Cephas Care Ltd Domiciliary Care Agency Also known as Cephas Care Limited

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 and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Following the last inspection, a new management team had taken over the day to day running of the service. At this inspection we found improvements had been made both across the domiciliary care service and supported living, although further work is needed to embed new processes and build greater trust with relatives.

Feedback from people using the domiciliary care service was positive overall but some people had been impacted by challenges with the electronic scheduling system and staff changes, which had led to some missed calls. The provider was monitoring these closely and told us that they had commissioned a new electronic system which they were about to start using. This provided us with some assurance that risks were reducing further.

Feedback from relatives of people using the supporting living service was inconsistent with some relatives telling us that their family member was happy and had a good relationship with staff, but others expressed concerns about staff skills and the use of agency staff. We have made a recommendation about staff training and the use of techniques to prepare people moving between services to increase the opportunities for a more positive experience.

Staff were in the processes of reviewing care plans. We have made a recommendation about accessing sensory assessments for some people to assist with the care planning process. End of life care planning was not well developed, and we have made a recommendation about this.

Throughout the inspection, the management team displayed a transparent approach. They spoke openly about challenges and shared their plans to address them. Audits were more robust and new systems had been put into place. We have made a recommendation about developing more observational audits.

People had increased choice and control over their lives and there was improved oversight of restrictions. The provider recognised that further progress is needed, and they had an action plan in place to drive improvement.

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:

• The service had enough staff to meet peoples' needs and promote people’s choice and independence. People had greater access to the community as staff were available to support them.

• Staff were clearer as to their responsibilities in relation to the Mental Capacity Act and care plans were clearer about how people communicated and made their views known.

Right Care:

• Risks to people's safety were identified and taken seriously. Guidance was available to staff on how they should reduce the risk of harm and promote people’s dignity and human rights.

• Incident reports were completed in more detail and reviewed by the management team to reduce the likelihood of further incidents. We saw that the numbers of incidents had reduced.

• People were supported to maintain relationships with friends and family, and we saw that there were a variety of arrangements in place reflecting people's individuality.

Right culture:

• The new management team were accessible and visible to people using the service and staff. There was a greater focus on improving people’s experience.

• Staff morale had significantly improved, and we saw that staff were encouraged to raise issues.

• Staff had greater confidence in the safeguarding systems and that their concerns would be taken seriously.

• The quality assurance systems had been strengthened and provided greater oversight.

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 29 June 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since 29 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cephas Care Ltd Domiciliary Care Agency on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Cephas Care Ltd Domiciliary Care Agency provides personal care to people who live in their own home. The service supports older people as well as autistic people and people with a learning disability. The supported living projects range in size from small to larger projects accommodating up to nine people in one dwelling sharing communal areas and staffing. In total they assisted 42 people with personal care in 15 supported living projects, across Suffolk. At the time of the inspection the domiciliary service supported 100 people of which 76 were in receipt of personal care across, the areas of Ipswich, Felixstowe, Sudbury and Bury St Edmunds.

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 and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

At this inspection we found continued shortfalls in the management of medicines, staffing and risk management. There was a lack of consistency across both the supported living part of the service and the domiciliary service and although some people’s experience was more positive this was not universal. Staff feedback was also contradictory, some told us they loved their job and felt supported, but others reported that morale was low, and they were not able to give the care they needed. Some changes had been introduced by the provider, but we could not see that these had yet made a significant impact.

People were not supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The service did not have enough skilled staff to meet peoples’ needs and consistently promote choice control and independence. People told us not being able to access the community caused anxiety and frustration.

• There were mixed views about how well people’s healthcare needs were being met. While we noted some good collaborate work other people told us that staff were not sufficiently proactive.

• The service aimed to maximise people’s choices, but staff were not clear, and records did not demonstrate best practice regarding the Mental Capacity Act.

• Staff did not always support people in the least restrictive way possible. Staff were not always clear about what was a restrictive practice.

Right Care:

• Risks to people’s safety were not always identified and effectively managed.

• Staff did not have confidence in the safeguarding systems and that their concerns would be taken seriously.

• Positive behaviour support plans (PBSP) varied in detail and incident reports were not adequately completed so it was not always clear what actions staff took to support people. A PBSP provides staff with a step-by-step guide to making sure an individual not only has a great quality of life but also enables staff to recognise when they need to intervene to prevent or reduce the likelihood of an episode of challenging behaviour that may cause the person or others distress or harm.

• People were supported to maintain relationships with friends and family, and we saw that there were a variety of arrangements in place reflecting people’s individuality.

