Eden Brook Home Care Ltd Also known as Eden Brook

New HQ (known as Eden Brook Home Care) is a domiciliary care agency providing personal care to people in their own homes. The service provides support to older people, people with physical disabilities and those living with dementia. At the time of our inspection there were 98 people using the service.

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. There were 97 people supported with personal care at this inspection.

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

Improvements were being made to staff training and supervision records to ensure people received safe care. The provider acted to respond to potential risks relating to medication, incidents or accidents. People had risk assessments in place to guide staff. Staff demonstrated effective infection prevention and control practice. Staff were recruited safely. There were sufficient staff available to support people consistently, and to meet their needs and preferences. Most people told us they were satisfied with the safety and quality of the care.

Whilst improvements had been made since the last inspection, these needed to be embedded and sustained to check any changes to systems and processes were effective. We have made a recommendation a system for monitoring this is established. Some record keeping was unstructured and informal. The nominated individual took action straight away, including introducing a provider-level audit as an additional level of oversight following our feedback. The service worked well in partnership with other professionals, such as the local hospice. Staff and people told us the service had improved.

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 January 2023) and there were breaches 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook a targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

However, during the course of the inspection we found additional improvements had been made, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New HQ on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about developing a process to monitor and review the implementation of new oversight systems, to ensure they are effective and sustained.

Follow up

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

New HQ is a domiciliary care service providing personal care to people in their own houses and flats. The service provides support to people living in and around Mid Essex. At the time of our inspection there were 96 people using the service. 95 people received personal care.

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

Not all staff had been recruited safely, in line with best practice guidance and regulations. Not all staff had received adequate training and assessment to ensure they were safe to carry out their role. The provider did not have robust processes in place for the oversight of the service to identify concerns and make improvements.

Not all risks to peoples safety had been adequately assessed and documented by the service. People and relatives gave us mixed feedback about how safe they felt. Not all staff had completed the providers training in key areas, such as Safeguarding, Moving and Handling, and Medication Administration. Peoples care plans contained information relevant to them and included details of how to keep them safe. People and relatives told us care staff were nice and treated them with respect.

Systems and processes in place to maintain oversight of the service and drive improvements were ineffective at identifying concerns raised on inspection. Policies and procedures in place at the service were not being followed in relation to staff training. We received mixed feedback from people about communications from the service. The provider was implementing a new IT system during the inspection to make updating staff easier. Staff told us management were approachable and responded when staff needed them.

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.

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 November 2018).

Why we inspected

We received concerns in relation to peoples call times, staff training, and staff recruitment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. You can see what action we have asked the provider to take at the end of this full report.

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 requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New HQ on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to managing risks to people, staff training and recruitment, and governance and oversight 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 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.

When we last inspected the service, it was rated requires improvement. At this inspection we found the service had made the necessary improvements and therefore it was now rated good.

The service had a registered manager in post. 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 and associate Regulations about how the service is run. Whilst the registered manager took overall responsibility the care manager had responsibility for the day to day management of the service.

People were safe from abuse and bullying. Staff had knowledge of safeguarding and were aware of their responsibilities to report any concerns. The registered manager and care manager knew of their responsibilities regarding the Mental Capacity Act 2005.

Risks were assessed and suitable control measures put in place, which still enabled people to maintain as much independence as possible. There were sufficient numbers of staff to ensure that people's needs were met and recruitment practices ensured that staff were of good character and suitable for their roles.

People were supported to take their medicines safely, if required. Systems were in place to record when medicines were given and were regularly audited to ensure there were no errors.

Staff received an induction and on-going training to make sure they had the right skills and knowledge to provide people with care in their own homes. Staff were well supported and had opportunities to discuss any concerns and training needs they might have.

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.

There were positive relationships between people and members of staff. Staff treated people with kindness and took the time to get to know them and their interests whilst providing their care. The service had involved people in producing their care plans to ensure that care was provided in the way they wanted it to be. In addition, people and their family members were provided with information about the service and what they could expect from them.

The care plans were detailed. Staff could describe how individual people preferred their care and support delivered and the importance of treating people with respect in their own homes.

The service worked in partnership with community professionals and local authorities to meet people's needs.

The provider had a system to regularly assess and monitor the quality of service that people received and identified and acted on areas for improvement.

We made a recommendation around the roles and responsibilities within the organisation.

Chelmsford and the surrounding area. At the time of our inspection there were 52 people using the service.

The service was last inspected in 2015 and was rated good.

We have made a recommendation about safeguarding in that staff need to be given details of external agencies to contact.

We have made a recommendation about staff training in that staff competencies need to be carried out.

The service had a registered manager in post. 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 and associate Regulations about how the service is run. Whilst the registered manager took overall responsibility the care manager took responsibility for the day to day management of the service.

People were safe and staff knew what actions to take to protect them from abuse. However, none of the staff we spoke with were aware of what external organisations to contact if they had concerns . The provider had processes in place to identify and manage risk.

People received care from a consistent staff team who felt well supported and trained. However, competency assessments had not been carried out of staffs practice. Therefore people could not always be confident about the skills and competence of the staff.

Care staff understood the need to obtain consent when providing care.

The systems in place to support people to take their prescribed medicines safely needed some improvements.

People were supported with meals and to make choices about the food and drink they received. Staff supported people to maintain good health and access health care professionals when needed.

Assessments had been carried out and personalised care plans were in place which reflected individual needs and preferences. The provider had an effective complaints procedure and people had confidence that concerns would be investigated and addressed.

The service benefitted from a clear management structure and visible leadership. However, audits carried out needed to be more robust in order to monitor the quality of the service and drive improvements.

The purpose of this visit was to check that improvements had been made.

During this inspection we spoke with two people. These were the provider and one of the managers.

We found that the provider had made improvements in all areas in relation to care and welfare of people who use services, safeguarding and safety. The provider had developed new care plans and training had been given to all staff regarding safeguarding.

To cover assessing and monitoring the quality of service provision the provider had commenced a robust audit trail. This monitored the service in several areas including care plan records, client and staff surveys and environmental risk assessments in people's homes.

We saw documentation and spoke with staff relating to supporting workers, and assessing the quality of service. We found that the provider was complying with all regulations that had been inspected.

People we spoke with told us they were given choices as to what they needed care staff to do for them. They said that they were asked about their care and staff ensured people were provided with their choices.

Comments from people included: "They call here every day and do everything they even take time for a friendly chat"; 'Staff are reliable and show a good understanding of my needs.' One person also told us that they felt at ease with staff and knew that they would look after them properly. However the information in peoples care plans was limited and did not identify the level of care and support required. The care plans held no evidence to show if they had been monitored or reviewed with the person using the service.

People we spoke with said they felt fully supported by the care staff. One person told us that the service was wonderful. Staff files we viewed had no evidence to show that staff who worked at the service had received any training while employed by Eden Brook Home Care.

Comments from people included: 'They're very experienced staff they know just what my X needs.' and: 'Staff are kind and caring and come and go at the right times.' However staff told us that they did not receive regular training, supervision or support.

The manager told us that the quality of the service had not been monitored by routine audits. There were no processes or systems in place to seek the views of people who used the service and those who acted on their behalf.