Essex Cares Mid Also known as Domiciliary Support & Reablement Service Chelmsford & Maldon

Essex Cares Mid is a domiciliary care service providing the regulated activity of personal care. The service provides reablement support and short-term assessment to people living in their own houses, flats and within specialist housing schemes for up to 6 weeks. At the time of our inspection there were 83 people using the service.

Each person who used the service received the regulated activity of 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

Some staff did not feel valued and supported by the provider and registered manager. Staff did not always feel communication with their internal managers was effective and supportive. Suitable arrangements were in place to assess and monitor the quality of the service provided. Overall, there was a positive culture within the service that was person-centred, open, and inclusive. People received a good quality service that was flexible and responsive to their needs, promoting their independence and ensuring the reablement package of support met their goals and aspirations. People's and others view about the quality of the service provided was sought and acted upon.

People told us they were safe and had no concerns about their safety. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Risks to people were identified and managed to prevent people from receiving unsafe care and support. The service was appropriately staffed to meet the needs of the people using the service. People received their medicines as prescribed and in a safe way. Recruitment procedures were followed to ensure the right staff were employed. People were protected by the provider's arrangements for the prevention and control of infection. Arrangements were in place for learning and making improvements when things go wrong.

Suitable arrangements were in place to ensure staff were trained and newly appointed staff received a robust induction. People were supported with their dietary requirement needs. The service ensured they worked collaboratively with others and people were supported to access healthcare services where needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with care, kindness, dignity, and respect. People received a good level of care and support that met their needs and preferences. Staff had a good knowledge and understanding of people's specific care and support needs and how they wished to be cared for and supported. Support plans were in place to reflect how people would like to receive their reablement care and support. Information about how to make a complaint was available and people's representatives told us they were confident to raise issues or concerns.

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 December 2017].

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

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

During this inspection, we found that the provider had significantly improved the culture and the running of the service. Improvements to the service had been sustained and there were elements of the service that were outstanding and we found that the service was “Outstanding” in the Well-led domain. The provider had plans in place to ensure that they continuously learnt, improved, and evolved as a service and they were now providing a service based on core shared values that were visible at all levels of staffing. This meant that the provider had created a firm foundation to work towards providing outstanding services in all areas.

At the time of inspection Essex Cares Mid were providing short, six week care to 38 people in their own homes. This was a new contract and the service worked within local hospitals, and with the local authority to support people leaving hospital until a permanent care package could be found or people were able to manage independently without support.

A registered manager was 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.

People receiving a service could be assured that they were receiving care provided by staff that had an excellent understanding of individual risks and needs. Staff were recruited safely and had undergone a values based assessment to ensure that their own values matched that of the organisation. Staff had an excellent understanding of safeguarding vulnerable people.

Staff were trained to safely manage medications and peoples complex physical and mental health needs. The registered manager and health care professionals provided care staff with the tools and information they needed to provide safe care.

The provider had revised and developed training for all staff according to the changes to people’s physical and mental health needs. This ensured that care staff had the appropriate skills and knowledge to care for people effectively. People told us that staff had an excellent understanding of how to care for them.

Staff, managers, and the provider had very good understanding of the Mental Capacity Act, 2005. Clinical records evidenced that staff supported people’s wishes and preferences and they supported and encouraged and respected them.

The registered manager had excellent links with other health professionals within hospital and social care settings, working together to source the best care options for people referred to the service. Staff had access to a physiotherapist and occupational therapist. They were on hand to offer advice and support regarding peoples changing physical needs and equipment needs.

People told us that staff were caring and considerate and treated them with compassion. Staff promoted person centred care at all levels of seniority to ensure the best outcomes for people. People told us that staff treated them in a respectful and dignified way at all times.

People were involved in all aspects of their care. Care plans and risk assessments were thorough and focused on people’s individual goals, needs, and risks. The registered manager actively sought people’s views of their care at regular intervals and where people had complained about the service, the manager had acted appropriately and respectfully to investigate and provide a meaningful resolution.

The service was outstandingly well led. The provider had retained overall oversight and responsibility for ensuring that they maintained improvements, and that the service continued to learn and improve. The Quality and Governance team had worked collaboratively with the registered manager to make significant improvements across the service. The service had been creative in making links with other health and social care professionals to ensure the best outcomes for people.

We found that the service was open and transparent and staff at all levels were friendly and approachable. Managers behaved as excellent role models for the service’s values and supported staff to achieve the best possible outcomes for people in their care.

The inspection was carried out six months following a comprehensive rating inspection in March 2016, which found the service to be inadequate and it was consequently placed in special measures. We found during this inspection that the service had made significant improvements in all areas of concern and had plans in place to continue with improvements.

The service no longer provided re-enablement care. Consequently the number of people they offered care and support to had significantly decreased, and they now provided 21 care packages for those who urgent support which cannot be immediately found from other services.

The service did not have a registered manager in place, but had recruited someone who was experienced and was waiting for the necessary checks to be carried out by the commission in order to be classified as the registered manager for this service. 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.

During the inspection in March 2016, we found that many people had experienced both late and missed visits which had led to some people missing their prescribed medication and had impacted on their health and wellbeing. After our inspection we asked the provider to submit weekly reports detailing what missed visits had occurred. We found the service had significantly improved this area and systems were in place to reduce the risk of this happening again.