Right culture:

• Staff were well intentioned, but people's care was not always person-centred and did not always promote people's dignity and privacy. There was culture of staff learning from each other and reflection was not embedded into the culture. Incidents were not effectively reviewed to identify learning.

• There were quality assurance systems in place, but they were not robust and had not independently identified some of the shortfalls that we had found to ensure people consistently received a good service.

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 requires improvement (published 18 August 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations

Why we inspected

This inspection was prompted in part due to concerns received about staffing and safeguarding. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to risk management, staffing, safeguarding, consent, dignity, person centred care and 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.

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.

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.

Cephas Care Limited is a supported living service providing personal care to people who lived in their own homes and a domiciliary care service. The domiciliary service supported in advance of 200 people and the supported living service was made up of 19 accommodations.

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 and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Good governance of the service had not always been achieved or the experience of lessons learnt applied across the whole service. There had been an issue with ordering and administering prescribed medicines and a similar situation had occurred again within the service some months later. Prior to our inspection, the registered manager had increased their auditing and monitoring processes.

Support plans and risk assessments for people’s health needs contained detailed person-centred information and informed staff how to manage and mitigate potential risks to people. Staff demonstrated a good understanding of how to keep people safe from abuse.

Staff had received training regarding how to protect people from harm and were aware of the service safeguarding procedures. Senior staff of the service had worked with commissioners to ensure there were sufficient numbers of staff employed to meet people's assessed needs. The service operated a robust recruitment process to employ staff who were suitable to work for the service. People were protected from the risks associated with the spread of infection.

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; the policies and systems in the service supported this practice.

People’s support plans were reviewed every six months or more frequently if so required in relation to events. People were supported and encouraged to participate in a range of activities of their choice and to access the community facilities as discussed and agreed with them, families and other professionals. People and their relatives had access to a clear complaint’s procedure.

All of the people using the service and relatives we spoke with told us staff were kind and caring.

Staff treated people with dignity and respect and spent time getting to know them and their specific needs and wishes. Staff had worked with the people using the service so that people’s likes and dislikes were recorded in the support plans.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports the Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

¿ People had individual tenancies in their own home or small home with a few others. This model of care maximised people’s choice, control and independence. Care and support had been developed around individual assessed needs. Staff worked in a way which promoted people's independence.

Right care

¿ Care was person-centred and promoted people's dignity, privacy and human rights. People confirmed their privacy and dignity was respected. Support plans were person centred and ensured the person was involved in the development and review of their plan as far as possible.

Right culture:

¿ Ethos, values, attitudes and behaviours of the manager and staff ensured people using services lead confident, inclusive and empowered lives. People’s diverse needs were assessed, supported and respected. People were supported to make choices and live the life they chose.

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 the service was rated good, (published on 27 June 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach in relation to good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was an announced comprehensive inspection which took place on 25 and 26 April and 4 May 2018. On the first day of our inspection the operational manager told us there were 197 people using the service. The service provided a support to live at home service and a supported living service to approximately 77 people in 19 supported living services ranging from people living alone to larger group living.

The service did not have a registered manager in post for the past two months. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 met the manager who was applying to the CQC to become the registered manager and they had been working in the service for the past month.

At our last inspection of December 2016, we rated the service as requires improvement because of concerns we identified in in the key questions of Safe, Effective, Caring, Responsive and Well-Led. Improvements were needed in the way that people were supported with their medicines and how

this was recorded and monitored. People experienced missed and late visits and the systems in place to monitor were not robust enough to analyse these issues. Improvements were needed in how care workers were provided with supervision to ensure that their work practice were robustly

monitored. People's capacity to make decisions was not always clearly identified in their care records to ensure that the service was acting in accordance with the Mental Capacity Act 2005 at all times. A complaints procedure was in place but improvements were needed in the way that records were maintained regarding complaints and the service’s response. The service had a quality assurance system, however this was not robust enough to ensure all people were provided with good quality care at all times.

At this inspection we found the service had made the necessary improvements in the key questions of Safe, Effective, Caring and Responsive. There were no missed visits and late visits were rare, reasons analysed and action taken to improve the service. People’s medicines were accurately recorded. Additional staff had been employed by the service since our last inspection and all staff were provided with supervision. Complaints received and the action taken to resolve the situation were recorded. Action had been taken to improve the recording of people giving consent but there were examples of where further improvements could be made regarding the recording of people having given their consent. We found that quality assurance still required needed further development and therefore rated the key question of Well-led as requires improvement. In line with our methodology we have therefore rated the service Good overall.

