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Inspection carried out on 31 July 2018

During a routine inspection

We carried out an announced comprehensive inspection of the service on the 31 July and 1 August 2018. The service was previously inspected in November 2017 and was rated requires improvement overall. At this inspection we found improvements had been made in relation to the management of people’s medication, staff receiving formal supervision

This service is a domiciliary care agency in Grays, Essex. It provides personal care to people living in their own flats within a housing complex benefitting from communal areas. It provides a service to older and younger adults. At the time of our inspection 46 people were using the service.

The service had a registered manager. 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. The day to day running of the service was undertaken by the service manager who reported to the registered manager daily, as the registered manager also oversaw other services under their registration.

Staff and people spoke very highly of the registered manager and service manager who they informed to be supportive and worked hard to provide an exceptional service. The service had quality monitoring processes in place, however these needed to be embedded to monitor the progress of the service and ensure continued good care delivery.

The service’s recruitment process ensured that appropriate checks were carried out before staff commenced employment. There were sufficient staff on duty to meet the needs of people and keep them safe from potential harm or abuse. People’s health and wellbeing needs were assessed and reviewed to minimise risk to health. People’s medication was managed well and although there was some recording these had not impacted on people negatively and the provider were working to address these.

People were cared for and supported by staff who had received training to support people and to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to health and social care services was made when required.

Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

Records we viewed showed people and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and when there was a change in care needs. People were supported to follow their interests and participate in social activities. The service responded to complaints received in a timely manner.

Inspection carried out on 14 November 2017

During a routine inspection

We carried out an announced comprehensive inspection of the service on the 14 and 16 November 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own flats within a housing complex benefitting from communal areas. It provides a service to older and younger adults. At the time of our inspection 47 people were using the service.

The service had a registered manager. 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. However, at the time of our inspection the registered manager had been absent from the service since September 2017 and the day to day running of the service was being managed by a service manager.

At our previous inspection carried out on 11 and 13 October 2016 the service received an overall rating of Requires Improvement. We found breaches of Regulations 12 [Safe care and treatment], 17 [Good governance] and 18 [Staffing] of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, the registered manager sent us an action plan to show what they would do to improve the key questions: Is the service safe? Is the service effective? Is the service responsive? and is the service Well Led? to at least Good. At this inspection, whilst improvements had been made, further improvements were still required.

At our inspection in October 2016 we found improvements were needed to ensure quality assurance systems were effective. Whilst we found some progress had been made at this inspection, further improvements were required to ensure the service was well led; and the systems available for the monitoring and on-going improvements regarding the quality of the service are fully embedded and used effectively.

When we last inspected the service we asked the provider to take action to make improvements to ensure the safe management of medicines. At this inspection, although we found some improvements had been made, further improvements were still required to ensure medicines were administered safely and as prescribed.

We had found that formal supervisions, appraisals and competency spot checks of staff practice were not consistent to ensure people received effective care. We also identified that staff training had not been monitored effectively. At this inspection whilst we found improvements had been made, further work was required to ensure effective systems were in place which ensured staff had completed the provider’s mandatory and refresher training.

People had told us at the last inspection that care staff were not always on time and we were informed that a new computerised system was in the process of being implemented to monitor people’s call times. At this inspection the new computerised system had been introduced to support the service to monitor calls times. People told us care staff were on time and the service manager was able to demonstrate how staffing numbers were calculated to ensure people’s individual care and support needs were met. There were thorough recruitment procedures in place to ensure staff were suitable to work with vulnerable adults.

People were positive about the caring attitude of staff. Staff encouraged people to maintain their independence as much as they were able to. People’s privacy and dignity was respected.

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. The service manager understood and complied with the requirements of the Mental Capacity Act (MCA) 2005.

The service had a number of ways of gathering people’s views including conducting questionna

Inspection carried out on 11 October 2016

During a routine inspection

The announced inspection took place on the 11 and 13 October 2016.

Extra Care Service provides personal care and support to people living in their own homes, within a housing complex benefiting from communal areas. At the time of our inspection there were 45 people using the service.

The service is required to and did have a registered manager. 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. However, the registered manager had been absent from the service for several months in which time the deputy manager and service manager had been overseeing this role. A manager had been newly appointed in October 2016 for the interim period.

There had been a lack of leadership within the service which the provider addressed by appointing an interim manager. The service needed to develop more robust quality assurance systems. Although some processes were in place, effective monitoring and auditing systems at service level were required to drive improvements and ensure consistent, high quality, safe and effective care.

The management of medicines was not always safe and improvements were required to the service’s practices with regard to the recording, monitoring and auditing of medications administered.

Care records in respect of people’s medication, health and specific end of life care did not adequately reflect people’s needs. Care plans were not audited regularly to ensure they contained accurate information to support people effectively.

Care workers were not supported regularly through formal supervisions or appraisals. Competency checks were also not carried out to ensure people were receiving care and support from adequately skilled and competent care workers. Required training and refresher courses were not monitored effectively and in some instances it could not be verified if care workers had completed certain courses. Concerns were responded to immediately by the service.

People’s nutritional needs were supported adequately and care workers were mindful of people’s wellbeing and helped people to get involved in activities to avoid social isolation. People and their relatives knew how to make a complaint; complaints had been resolved and documented appropriately. However analysis of complaints needed to be more robust to drive improvements.

The service responded to people’s concerns immediately and appropriately about lack of dignity and respect for privacy from care workers towards people. The majority of comments reported care workers were respectful and caring towards people. Care was predominantly provided in a way that intended to promote people’s independence and wellbeing.

People felt safe and care workers voiced adequate understanding of how to keep people safe and avoid harm. Management and the provider had taken steps to ensure that sufficient members of staff would meet people’s individual needs consistently and within reasonable time frames. A robust recruitment process was in place and staff were employed upon completion of appropriate checks.

Staff supported people to ensure they received access to healthcare services when required. Management and staff understood their responsibilities and the framework of the Mental Capacity Act 2005 (MCA) despite management being unable to demonstrate adequate training. Care workers supported people to maintain their independence and make their own choices.