Archived: EcoClean Community Care

EcoClean is a domiciliary care agency providing care and support to 32 people at the time of the inspection. Of these, 20 received regulated activity.

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

Although we found there had been improvements in the service, shortfalls remained in the governance of the service. Quality assurance checks had not been effective enough to identify and address concerns, to drive all the necessary improvements forward in a timely way.

Risks to people were assessed but actions for staff to take were unclear and risk assessments were not always in place.

The provider did not conduct mental capacity assessments or best interests decisions for people who may lack the capacity to make decisions about their care and support. Therefore, people were not always supported to have maximum choice and control of their lives and staff did not always 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.

Care plans we saw contained good person centred detail about their routines, preferences and how staff were to support them. However, records did not always contain consistent information.

People received their medicines as prescribed, and staff had sufficient training and support to meet peoples needs. There were enough staff deployed to meet people’s needs.

Care plans took into account people’s diverse characteristics and backgrounds. Staff promoted people’s dignity and independence.

There was a complaints policy in place and complaints were managed in line with the service's policies and procedures.

We made a recommendation with regards to risk assessment.

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 September 2018) and there were three breaches of the regulations identified. 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 that although some improvements had been made and was no longer in breach of some regulations, the provider was still in breach of regulation 17 and a new breach of regulation was identified (regulation 11).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

EcoClean Community Care is a domiciliary care agency. It provides personal care to older people living in their own houses and flats.

At the time of inspection 17 people were using the service.

At the last inspection in August 2017 the service was not meeting all of the legal requirements with regard to regulation 17, good governance.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions needed for governance to at least good.

At this inspection we found some improvements had been made with regard to the breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, the service was still in breach of this regulation 17 as other improvements with regard to governance were required. Breaches of regulation 9, person-centred care and regulation 18 staffing were also made at this inspection.

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

This is the first time the service has been rated Requires Improvement.

The provider was also registered as the manager of the 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.

Improvements had been made and the provider undertook some audits to check on the quality of care provided. However, more frequent audits were required.

People and their relatives told us they felt safe using the service and they trusted the workers who supported them. However, some aspects of service delivery required strengthening to ensure people were kept safe.

People mostly received their medicines in a safe way. However, we identified more frequent audits of medicines management was required to ensure all people received their prescribed medicines.

Improvements were required to staffing capacity to ensure sufficient staff were employed to provide safe, consistent and flexible care to people. Improvements were required to the provider’s recruitment process to minimise the risk of unsuitable staff being employed.

There was communication between people, relatives and the service to try to ensure relevant people were kept up-to-date about people's care and support needs. However, improvements were required to ensure people’s care was co-ordinated effectively by the agency.

Initial assessments of people’s needs took place when people started to use the agency but a system of review was required to ensure they continued to identify any current risk to people. Care plans were in place for some needs but they did not provide guidance for how people were to be supported to ensure consistency of care. Care plans did not show evidence of regular review or review as people’s needs changed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible, the policies and systems in the service were not available to support this practice. Staff had some understanding of best interest decision making, when people were unable to make decisions themselves. People were not kept involved in decisions about their care. Staff had not all received training about the Mental Capacity Act 2005.

People did not have the opportunity to give their views about the service. There was consultation with staff, family members and friends and their views were used to improve the service.

People did not receive an accessible information pack when they started to use the service that gave them information about the service and informed them about their rights.

Staff had received training about safe working practices. Staff received limited opportunities for training to give them more insight into people’s care needs. Informal supervisions took placed with staff to support them in their role, a formal system was not in place.

Staff were aware of people's nutritional needs and made sure they were supported with eating and drinking where necessary. People were supported to attend medical appointments if necessary to ensure their health needs were met.

People, relatives and staff said the registered manager and management team were supportive and approachable.

A complaints procedure was available and people we spoke with said they knew how to complain if they needed to or bring any concerns to the registered manager’s attention.

People and relatives told us staff were kind and caring as they carried out their role. People’s privacy and dignity were respected.

EcoClean Community Care is a domiciliary care service that provides personal care to people in their own homes within the Leeds area. EcoClean Community Care was registered with the Care Quality Commission in June 2016 and this was the first inspection of the service. The service provides care for older people and people living with dementia. At the time of our inspection there were four people using this service.

The service has 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.

People told us that they liked the culture of the service as they were listened to and were supported by the registered manager. However, we found there were no processes in place to monitor and improve the quality of the service provided. The registered manager was not aware of the issues we found during this inspection in relation to supervisions and appraisals for staff to develop their skills and knowledge. No audits or surveys had been completed which meant that the registered manager could not identify areas for improvement and whether people were satisfied with the care provided.

People we spoke with told us they felt safe. Staff received training in how to protect people from abuse and how to respond if they suspected abuse was taking place. Safeguarding concerns had been appropriately managed.

Procedures were in place to guide staff on the safe administration of medicines and staff had received medicines training. Medicines were managed safely, although we found two errors which had not been identified or reported to management. We have made a recommendation about this.

Risk assessments had been developed and were in place for people who needed them. They had been regularly reviewed and updated when required to ensure they contained the most up to date information. Risks regarding people’s home environment had been identified and appropriate risk assessments were in place.

Staffing numbers were sufficient to meet people's needs. The most recently recruited staff files demonstrated that the provider’s policy regarding recruitment had been followed. Previous records were missing documentation such as references.

People using the service were mostly independent with their dietary needs. Staff encouraged and promoted healthy options and fluid intake during visits.

Care records contained evidence of close working relationships with other professionals to maintain and promote people’s health. People were clear about how they could get access to their own GP and other professionals and staff at the service arranged this for them when required.

Staff received the support and training they needed to give them the skills and knowledge to meet people's needs. They were provided with an induction programme at the start of their employment. Staff understood how to support people in line with the Mental Capacity Act 2005 and were aware of the procedures to follow if they suspected a person lacked capacity to make decisions.

Staff supervisions and appraisals were informal and not documented in line with the provider’s policy. The registered manager was informed of this on the first day of inspection and had started completing appraisals at the second day of inspection.

Staff were caring, had positive relationships with people using the service and communicated well. Staff treated people with dignity and respect and were supported to be independent.

People received personalised care and support. They and the people that mattered to them had been involved in identifying their needs, choices and preferences and how these should be met. The registered manager ensured people's care plans were up to date so information was consistent for staff to follow. People were supported to do activities to avoid social isolation and promote wellbeing. People usually consented to their care and support from staff by verbally agreeing to this. People told us they and their relatives were actively involved in the planning and reviewing of their care.

A complaints procedure was in place for the registered manager to follow in responding to any complaints and people using the service knew who to contact.

The service had a positive ethos and culture. Staff members worked hard to ensure people's needs were met and they were motivated to perform their roles. People and staff knew who the registered manager was and felt well supported by them. Staff told us any concerns could be raised with the manager and they also had team meetings.

We identified a breach of the Health and Social Care Act (Regulated Activities). You can see what action we told the provider to take at the end of the full version of the report.