Background to this inspection
Updated
17 June 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
During this inspection we checked whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspection team
The inspection was carried out by 2 inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post. The registered manager is also the provider. Throughout this report we will refer to them as the provider.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.
Inspection activity started on 13 April 2023 and ended on 20 April 2023. We visited the location’s office on 13 April 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority quality improvement and safeguarding teams. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 2 people who use the service and 3 relatives about their experience of the care provided. We spoke with and received feedback from 4 members of staff including the provider, a senior carer and 2 care assistants. We spoke with 2 health professionals and received written feedback from 1 other health professional.
We reviewed a range of records. This included 8 people's care records and multiple medication records. We looked at 3 staff files in relation to recruitment, induction, and training. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
17 June 2023
About the service
Emmcare is a domiciliary care agency providing personal care to people in their own homes. At the time of our inspection they were providing a personal care service to 8 people who were supported by a team of 3 care staff and the registered manager.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support
People remained at risk of receiving unsafe care and treatment. Risk assessments were not always in place for people when required, for example, if they had vulnerable skin or were at risk of falls. Where risk assessments had been done these lacked sufficient detail to support staff to mitigate people’s identified risks.
The lack of governance measures in place and poor management oversight identified at the previous inspection remained at this inspection. The provider, who was also the registered manager, continued to deliver a significant number of care hours. This impacted on their capacity to manage the service. This included a lack of auditing of important areas including medicines management, infection prevention and control and care plans.
Recruitment processes remained an issue at this inspection; as they did not always ensure people were supported by staff of good character and with the necessary qualifications, competence, skills, and experience required of the role.
People’s rights were not always respected as the provider was not compliant with the Mental Capacity Act 2005. There were occasions consent had been given by representatives without the legal authority to do so. Mental capacity assessments had not always been completed when required to determine if a person could give informed consent themselves.
People were supported by staff who were trained to recognise signs of abuse and knew who to report if they had concerns. People told us they felt safe. Their relatives agreed.
Right Care
People and their relatives said they enjoyed visits from the staff. They felt staff had a good understanding of their needs and supported and encouraged them to remain as independent as possible. People and relatives felt all staff were kind, caring and treated them with dignity.
People were confident staff were well trained and knew how to support them. People were encouraged to make decisions and express their views about the care and support they received by staff who were attentive and familiar to them.
Right Culture
There was a supportive culture at the service. Staff enjoyed working for Emmcare and felt appreciated and invested in.
All stakeholders spoke positively about the registered manager.
The service had established and maintained positive working relationships with other agencies including district nurses and GP surgeries.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection and update
The last rating for this service was inadequate (published 9 August 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We served a Warning Notice in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At this inspection we found the provider remained in breach of regulations and had not met the Warning Notice in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At our last inspection we recommended that the provider reviewed the processes in place for working with other agencies to ensure staff have access to up-to-date professional guidance and researched best practice guidance to ensure they are following the principles off the Mental Capacity Act (2005) and updated their practice accordingly. At this inspection we found the provider had met the recommendation about working with other agencies but not met the recommendation around the MCA.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.
We have found evidence the provider needs to make improvements. Please see the safe, effective, responsive and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Emmcare on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to consent and mental capacity, safe care and treatment, governance and fit and proper persons employed.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.