The rota’s informing people of the staff coming to support them were not always accurate. However, staff did attend the scheduled care visit. Most people were supported by regular members of staff who got to know their support needs well through speaking with them and/or their family. Staff knew the risks associated with people’s health and knew what action to take in order to keep people safe.

People were supported by enough members of staff who had the knowledge and skills they required to care for people safely and effectively. The number of late call visits to people had reduced particularly in the past three months leading up to our inspection. This was because additional staff had been appointed to provide support and also manage the staff providing the support.

There remained inconsistencies of quality in care planning between the support to live at home service and the supported living services. The senior staff were aware of the shortfalls and had introduced a new assessment and care planning recording system in the support to live at home service. People and staff spoke positively of this new system and the managers planned to roll this out across the whole service in the near future.

Robust recruitment practices had been followed consistently to ensure only suitable people were employed to care for people.

Staff received training regarding the risk of abuse and avoidable harm and staff knew about the different types of abuse and what actions were needed to keep people safe. The service had effective systems in place to report and investigate any concerns raised, which included working collaboratively with external agencies.

People received support to take their medicines as prescribed.

There were procedures in place to provide staff with regular supervision including spot checks of their practice and an appraisal system.

People were involved in making decisions about their care and support. People's capacity to make decisions was clearly identified in their support records to ensure that the service was acting in accordance with the Mental Capacity Act 2005 at all times.

People were supported by staff that were kind, caring and respectful and who took the time to get to know people and their families. People were encouraged to be as independent as possible and were supported to have enough food and drink.

People knew how to complain if they were unhappy and they were confident that their concerns would be responded to efficiently and effectively. Senor staff carried out an assessment to identify people’s needs before a service was provided. The support plan written with the person from the assessment information explained how the support would be provided to meet the person’s needs.

Staff reported to feel supported and valued within their work and felt that the senior staff maintained open, honest and transparent communication systems with them.

The service had management systems in place to assess and monitor the quality of the service provided to people. However, some of these were not always implemented effectively to ensure records were robust and information gathered was not always used effectively to drive improvements within the service.

This was an announced inspection. On the first day of our inspection on 13 December 2016 the registered manager told us there were 198 people using the personal care service. The service provided a support to live at home service and a supported living service to approximately 77 people in 19 supported living services ranging from people living alone to larger group living. The service had recently undergone some change, including taking on more commissioned care packages from other support to live at home services.

There was a registered manager in post. 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.

There were inconsistencies of quality in care planning between the support to live at home service and the supported living services. The registered manager was aware of the shortfalls in the way that people’s needs were assessed and planned for in the support to live at home service and they were in the process of reviewing the care records.

Improvements were needed in the way that people were supported with their medicines and how this was recorded and monitored. The service had identified the shortfalls and were taking action to address them.

People and care workers in the supported living service told us that they felt that there were sufficient numbers of care workers to meet people’s needs. However, feedback received from people using the support to live at home service gave varied comments about missed and late visits. The systems in place to monitor and use incidents of missed and late visits were not robust enough to analyse these issues and use them to improve the service.

Care workers were trained to meet the needs of the people who used the service. Improvements were needed in how care workers were provided with supervision to ensure that their work practice was robustly monitored.

People were involved in making decisions about their care and support and people received care and support which was planned and delivered to meet their specific needs. However, people’s capacity to make decisions was not clearly identified in care records to ensure that the service was acting in accordance with the Mental Capacity Act 2005 at all times. Therefore there were risks that people were not supported to have maximum choice and control of their lives.

A complaints procedure was in place. Improvements were needed in the way that records were maintained regarding complaints and the service’s response.

The service had a quality assurance system, however this was not robust enough to ensure all people are provided with good quality care at all times. Improvements were being made but these were not yet fully implemented and embedded in practice.

There were systems in place which provided guidance for care workers on how to safeguard the people who used the service from the potential risk of abuse. Care workers understood their roles and responsibilities in keeping people safe. There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments which identified how the risks to people were minimised.

Care workers had good relationships with people who used the service.

Where people required assistance with their dietary needs, there were systems in place to provide this support safely. Where required, people were provided support to access health care professionals.

We have identified breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the full report for the actions we have asked the provider to take to improve the service.

Care was planned and delivered in a way that was intended to ensure people's safety and welfare.

There were recruitment and selection processes in place with appropriate checks undertaken before new staff took up their appointments. This helped ensure that people were cared for by suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

There was an effective procedure for dealing with concerns and complaints.