Background to this inspection
Updated
23 December 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 six inspectors and two Experts 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.
Two inspectors visited the office and reviewed records; visits were made to four supported living services and inspectors spoke to staff and the people using the service. The experts by experience made telephone calls to people and relatives about their experiences of care.
Service and service type
This service is a domiciliary care agency. It provides personal care to 53 people living in their own homes. The service also provides care and support to people living in 17 supported living settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
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
This inspection was announced, and we gave the service 24 hours’ notice of the inspection as people are often out and we wanted to be sure there would be people at home to speak with us and that they consented to this. Inspection activity started on 28 November 2022 when we visited the location’s office. We concluded the inspection on 13 December 2022 when we provided feedback.
What we did before the inspection
We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also sought feedback from the Local Authority. We used all this information to plan our inspection.
During the inspection
Some people we met during the inspection had complex needs and were not able to tell us about their experiences. We therefore used our observation of care and other evidence to help form our judgements. We visited four supported living locations as part of the inspection. We spoke with one person and 15 relatives of people who used the supported living service.
We spoke with eight people and six relatives of people using the domiciliary care service. We spoke to seven staff when we visited the providers head office, we received ten emails from staff telling us about their experience and talked with 16 others.
We looked at selected care plans and risk assessments, medication and staffing rotas. We reviewed 6 staff recruitment records and training records as well as quality assurance systems.
Updated
23 December 2022
Cephas Care Ltd Domiciliary Care Agency provides personal care to people who live in their own home. The service supports older people as well as autistic people and people with a learning disability. The supported living projects range in size from small to larger projects accommodating up to nine people in one dwelling sharing communal areas and staffing. In total they assisted 39 people of which 32 people were assisted with personal care in 17 supported living projects, across Suffolk. At the time of the inspection the domiciliary service supported 53 people who were in receipt of personal care across Ipswich and Felixstowe.
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
Following the last inspection, a new management team had taken over the day to day running of the service. At this inspection we found improvements had been made both across the domiciliary care service and supported living, although further work is needed to embed new processes and build greater trust with relatives.
Feedback from people using the domiciliary care service was positive overall but some people had been impacted by challenges with the electronic scheduling system and staff changes, which had led to some missed calls. The provider was monitoring these closely and told us that they had commissioned a new electronic system which they were about to start using. This provided us with some assurance that risks were reducing further.
Feedback from relatives of people using the supporting living service was inconsistent with some relatives telling us that their family member was happy and had a good relationship with staff, but others expressed concerns about staff skills and the use of agency staff. We have made a recommendation about staff training and the use of techniques to prepare people moving between services to increase the opportunities for a more positive experience.
Staff were in the processes of reviewing care plans. We have made a recommendation about accessing sensory assessments for some people to assist with the care planning process. End of life care planning was not well developed, and we have made a recommendation about this.
Throughout the inspection, the management team displayed a transparent approach. They spoke openly about challenges and shared their plans to address them. Audits were more robust and new systems had been put into place. We have made a recommendation about developing more observational audits.
People had increased choice and control over their lives and there was improved oversight of restrictions. The provider recognised that further progress is needed, and they had an action plan in place to drive improvement.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right support:
• The service had enough staff to meet peoples' needs and promote people’s choice and independence. People had greater access to the community as staff were available to support them.
• Staff were clearer as to their responsibilities in relation to the Mental Capacity Act and care plans were clearer about how people communicated and made their views known.
Right Care:
• Risks to people's safety were identified and taken seriously. Guidance was available to staff on how they should reduce the risk of harm and promote people’s dignity and human rights.
• Incident reports were completed in more detail and reviewed by the management team to reduce the likelihood of further incidents. We saw that the numbers of incidents had reduced.
• People were supported to maintain relationships with friends and family, and we saw that there were a variety of arrangements in place reflecting people's individuality.
Right culture:
• The new management team were accessible and visible to people using the service and staff. There was a greater focus on improving people’s experience.
• Staff morale had significantly improved, and we saw that staff were encouraged to raise issues.
• Staff had greater confidence in the safeguarding systems and that their concerns would be taken seriously.
• The quality assurance systems had been strengthened and provided greater oversight.
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 inadequate (published 29 June 2022).
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. This service has been in Special Measures since 29 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cephas Care Ltd Domiciliary Care Agency on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 continue to monitor information we receive about the service, which will help inform when we next inspect.