Safeguarding practices had improved and concerns were raised in a timely manner. Staff received regular support and we saw that supervision from their managers had significantly improved. They told us that the new management team were supportive and listened to their concerns. Regular meetings took place at all levels and the information as shared appropriately across the staff groups.

During the inspection in March, staff had not always received the correct training. However, this had also significantly improved. The training team were seeking out new and innovative ways to make sure that staff had the correct training.

We checked how the service followed the principles of the Mental Capacity Act 2005 (MCA). The MCA governs decision-making on behalf of adults who may not be able to make particular decisions. The requirements of the MCA were being followed, and the provider had implemented systems since our last inspection to ensure that people were protected and supported safely.

People told us that carers were respectful and kind and often went that extra mile to support them.

When the service had been given detailed information from other professionals, care records lacked detail and were not person centred.

At the time of this inspection support plans and risk assessments did not always document identified risks or people’s individual needs, level of independence, preferences, and choices. They were not reviewed in a timely way. However, new internal quality monitoring by the service had also identified these issues and plans were in place to improve this area. We also saw that whilst support plans and risk assessments were poor, that communication records demonstrated that staff were safely meeting people’s needs, often going the extra mile to do so. The service had improved its continuity of care, ensuring that people received a regular core team of staff to support them. Consequently, they had been able to develop relationships with people, and understood their personal preferences.

The provider had significantly improved the procedure for handling complaints, comments, and concerns and had introduced systems to investigate these effectively. We saw that the service went that extra mile to apologise.

Improvements to the management and quality monitoring systems meant that the provider could now identify when missed calls had not taken place and took action to make sure that people were placed at harm.

We did not identify any breaches in regulation within this visit and consequently the service is no longer in special measures.

The inspection was carried out following the receipt of concerning information related to missed and late visits, and people being left without care and support. Concerns included people’s personal care needs not being met; people not receiving their medicines at the prescribed times, and in some cases people being unable to access food and drink because of the lack of support.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Essex Cares provides personal care to people in their own homes. At the time of inspection, up to 190 people were using the service at Essex Cares Mid. Some of these people are vulnerable due to their age and frailty, and in some cases have specific and complex health care needs.

The service provided ‘re-enablement’ support to people in their own homes for up to of 6 weeks. Re-enablement is a service that supports people to rebuild their confidence to cope at home following their discharge from hospital .At which point the person is ‘reassessed’ and leaves the service having achieved their agreed independency levels or if they required on-going support they may be transferred to an alternative provider. However if suitable alternative care provision cannot be sourced the person will stay with the service under their other contract ‘Resource of last resort’. This was an additional contract, which required the service to take care packages for people where the Local authority had been unable to secure the required care provision.

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.

Although people told us they found the staff who delivered their care to be respectful and kind, many people had experienced both late and missed visits which had led to some people missing their prescribed medication and impacting on their health and wellbeing

We looked at 15 care files and found that people’s needs had not always been assessed prior to receiving a service from Essex Cares Mid. Care plans and risk assessments were incomplete and did not always ensure people’s individual needs, preferences and choices were considered.

We checked how the service followed the principles of the Mental Capacity Act 2005 (MCA). The MCA governs decision-making on behalf of adults who may not be able to make particular decisions. The requirements of the MCA were not being followed. The provider failed to protect and support people safely due to ineffective and incomplete recruitment practices and insufficient staffing levels to ensure people’s health and welfare was met. Staff did not always receive regular support and supervision from their managers. Staff told us they had reported significant difficulties in carrying out care; however, no actions were taken following concerns.

The provider failed to support and supervise people safely and effectively to take their medicines. Not all staff had received up to date training or supervision of their practice in relation to administering medicines or had their competency assessed.

The provider had a procedure for handling complaints, comments, and concerns but failed to ensure that complaints were handled effectively and in a timely manner. People and their relatives told us that most staff were caring and staff we spoke with had a good understanding of abuse and how to raise any concerns.

There were safeguarding policies and procedures in place. However, these were not being implemented and some safeguarding concerns were not recognised or addressed.

The provider had ineffective management and quality monitoring systems in place that failed to identify serious errors and omissions in the monitoring of missed calls, which placed people at risk of serious harm.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that they were satisfied with the service that they were provided with and that their care workers treated them with care and compassion. One person said, "I am very pleased with them." Another person told us, "Wonderful service. I cannot emphasise it enough."

We looked at the care records of 10 people who used the service and found that the records showed the care and support people required and that people experienced care, treatment and support that met their needs and protected their rights.

We looked at the personnel records of five care workers. We found that staff were well supported, supervised and trained to perform their duties safely.

The main service provided by the agency was reablement but they also provided a crisis response service and a private care service. The crisis response service was provided for a period of two weeks and had the aim of preventing hospital admissions. There were good systems in place to evaluate the effectiveness of the support being provided.

People told us that they were involved in decisions about the support provided by the reablement service. They had gained confidence, were more independent and felt that the service was generally meeting their needs. One person said 'They helped me to regain my independence, which was so important to me.' Another told us 'The staff were all very good and seemed very able.' People all said that they were happy with the overall service.