The inspection took place on 6 and 26 June 2018 and was unannounced. This meant the provider did not know we were coming.

Heritage Healthcare Teesside is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection the service was providing support to 66 people in total.

In 2017 the provider amalgamated two of their locations into one service and registered the location as Heritage Health Care Teesside. This is the first inspection of the new service.

The service did not have a registered manager. The manager of Heritage Healthcare Teesside had previously been employed in one of the provider’s other locations. Therefore, was familiar with the systems and processes and was able to support us during the inspection.

‘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.

Not everyone using Heritage Healthcare Teesside receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, support with medicines and eating. Where they do we also take into account any wider social care provided.

We found gaps in the recording on the medicine administration records. Medicine audits from 2017 – 2018 highlighted issues with staff not always completing MAR charts correctly.

We made a recommendation about medicine recording.

Where commissioners required the service to commence emergency packages of support, staff did not always have written information on how to support the person. Verbal instructions were given to staff prior to care coordinators completing an initial home visit to develop care plans.

Staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service.

Recruitment processes were in place with all necessary checks completed before staff commenced employment.

The provider ensured appropriate health and safety checks were completed to ensure staff were aware of position of gas and electricity meters in case of emergency. The provider had lone working policies in place for the safety of staff.

Staff received regular supervision and an annual appraisal. Staff told us opportunities were available for staff to discuss performance and development. Staff completed mandatory training and followed an induction process which included shadowing experienced staff.

Staff understood the Mental Capacity Act and gained consent prior to any care being delivered. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Where people required support with nutritional needs staff supported them with meal preparation. People were supported to maintain good health and were supported to access to healthcare professionals when necessary.

People and relatives felt the service was caring. Staff provided support in a respectful manner ensuring people’s privacy and dignity was promoted. People were supported to be as independent as possible.

Support plans were personalised to include people’s likes, dislikes and preferences. The provider had a system in place to ensure support plans were reviewed and updated where necessary.

The provider had a complaints process in place which was accessible to people and relatives.

Staff were extremely positive about the manager. They confirmed they felt supported and could raise conc