Background to this inspection
Updated
6 July 2022
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 two inspectors and one 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
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
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
We gave the service 72 hours’ notice of the inspection. This was because we needed details of people and their relatives to contact and to be sure the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 16 May 2022 and ended on 26 May 2022. We visited the location’s office on 19 May 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 21 March 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.
During the inspection
We spoke with nine people who used the service and seven relatives about their experiences of using the service. We spoke with seven members of staff, including care workers, the registered manager and the provider. We had email information from one care staff. We reviewed four people’s care plans, four staff recruitment files and a variety of policies, procedures, audits and other systems used for managing the service.
Updated
6 July 2022
About the service
Essex and Suffolk Quality Care is a home care agency providing personal care to people living in their own houses and flats. At the time of our inspection there were 64 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.
People’s experience of using this service and what we found
We made recommendations at the last inspection about risk assessments, training and Accessible Information Standard. Some improvements had been made but further work was needed. We have made a recommendation about the monitoring of people's nutrition and hydration.
People gave mixed feedback about their experience of the staff, management and the care provided. The service was not always safe, effective, responsive and well led. Systems and processes for the governance, oversight and management were not robust to support the effective running of the service. Staff were not always recruited safely.
Risks to people’s health and wellbeing were assessed but not adequately recorded in their care plans in order to understand and mitigate those risks. The medicines administrative system was not monitored or managed effectively. A system for monitoring the visits to people was not in place to know if people had late or missed calls. There was no analysis of safeguarding themes and trends to reduce the risk of reoccurrence. Infection prevention and control procedures were not in place in line with government guidance.
Staff did not receive all the necessary training to support them in their role. Not all checks on staff members’ competency were undertaken.
People were not always supported to have maximum choice and control of their lives and staff did not 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. People’s capacity was not adequately assessed and recorded to ensure their rights were protected.
People’s oral health care and communication needs were recorded. The provider logged and responded to complaints. People’s feedback about their care was sought but changes were not always made as a result.
Some supervision and support systems were in place for staff. Staff felt generally supported by the registered manager. The provider worked with other health and social care professionals. No-one using the service was receiving end of life care.
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 4 March 2020) and there was a breach of the regulations. 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 some improvement had been made but the provider was still in breach of the regulations.
At our last inspection we recommended that the provider reviewed their risk assessments, training and the AIS (Accessible Information Standard). Some improvements had been made and further recommendations made.
Why we inspected
We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report and you can see what action we have asked the provider to take.
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 stayed the same and is requires improvement based on the findings of this inspection. You can read the report from our last inspection, by selecting the ‘all reports’ link for Essex and Suffolk Quality Care on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 person centred care, safe care and treatment, safeguarding people from abuse or improper treatment, recruitment practices and governance and oversight of the service.
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.