Essex and Suffolk Quality Care Ltd

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.

Essex and Suffolk Quality Care Limited is registered to provide personal care to older people in their own homes. At the time of our inspection, Essex and Suffolk Quality Care Limited was supporting 71 people with 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

People were cared for by staff who knew how to keep them safe, however risk assessments did not always provide information on how to reduce the risk of harm. Staff recruitment systems required improvement to ensure staff had the suitable skills and experience to support people effectively. People’s medicines were not always managed safely, and further guidance was needed regarding the administration of ‘as and when required’ medicines. There were enough staff to meet people’s individual needs and care visits were carried out as required.

Staff had received training to support people effectively. Where required, people’s nutritional needs were met, and referrals made to health professionals to ensure people remained well. 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.

Staff knew people well, were kind and respected people’s privacy and dignity. Positive relationships had been formed between staff and people using the service and people were encouraged to maintain their independence.

Care plans lacked detail about how to care for people according to their needs and preferences. End of life care planning required further development to include people’s preferences, cultural requirements and their wishes. A complaints process was in place and people and their relatives knew how to raise any concerns.

People, relatives and staff were mostly positive about how the service was managed. The oversight and governance of the service required review to ensure that any issues were identified and rectified to ensure the service continuously improved.

We have made a recommendation about risk assessments, training and the AIS (Accessible Information Standard).

Rating at last inspection

The last rating for this service was Good (published 1 April 2017).

Why we inspected

This was a planned inspection.

Enforcement

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

Follow up

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Essex and Suffolk Quality Care provides care and support to people living in the Tendring area of Essex, covering Clacton-on-Sea, Brightlingsea, St Osyth and Jaywick. At the time of our inspection the agency provided a service for approximately 40 people.

At the time of our inspection there was no registered manager in post. The day-to-day running of the agency was carried out by a management team consisting of an acting manager and the provider. 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 were safe because staff understood their responsibilities to recognise abuse and keep people safe. People received safe care that met their assessed needs and staff knew how to manage risk.

There were sufficient staff who had been recruited safely and who had the correct skills to provide care and support in ways that people preferred.

The provider had improved systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People were supported effectively with their health needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and we found that the provider was following the MCA code of practice.

The management team supported staff to provide care that took people’s wishes into account and staff understood their responsibility to treat people as individuals.

People were treated with kindness and respect by staff who knew them well. Staff respected people’s choices and took their preferences into account when providing support.

Staff were supported by the management team to provide care that met people’s needs.

The provider had systems in place to check the quality of the service and take the views of people into account to make improvements to the service. There were systems in place for people to raise concerns and there were opportunities available for people to give their feedback about the service.

Staff were positive about teamwork.

We looked at people's support records as well as information relating to the management of the agency including staff training and supervision records. We assessed the provider's arrangements for managing people's medicines and for monitoring the quality of the services provided.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Relatives told us that sometimes there had been missed calls and this could put people at risk. A relative told us that recently things had improved. They said, 'Things have picked up in the last month. We are getting a bit more consistency from the same three care staff.' Another relative told us that they felt their relative was safe.

One relative told us that they had raised concerns about medication and they had not been addressed promptly which was not safe for their family member. Since this incident procedures around medication were improved and a process for monitoring medication was put in place. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Essex and Suffolk Quality Care had made improvements to systems in place to assist people with their medication safely but further improvements were needed to check that records relating to medicines were complete and accurate.

Is the service caring?

We found that improvements had been made so that people received a more consistent service. Further improvements are needed so that people can be confident that all staff provide care and support to a similar standard and that the recent improvements are sustained.

Feedback from people who used the service and from relatives was complimentary about some staff but less positive about others.

A relative told us that one member of staff was, 'Very caring' and 'Makes [my relative] laugh and cheers them up' but another member of staff, 'Does not relate at all well' to the person. Another relative told us, 'In general the staff are caring and respectful but for a couple of them their main objective is to move on as soon as possible.' Another relative told us that most of the staff were caring but some, 'Rush in and rush out as quickly as possible.'

One person described staff as, 'Very caring and helpful' and said, 'They go over and above and go out of their way to help.'

Is the service effective?

Some people and relatives were happy that they had continuity of care, others were not happy about the changing care staff. One relative told us, 'If [my relative] keeps getting new staff they don't know, it's very unsettling as they are on their own.' They added that continuity of care had been poor in the past but had improved recently.

A person who used the service told us, 'In the past timing wasn't always good but recently it has improved.'

There were procedures in place to provide staff with a range of training relevant to the needs of people who used the agency. This provided them with the information they required to provide safe and effective care and support to people who used the service.

Is the service responsive?

People said that the standard of care and support could vary. A relative told us that some of the staff were good but some were not always so good but the new person in the office was dealing with things better. They said, 'Things have picked up in the last month. We are getting a bit more consistency from the same three care staff

A relative told us that a member of staff had telephoned the person's GP a couple of times when they were not well. Another relative described how one member of staff stayed for an additional two hours when they were concerned about a person's medical condition.

A person who used the service told us that staff were able to respond, 'If I have differing need on different days.'

Is the service well-led?

Essex and Suffolk Quality Care had made changes to the management of the service and people told us that they felt communication had improved. Further improvements were necessary in processes to monitor the quality of the service so that the management team could demonstrate that they listened to people and took their views into account to make the service better. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

A relative told us some of the 'Basic management' was not good but that it was improving. Two other relatives said that there had been poor communication from the office staff and a lack of organisation within the agency. Two people told us that care staff had not turned up in the past and that the office staff did not inform them or arrange for another member of staff to visit. A relative told us that there had been missed visits in the past but they felt that the provider did not always address the issue. They said, 'It was the inconsistency more than anything, that was the problem, but that's improving.'

A relative told us the new person in the office was 'On the ball' and felt that had helped improve some of the issues. Another relative told us, 'Recently some things have improved. In the past timing wasn't always good but it has got better.'

The way that staff duty was managed had improved. One member of staff said that sometimes they would get called at short notice but on the whole they had notice of their shifts. Another member of staff said the management of rotas has improved, they were given more notice of shifts and their 'off duty' time was more regular. They were having every other weekend off and this had had a good effect on morale.

We asked people if they felt involved in the care they were provided by the service provider. We also asked whether they felt the care met their needs. One relative told us: "The carers are respectful and asks X about choices.'

People's needs were not assessed and care and treatment was not planned and delivered in line with their individual care record.

People receiving care said they felt safe with the carers in their homes, and we saw staff had received training for the safeguarding of vulnerable adults that was up to date.

People were not protected against the risks associated with medicines because appropriate arrangements were not in place to manage medicines.

We found appropriate recruitment checks had been undertaken before staff started work for the service provider and they were supported through training to deliver care and treatment safely and to an appropriate standard.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

We found people were not protected from the risks of unsafe or inappropriate care and treatment because records were not maintained, and kept appropriately.

The service inducted and trained its staff to ensure that people were supported by competent care workers.

The service used appropriate methods to obtain the views of people using the service. The service responded to requests to change the service.