Essex Cares North

At the last inspection on the 7 and 12 of October 2016 we asked the provider to make improvements because the service did not always assess and record risks correctly and did not always identify errors or omissions in medicines promptly. We also found that care plans were task focussed and lacked detail.

During this inspection, we found that the provider had improved the running of the service. There were elements of the service that were outstanding. We found that the service was “Outstanding” in the Well-led domain this was because the provider had plans in place to ensure that they continuously learnt and improved. The service provided a service based on core values that were visible at all levels of staffing. This meant that they had created a firm foundation to work towards providing an outstanding services in all areas.

People were receiving care from staff that had an excellent understanding of individual risks and needs. Staff had been thoroughly vetted and were employed because of their personal values as well as their skills. Staff were supported to develop their skills and knowledge and their understanding of safeguarding vulnerable people was excellent.

Systems were in place so people could take their prescribed medicines safely and people told us they were satisfied with the service being offered to them but some people told us that sometimes their visit times could vary. There were sufficient staff to meet people’s needs and to manage risk.

The registered manager had good links with other health professionals within hospital and social care settings, working together to source the best care options for people referred to the service. Staff had access to a physiotherapist and occupational therapist who were on hand to offer advice and support regarding people's changing physical needs and equipment needs.

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.

Staff knew people well and had time to develop positive relationships with them. People were supported to consume food and drink of their choice and staff worked well with people and health care professionals, to ensure people maximised their health and wellbeing. People received support that was personalised and staff responded flexibly to changes in their lives.

Guidance was in place to enable staff to provide a consistent level of support. We have made a recommendation about end of life care. People and their relatives told us they were aware of how to make a complaint and felt they were listened to by the registered manager.

People told us that staff were kind and compassionate and spoke highly of them. Staff promoted person centred care at all levels of seniority to ensure the best outcomes for people. People told us that they were treated in a respectful and dignified way at all times.

There was a registered manager in post. 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.

At our comprehensive inspection of 8,16 and 17 March 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which were: Regulation 9 Person centred care, Regulation 12 Safe care and treatment, Regulation 18 Staffing and Regulation 17 Good governance.

You can read the reports from our last comprehensive inspection, by selecting the 'all reports' link for Essex Cares North on our website at www.cqc.org.uk.

There were improvements in the management of people’s medicines. However there had been a delay in the monitoring of medicines records which meant errors had not always been promptly identified.

Risk assessments for specific health conditions were included in some records but lacked guidance for staff to know how to support people with these conditions.

Care plans remained task focussed and lacked detail. Support tasks were listed but gave no indication of people’s preferences or what was important to them. Despite the shortfalls in the care records, people and their families told us they received personalised care which was responsive to their needs and their views were listened to and acted on.

Staff were provided with training and guidance in how to keep people safe and what they should do if they were concerned that a person was at risk or was being abused. People knew how to raise concerns and were confident that any concerns would be listened and responded to.

There were enough staff to deliver people's assessed care needs. Staff demonstrated empathy, understanding and warmth in their interactions with people. People were confident in the ability of the staff and felt that they knew them well and understood their care and support needs. Staff understood the importance of gaining people’s consent to the support they were providing.

Staff were provided with the basic training they needed to meet people's needs and preferences effectively. There were future plans for further equipping the staff by delivering more specific training in subjects such as diabetes or chronic obstructive pulmonary disease (COPD).

People were mostly satisfied with the support they received with their nutrition. Where appropriate the service had made referrals to health care professionals such as the community nursing team and GP’s.

The provider had quality assurance systems in place which were used to identify shortfalls and to drive continuous improvement. The management team were responsive to any concerns raised through the inspection and quickly responded and used the feedback they received to make immediate improvements.

This inspection took place on 8, 16 and 17 March 2016. The inspection was unannounced.

The service provides reablement support to people for up to six weeks when they leave hospital. It also provides services as a provider of last resort where other support agencies are not available. It supports between 120 – 150 people at any one time. It receives between 45 and 50 referrals a week.

The service had 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 did not always receive their medicines as they were prescribed. This related in particular to the time which people should receive their medicines. This was due in part to the way in which the provider organised the timing of calls. Although the registered manager told us that action had been taken to address this issue it had not always been effective.

People’s care plans contained risk assessment in respect of the care and support provided. However, risk assessments were not carried out relevant to particular conditions people may be living with, for example diabetes and epilepsy.

The service assessed the level of support a person needed but the time it would take to deliver that support was not always fully considered. It was expected that the support each person required would reduce as their support package progressed. This had led to some people telling us that there was insufficient time for the support they required. The service had a two or four hour window in which people could expect their support worker to attend. This meant that people did not always get their support at times they preferred.

Staff received training in mandatory areas such as moving and handling and safeguarding. However, the service primary objective is ‘reablement.’ There was no evidence in records or from speaking with staff to show that staff had received training specific to reablement.

Due to people receiving support from a high number of support workers people were unable to build up relationships with the people providing their care.

Care plans were written with the person when they first began receiving support from the service. These identified goals which the person wished to achieve during the period the support was provided. However, the service could not demonstrate how progress to achieving these goals was monitored. This had particular relevance where a number of different support workers worked with a person.

The provider did not have an understanding of the day to day challenges of the service. The registered manager, although aware of their responsibilities as a registered person, were not always supported by the provider to deliver what was required.

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

People made positive comments about the service they received. People told us that they were very happy with the service. One person said, 'The carers were really excellent.' Another person who had used the service after a stay in hospital told us, 'They were very caring, very good. They got me over the worst and helped me get back on my feet again.'

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. Staff were not clear about the extent of their role in supporting people with their medicines. Accurate information about people's medicines was not always available in their care plans.

There were arrangements in place to ensure that there sufficient staff on duty to meet the needs of people who used the service.

The provider sought the views of people to help improve the service. Feedback was collated and any shortfalls identified were dealt with in an action plan arising from the provider's annual report.

People were given information about the provider's complaints system and knew who to make a complaint to.

All the people we spoke to were very happy with the service and with the decision making process's that involved them in their care. We heard people being spoken to in a professional and dignified manner that was respectful and showed compassion.

We found the records we looked at during the inspection to be of a good standard.

The staff members that we talked to were knowledgeable and professional, giving us a clear understanding of the aims for the people using the service.