E2E Homecare

Updated 5 April 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.

Inspection team

The inspection was carried out by 2 inspectors and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The service is a domiciliary care service. It provides personal care to people living in their own homes.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was announced giving 24 hours notice so a representative of the provider would be available.

Inspection activity started on 31 October 2023 and ended on 14 December 2023. We contacted people and relatives on 6 November 2023. We visited the service on 8 November 2023.

What we did before inspection

We reviewed information we held about the service. We sought feedback from the local authority, professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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 of this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service and 5 relatives about their experience of the care provided. We spoke with the registered manager, deputy manager, a care-coordinator and the administrator. We received written responses to questionnaires we sent from 7 staff members.

We reviewed a range of records including 6 people's care and medicines records. We looked at recruitment records for 6 members of staff. A variety of records relating to the management of the service, including policies and procedures, were also reviewed.

We used technology such as video/telephone calls and emails to enable us to engage with people using the service and staff, and electronic file sharing to enable us to review documentation sent to us by the provider.

Following the inspection

We continued to seek clarification from the provider to validate evidence found. We reviewed all evidence sent to us electronically by the provider.

Updated 5 April 2024

About the service

E2E Homecare supports people to live in their own homes. The service provides personal care and support to children, younger adults and people of an older age, who may be living with a physical disability, sensory impairment, or mental health needs. At the time of the inspection the service was providing personal care to 19 people.

Not everyone who used the service received personal care. The Care Quality Commission (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

Staffing levels and deployment were not always effectively managed. People told us they did not receive care from a consistent staff team, they had experienced missed calls and on occasions the calls were not at their scheduled times.

We were not assured staff had received all the appropriate training and supervisions to support people safely. We received mixed feedback from people and their relatives about the training of care staff.

The provider’s medicines management systems were not always effective.

Systems were not in place to effectively monitor and develop standards at the service.

The provider’s electronic care plans did not always provide concise guidance for staff about how to deliver people's care and support requirements.

Staff were recruited safely. Staff files contained appropriate immigration, sponsorship, and pre-employment checks; however, some records were incomplete.

People and their relatives told us some staff did not always listen to them, talk to them appropriately and in a way they could understand. As a result, this sometimes impacted on the quality of the care received.

People were not always happy with the support they received from staff at mealtimes.

The provider’s electronic care plans did not always provide concise guidance for staff about how to deliver people's care and support requirements.

Some people and their relatives were happy with the care and support they received from the care staff. One person told us, “The majority of the carers I have are very kind and supportive.” A relative told us, “The carers who come to assist (Name) have been brilliant, we could not ask for better.”

Policies and systems were in place to help ensure people were protected from the risk of abuse. Most of the people we spoke with during the inspection told us they felt safe in the presence of staff.

Support was personalised and based on people's assessed needs and preferences. 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.

Risks to people’s health, safety and well-being were identified and managed. The provider had effective infection prevention and control systems in place.

The provider had systems for recording accidents and incidents, complaints and safeguarding concerns.

People and relatives were involved in making decisions about their care. People’s end of life decisions were respected.

People and relatives were aware of the provider’s complaints procedure and felt confident to raise concerns. Feedback was regularly sought from people and their relatives and valued. People and relatives felt the registered manager was approachable.

Most staff told us they were happy working at the service. They felt supported through their training, observations and supervision.

Staff worked with external professionals to ensure people received the support they wanted and needed.

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 12 January 2023, and this is the first rated inspection.

Why we inspected

This was a planned inspection to rate the service and was prompted by a review of the information we held.

Enforcement and Recommendations

We have identified breaches in relation to staffing and good governance.

We have made a recommendation about communication.

Please see the action we have told the provider to take at the end of this report.

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.