This inspection took place on 19 July and 2 and 9 August 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because we wanted to be sure that senior management were present for our visit.

This service is a domiciliary care agency. It provides personal care to children, young people and adults living in their own houses and flats in the community. At the time of our inspection 29 people were using the service.

At the last inspected the service on 24 May 2016 and rated the service as good. At this inspection we found the service had deteriorated and rated the service as requires improvement. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

At the time of the inspection the service did not have a registered manager 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 service provided by Interserve Healthcare - Tees Valley was not reliable. There were not enough care and nursing staff who were adequately trained to support all children, young people and adults who used the service. Calls to people were often cancelled at last minute or didn’t take place at all which meant parents and relatives had needed to step in and provide care. This had not only impacted on children, young people and adults but also the parents, relatives and other siblings.

We looked at the staff training chart and found most training for staff was up to date. However, people who used the service had very individual needs and staff needed specialist training in areas such as tracheostomy care. This training also involved competency assessments to make sure staff followed safe practice. Staff competency assessments were not up to date and this was one of the reasons why people had been let down and their calls uncovered. Most of the competency assessments were undertaken by nurses employed at the service, however there had only been one nurse for some time and they had not been able to undertake all competencies as they had other responsibilities.

Staff were not encouraged or supported to gain further qualifications such as the diploma in health and social care. Staff supervisions and were not up to date for all staff. Supervision is a process, usually a meeting, by which an organisation provides guidance and support to staff.

For those people lacking in capacity, health and social care professionals, staff and relatives had been involved in making best interest decisions for people, however there were no decision specific mental capacity assessments or best interest decisions available within peoples care records.

Parents and relatives told us they did not think the service was well led and heavily criticised office staff for their poor communication. Senior staff had carried out a number of quality assurance checks to monitor and improve standards at the service. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. However, these had been ineffective as they had failed to pick up on areas of concern that we had identified during the inspection.

Staff understood the procedure they needed to follow if they suspected abuse might be taking place. Medicines were managed safely with an effective system in place.

Staff were aware of the action to take to manage risks to the health, safety and welfare of people who used the service but, we found some risk assessments to be generic. However, we did find detailed information within people’s care plans on how to keep them safe.

We found that sa

This inspection took place on 24 May, 25 May, 9 June and 10 June 2016 and was announced. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in to assist us.

Interserve Healthcare - Tees Valley is a domiciliary care service providing personal and nursing care to people within their own home. The service support adults and children with complex health and support needs. The service employs nurses to plan and monitor personal care. At the time of the inspection 27 people were using the service, most of whom were children.

The service had a registered manager. 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 and their relatives said the service provided safe care. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Risk assessments were regularly reviewed to ensure they reflected people’s current support needs. Accidents and incidents were investigated and recorded to see if remedial action was necessary.

There were procedures in place to safely support people with medicines. Staff had access to a medicines policy, which provided detailed guidance on medicines management. Details of the medicines people used and how they should be supported with them were clearly recorded in their care plans and medicine administration records (MARs).

Policies and procedures were in place to investigate safeguarding incidents. Staff were familiar with safeguarding issues and said they would be confident to raise any concerns they had. Staff were also confident to whistle blow on any concerns they had.

Staffing levels were sufficient to support people safely and staffing levels were considered before new care packages were accepted. Recruitment policies and procedures minimised the risk of unsuitable staff being employed.

There was a business continuity plan in place to help ensure a continuity of care in emergency situations that disrupted the service. People receiving 24 hour care had personal emergency evacuation plans (PEEP) in place. Staff and the people they supported told us they were provided with all of the equipment they needed to support people safely, such as gloves and aprons.

Staff received mandatory training in areas including health and safety, safeguarding, manual handling, basic life support and medicine administration. Staff also received training to support people with the particular support needs they had, such as spinal injuries or PEG.

Staff said they received the training they needed to support people effectively and would be confident to request additional training. Newly recruited staff completed an induction programme before being allowed to support people on their own. Staff were supported through regular supervisions and appraisals.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Staff understood the principles of the MCA and could describe how they ensure they had people’s consent to provide care and support.

People who used the service received support with food and nutrition. Nutrition care plans were in place setting out their support needs and dietary preferences. People were supported to access external professionals to maintain and promote their health.

People and their relatives spoke positively about the care they received. Staff said they were able to spend quality time with the people they supported and enjoyed getting to know them.

People and their relatives told us they were treated with respect and their dignity was protected by staff. Staff told us how they helped to protect people’s dignity and put them at ease