Emmcare Also known as Emmcare Limited

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.

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 10 people who are supported by a team of three care staff.

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

People's needs and choices had not always been appropriately assessed to ensure effective outcomes of their care.

We found weaknesses in risk assessments, risk management and care planning. Risk in relation to people receiving personal care were assessed, however the service failed to provide clear plans and guidance in how to manage such risks.

People had care plans in place. However, these did not include information about people's likes, dislikes or preferences. Information was not recorded clearly to guide staff to provide care and support.

Staff had not always received training to equip them to support people, understand their individual needs and mitigate associated risks.

The provider was not working in line with the principles of the Mental Capacity Act 2005 (MCA). We gave a recommendation to the provider to research current best practice guidance to ensure they were are following the principles of the MCA and updates their practice accordingly.

The provider's recruitment practices were not safe or robust, which meant people were at risk of being supported by unsuitable staff.

People were at risk of harm due to poor medicines management. There was a lack of information to ensure staff understood when to give medicines which were prescribed 'as and when required'. We could not be sure people received their medicines safely, as prescribed or by staff that had been sufficiently trained and competent to do so.

The provider was not following current government guidance regarding COVID-19 testing.

The provider worked in partnership with other professionals, although the documentation from these professionals was not always up to date. We gave a recommendation to the provider to review the process in place for working with other agencies to ensure staff have access to up to date professional guidance.

The service quality assurance system was not fully effective and did not address the shortfalls we found during our inspection. The lack of governance measures in place and poor management oversight meant people were at risk of receiving care which placed them at risk of harm.

We found no evidence that people were harmed but these shortfalls put them at increased risk. We discussed these concerns with the provider/registered manager who was responsive to feedback and started making changes to how the care was monitored and organised to improve it for people.

People told us staff were kind and caring and that people felt safe with staff. Relatives spoke positively about the care provided. Relatives and people told us the staff team were familiar and made them feel safe. One relative said “If [provider] wasn't here, [family member] would be in a home as I couldn't cope”.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 6 April 2021 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, risk management, infection control, safeguarding, recruitment, assessment and care planning, staffing and management of the service.

We have also made recommendations in relation to the Mental Capacity Act and working with other professionals.

Please see the action we have told the provider to take at the end of this report. 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 and request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will alert the Local Authority and work alongside the provider 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 is therefore 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.