Essex Care Consortium - Colchester

Updated 9 February 2024

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.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

Essex Care Consortium - Colchester is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Essex Care Consortium - Colchester does not provide nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

Notice of inspection

This inspection was unannounced. Inspection activity started on 21 November 2023 and ended on 22 November 2023. We visited the service on both days.

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 and professionals who work with the service. 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 talked with people who used the service whilst observing their experience of the care they received. We spoke with the nominated individual (NI) responsible for supervising the management of the service on behalf of the provider, registered manager, assistant manager, business support manager, administrator, and the general manager. We also spoke with 5 members of care staff. We reviewed a range of records, including 5 people's care records, 3 staff files in relation to recruitment, staff supervision and a variety of records relating to the management of the service.

Updated 9 February 2024

About the service

Essex care Consortium – Colchester is a residential care home providing the regulated activity accommodation for people who require personal and nursing care to up to a maximum of 20 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 17 people using the service.

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.

The service was not consistently meeting the underpinning principles of Right support, right care, right culture. The service was not well led. The service had a range of managers responsible for the management and oversight of the service. However, systems and processes to assess, monitor and improve the quality and safety of the service were not identifying where improvements were needed. There was a lack of understanding of the risks and issues facing the service. Legal requirements were not always fully understood or met. The provider was not following their own policies and procedures, including safeguarding people and duty of candour.

Governance arrangements needed to improve to ensure effective oversight of the quality and safety of the service and used to identify and drive improvement. Failure to have oversight of all incidents occurring in the service placed people at a risk of harm, or a significant risk of harm occurring. Systems to log incidents, accidents, and safeguarding concerns were not effectively used to identify themes or trends. Where incidents had occurred, these had sometimes lacked the full rigour needed to thoroughly investigate the root cause or actions for improved practice to prevent any reoccurrence.

Right Support:

Essex Care Consortium – Colchester is made up of a series of houses in a campus style setting on the outskirts of the town of Colchester, which enables people to access the local community and its amenities. People had exclusive possession of their own rooms, in shared accommodation and access to shared gardens and woodlands. Internally the premises were well designed for the people living there.

The service had enough staff on duty to meet people’s needs, including additional staff 1-1 hours to support people to manage anxieties and have a good day, including accessing day care facilities and the community. People were provided with opportunities to gain new skills and become more independent. Staff were kind, and caring and as a result we saw people were at ease, happy, engaged and stimulated. Staff worked well with other professionals to ensure people received the right level of support to manage their health and manage signs of distress and or frustration.

Right Care:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, further work was needed to ensure where people lacked capacity, the use of video monitors to detect seizure activity at night were granted under the Deprivation of Liberty Safeguards (DoLS). We have made a recommendation about making DoLS applications regarding people’s right to privacy.

Safeguarding concerns were not routinely being identified and reported to the appropriate authorities. Safeguarding incidents were not given sufficient priority to ensure concerns about people’s safety were investigated and lessons learned when things had gone wrong. Risks to people’s safety, were not managed well. Personal Emergency Evacuation Plan’s (PEEP’s) did not contain sufficient information for staff to safely evacuate people in the event of a fire or similar emergency.

Managers and staff were failing to properly assess and manage risks to people at risk of choking and mealtime behaviours, such as eating too quickly which placed them at risk of harm or exposed them to a significant risk of harm occurring. Information in peoples care records and in kitchens was inconsistent and did not provide clear guidance for staff on how to deliver safe care, including the safe consumption of food and drink. Staff had not received training to provide them with the knowledge and skills to safely prepare, cook and support people to eat and drink, in line with speech and language therapist (SaLT) recommendations. Staff had made decisions on people' s behalf about food choices where they did not have the capacity to make decisions or consent to all aspects of their care, which had placed them at risk of harm.

People’s medicines were being managed in line with the principles of Stopping over-medication of people with a learning disability, autism, or both (STOMP). However, improvements were needed to ensure people’s records contained accurate information about their medicines to ensure these were administered correctly and accounted for. We have made a recommendation about medicines management.

Effective recruitment systems were in place to ensure staff were suitable to work with people using the service.

Right Culture:

Improvements were needed to ensure the service was transparent, and open with all relevant external stakeholders and agencies, including the local authority safeguarding team, CQC and the police. Review of documentation identified allegations of physical abuse, a previous choking incident and where a person sustained a fractured ankle had not been reported to the appropriate authorities.

The registered manager and the assistant manager were passionate about the service, people, and the staff, but lacked support and direction by the nominated individual (NI) (responsible for supervising the management of the service on behalf of the provider) and general manager to ensure they were adhering to best practice, and legislation.

People, their representatives and staff provided positive feedback about the service. Staff told us they felt supported by the managers.

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

Rating at last inspection

The last rating for this service was good (published 09 January 2020)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Immediately following the inspection, the registered manager confirmed PEEPs had been updated. The management team had worked well with CQC, the local authority's learning disability and speech and language therapy (SaLT) teams to make the required improvements to reduce the risk of further choking incidents. As of 1 December 2023, all staff had completed dysphagia training. The SaLT team had arranged to provide additional person specific training. Staff competency to prepare food and drink in line with SaLT guidance had been assessed to ensure they had the knowledge and skills to support people with dysphagia and associated choking risks. These measures ensured there were always suitably qualified and competent staff on duty to support people to eat and drink safely. The records for people at risk of choking had been reviewed to ensure these contained the correct information to guide staff in relation to safe consumption of food and drink.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, safe care and treatment and good governance at this inspection.

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. You can see what action we have asked the provider to take at the end of this full report. You can also read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Essex Care Consortium - Colchester on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 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 op