This inspection took place on 18 October 2018 and was announced.

This was the first inspection since Direct Health (Crewe) was registered with the Care Quality Commission (CQC).

Direct Health (Crewe) is a domiciliary care agency. The registered provider is Accord Housing Association Limited. This service provides care and support to people living in their own homes and supports them to live as independently as possible.

Direct Health (Crewe) provides a service to young and older adults who are living with a range of different support needs such as learning disabilities, autism, physical disabilities and sensory impairments. At the time of the inspection the registered provider was supporting 41 people.

There was no 'registered manager’ at the time of the inspection however a newly recruited manager had been in post for approximately three weeks; they had submitted the relevant registered manager applications to CQC. A registered manager is a person who has registered with 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.

Care plans and risk assessments were in place for people who were receiving support. Records contained up to date and relevant information. Staff were familiar with people’s individual support needs and the risks which needed to be mitigated.

Medication management systems were safely in place. Staff received the relevant medication training and regularly had their competency assessed. Routine medication audits were completed and any medication errors which occurred were thoroughly explored.

Recruitment was safely managed. Staff were appropriately vetted, suitable references were obtained and Disclosure and Barring System (DBS) checks were in place.

There were sufficient numbers of staff to provide the support that people required. Staff confirmed that from ‘time to time’ staffing levels did decrease but this was an area that was well managed. People still received the support they needed; the management team and staff team worked together to support this.

Accidents and incidents were appropriately recorded and analysed. The manager explained that there was very little activity in relation to accident/incidents but staff were aware of the reporting procedures.

People were protected from avoidable harm and risk of abuse. Safeguarding and whistleblowing policies were in place, staff received the necessary safeguarding training and were familiar with reporting procedures.

Infection prevention control procedures were in place and staff were provided with the relevant personal protective equipment (PPE).

The registered provider was complying with the principles of the Mental Capacity Act, 2005. People’s capacity had been assessed; consent to care had been obtained by people who had the capacity to make decisions.

Staff told us that they were fully supported by the registered provider and had developed the correct skills and competencies to provide the level of support that was expected. Staff were regularly supported with training, learning and development opportunities.

The overall health and well-being needs of people who received support was effectively managed. Appropriate referrals were taking place to external healthcare professionals (when needed) and the relevant guidance and advice which was provided was routinely followed.

Nutrition and hydration needs were effectively assessed. People were supported with a ‘choice’ of food and drink and support needs were well managed.

Staff received dignified, respectful and compassionate care. We received positive feedback about the level of care that was provided and how staff always ensured that care was delivered to a high standard.

People’s sensitive and private information was stored at the registered address and was not unnecessaril