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Inspection carried out on 21 June 2018

During a routine inspection

This was an announced comprehensive inspection which took place on 21 and 26 June 2018.

This service is a domiciliary care agency. It provides the regulated activity personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of our inspection there were 218 people using the service.

Not everyone being supported by Direct Care (Tameside) receives a regulated activity; CQC only inspects the ‘personal care’ service being received by people; which includes help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service was inspected in January 2017 when we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These were in relation to medicines management and governance systems, including how accidents and incidents were recorded and monitored. We issued requirement actions. The service was rated requires improvement overall. Following the inspection we asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions, is the service safe and well-led to at least good.

During this inspection we found the required improvements had been made.

Medicines were managed safely and people received their medicines as prescribed.

There was a good system of quality assurance in place. Weekly and monthly checks and audits were carried out by the registered manager and other managers of the service. These were used to assess, monitor and review the service.

Detailed records of accidents and incidents were kept. Managers of the service kept a log of all accidents and incidents so that they could review the action taken and identify any patterns or lessons that could be learned to prevent future occurrences.

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 had two registered managers. One of the registered managers was newly registered with CQC, the other was one of the providers of the service and had been in post for some time. They told us that they were remaining registered to provide support and guidance to the new registered manager until they had finished their induction and would then deregister.

People who used the service and staff we spoke with were positive about both the registered managers.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff. Staff received the induction, training, support and supervision they required to carry out their roles effectively.

Staff we spoke with were aware of safeguarding and how to protect vulnerable people. Staff were confident any issues they raised would be dealt with properly. There were systems in place to protect people’s security and their property.

Risks to people who used the service and staff were assessed. Guidance was given to staff on how to minimise those risks. Suitable arrangements were in place to help ensure people’s health and nutritional needs were met.

People who used the service told us they were consulted about the care provided and staff always sought their consent before providing support. The requirements of the Mental Capacity Act (MCA) 2005 were being met. People were supported to have maximum choice and control of their lives.

Care visits were well organised, staff worked in geographical teams. This helped to provide consistency of support. People told us visits where rarely missed.

The provider was part of a pilot project and was developing more effective, holistic and outcome based practices for meeting peoples care needs. This was being trialled in two local g

Inspection carried out on 5 October 2016

During a routine inspection

This inspection took place on 5 and 6 October 2016 and was announced. We gave the service notice of our inspection to enable them to organise suitable staff cover to assist with the inspection process.

The service had been registered with the Care Quality Commission (CQC) since November 2013 and this was the service’s first inspection.

Direct Care has offices in Stalybridge, Tameside and provides care and support to people living in their own homes in the surrounding Tameside and Glossop areas. At the time of our inspection Direct Care was providing a service to 166 people.

The service had 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.

We identified breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the management and administration of medication and the recording and management of accidents and incidents and good governance of the service. You can see what action we told the provider to take at the back of the full report.

People spoke highly of the service; one person told us, “I’m very pleased with the care. I’m very happy with it.”

We found management and staff were kind and caring and spoke highly of the people they provided a service to and told us how much they enjoyed their caring role.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been used to ensure that suitable staff were employed to care for people who may be vulnerable.

Staff we spoke with were aware how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.

Staff told us they had their own service round and saw the same people each time. This consistency in care staff visits was confirmed during telephone conversations with people who use the service.

Care files we looked at showed comprehensive plans and risk assessments documenting people’s specific care and support needs. These were detailed plans outlining how people needed to be cared for in an effective, safe and personalised way. The plans included detailed information around their preferences. Additionally, we saw that these care files were regularly reviewed in a comprehensive way; meaning that information in the files was current and up-to-date to ensure people received the correct care and support.