We last inspected Home Group in October 2016. At that inspection we rated the service good. At this inspection we found the service was in breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008. We rated the service requires improvement.

Home Group operates from an office in Newcastle upon Tyne. The service provides personal care for adults with learning disabilities, or who have needs relating to their mental health, either in their own home or within supported tenancies. Supported tenancies enable people with physical or learning disabilities, or who have other care and support needs, to live in their own home. The service also provides person care to older people living in their own flats. At the time of the inspection there were 65 people in receipt of a service.

Home Group is not regulated to provide accommodation which meant we did not inspect people’s premises.

This inspection took place on 19 and 21 February 2019, with further phone calls with relatives and external professionals on 22 February 2019.

The service had two registered managers in place. 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 registered managers had suitable experience relevant to the needs of people who used the service. One, who managed the learning disability service, had been in place for several years. The other, who managed the care of older people, had been in post for less than a year and acknowledged there remained some improvements to make.

Oversight and auditing of older people’s care records was not effective and some records were outdated or inaccurate. These included medicines records and risk assessment records.

Auditing and oversight of care regarding the learning disability service was comprehensive and well planned. Medicines management and risk management was also well planned in this area.

Corporate support was in place for the registered managers but this was at the time of inspection more focussed on the learning disability service. Older people’s care and support was managed more in isolation by a registered manager and limited support staff.

There were no concerns raised by external agencies regarding the safety of the service. Whilst some records required improvements, staff understood the risks people faced, and how they helped people reduce those risks.

Appropriate staff training was in place, specific to the needs of people who used the service.

People who used the service and their relatives were extremely complimentary about how staff cared for them and supported them to live their lives as they wanted.

People were treated with dignity and respect. Their individualities and preferences were supported. These were well documented in some detailed care records.

Person-centred planning needed to improve for older people who used the service.

People’s healthcare needs were well met through liaison with external healthcare professionals. This was clearly reviewed and documented.

People were 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. In the learning disability service, people were comprehensively involved in the planning of their care and the running of the service.

The registered managers had ensured the culture was open, positive and welcoming of challenges from people who used the service. Staff were passionate about their roles and shared the ethos of the service, which was centred around enabling people’s independence.

We found the provider in breach of one regulation relating to governance. Further information is in the detailed findings below.

We carried out an inspection of Home Group on 7 and 15 July and 9 August 2016. The inspection was announced. This was to ensure there would be someone present to assist us. We last inspected Home Group in September 2014 and found the service was meeting the legal requirements in force at that time.

Home Group operates from an office in Newcastle upon Tyne. The service provides personal care for adults with learning disabilities, or who have needs relating to their mental health, either in their own home or within supported tenancies. Supported tenancies enable people with physical or learning disabilities, or who have other care and support needs, to live in their own home. Rented properties are often adapted to meet the tenants’ needs. Supported tenancies are often shared by a small group. Staff are based in the property to provide support to tenants with their daily needs, for all or part of the day. At the time of the inspection there were 22 people in receipt of a service. Personal care was provided to people across the Newcastle area.

The service had a registered manager in post. 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.

People told us they felt safe and were well cared for. Staff knew about safeguarding vulnerable adults. Alerts were dealt with appropriately, which helped to keep people safe. Incidents and allegations were notified to the local safeguarding team and the provider worked positively with statutory agencies, such as the police, local authority and CQC.

We were told staff provided care safely and we found staff were subject to robust recruitment checks. There were sufficient staff employed to ensure continuity of care and the reliability of the service. Staff managed medicines safely.

Staff had completed relevant training for their role and they were well supported by their supervisors and managers. Training included care and safety related topics and further topics were planned. Care professionals commented on the skills of staff and the effectiveness of the service in meeting people’s needs

Staff obtained people’s consent before providing care. Staff were aware of people’s nutritional needs and made sure they were supported with meal preparation, eating and drinking. People’s health needs were identified and where appropriate, staff worked with other professionals to ensure these needs were addressed.

People spoke of staff’s kind and caring approach. Staff explained clearly how people’s privacy and dignity were maintained.

Assessments of people’s care needs were obtained before services were started. Care plans had been developed which were person-centred and had sufficient detail to guide care practice. Staff understood people’s needs and people and their relatives expressed satisfaction with the care provided.

Events requiring notification had been reported to CQC. Records were organised and easily retrieved.

There were systems in place to monitor the quality of the service, which included regular audits and feedback from people using the service, their relatives and staff. People’s views were sought through annual surveys, meetings, care review arrangements and the complaints process. Action had been taken, or was planned, where the need for improvement was identified.

There were 14 people receiving personal care on the days of our inspection. People lived in houses in the Newcastle area which they rented from various housing associations. A tenancy agreement was in place. Home Group provided staff to support people who lived in these houses.

We contacted a principal clinical psychologist and a clinical psychologist from the local NHS mental health trust by email. We also conferred with a community nurse and health facilitator and an Independent Mental Health Advocate to obtain their views on the service.

We visited the service’s head office on the first day of our inspection. On the second day, we visited two of the five houses where people lived. Three people lived in one house and four in the other. We talked with all seven people. We also spoke with five relatives to obtain their views.

We spoke with the registered manager and five staff including two supported living care coordinators and three support workers. The registered manager told us that supported living care coordinators, “Check the day to day quality [of the service] and have meetings with staff.”

We looked at two care plans and records relating to staff and the management of the service. We considered our inspection findings in order to answer the questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found:

Is the service safe?

We did not inspect all aspects of this question. The principal clinical psychologist stated, “I have not had any safeguarding concerns in relation to the staff and services I have worked with. It is my experience that staff are aware of what abuse is and work to safeguard their clients from abuse.”

Is the service effective?

People and relatives told us that they thought that staff were well trained. One relative told us, “I think they know what they are doing…They seem adept at meeting people’s needs.” We found that staff had completed training in safe working practices and training to meet the specific needs of people who used the service.

People had access to health and social care professionals such as the GP; specialist consultants; psychologists and social workers.

Staff followed the “best interests” principle outlined in the Mental Capacity Act 2005. This states that any act done or decision made on behalf of an adult lacking capacity must be in their best interests. Best interests meetings and decisions were made for people when important decisions needed to be made. Members of the multi- disciplinary team, relatives and staff from the service were involved.

Is the service caring?

We observed that people were treated with kindness and patience. We observed positive interactions between staff and people. The principal clinical psychologist stated, “My experience suggests that Home Group staff aim to provide meaningful person centred care. I have been generally impressed by the staff that I have worked with.”

Is the service responsive?

People informed us and records confirmed that there was an emphasis on meeting social needs and that the service promoted their hobbies and interests.

There was a complaints procedure in place. People and relatives told us that they had no concerns or complaints about the service.

Is the service well-led?

There was a manager in place at the service who was registered with the Commission in line with legal requirements. We noted that a number of checks and audits were carried out and recorded on all aspects of the service.