at the time scales they identified as necessary.

People were supported by care workers to make their own decisions. Care workers were knowledgeable about the requirements of the Mental Capacity Act 2005 (MCA 2005). The service worked with people, relatives and social care professionals when required to obtain assessments on people’s capacity to make specific decisions for themselves. Care workers sought consent before carrying out care, treatment and support.

People were supported to eat and drink enough to meet their nutrition and hydration needs. Care workers assisted people to make choices about their food and drink. People were encouraged to participate in preparing their meals to regain and retain their independence.

When people’s additional health care needs were identified the care workers engaged with other health and social care agencies and professionals to maintain people’s safety and welfare. The agency had access to a range of health care professionals within the County Council such as Occupational Therapists and District Nurses. These healthcare professionals were deployed when people’s needs changed.

People received support from care workers who were motivated to develop positive and caring relationships. People felt that care workers were familiar faces who delivered caring support.

People were encouraged and supported by care workers to make choices about their care on a daily basis. People and relatives told us they felt listened to and their views were respected.

The registered manager and care workers understood the importance of maintaining people’s privacy and dignity. People told us and we could see care workers met people’s needs in a respectful private way whilst maintaining their dignity.

Care plans were personalised to each individual. They contained detailed information to assist care workers to provide care in a manner that respected each person’s individual needs and wishes. Relatives told us, and records showed, they were encouraged to be involved at the care planning stage, during reviews and when their family member’s health needs changed.

People knew how to complain and told us they were happy to do so if this was required. Procedures were in place for the registered manager to respond to complaints in an effective way. Complaints were investigated thoroughly. This ensured the quality of the service was maintained.

The registered manager and care workers promoted a culture that was open and transparent. People were assisted by care workers who were encouraged to raise concerns with the registered manager. Out of hour telephone contact details were provided to people and care workers. This meant additional support and guidance was always accessible to people and care workers from an on call registered manager. Care workers told us they felt supported by the registered manager and office staff as a result.

People told us they were receiving high quality care from the agency.

We found a breach 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.