EJS Quatro House

Updated 18 October 2019

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 planned this inspection to check 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 Care Act 2014.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care and live in care to people living in their own houses and flats. The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

We gave the service 24 hours’ notice of the inspection visit because it is small, and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection site visit activity took place on 3 July 2019. We visited the office location on this date.

What we did before the inspection

We reviewed information we had received about the service from the provider since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with the registered manager of the service.

We reviewed a range of records. This included four people’s care, medication records, five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.

After the inspection

Following the inspection, we received feedback from with one person who used the service by email, two relatives and two staff members by telephone. We sought feedback from the local authority and professionals who work with the service.

Updated 18 October 2019

About the service

EJS Quatro House is a domiciliary care agency. It provides personal and live in care to 12 people living in their own houses and flats. It provides a service to older adults, some of whom are living with dementia. Not everyone using ESJ Quatro House receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

People’s experience of using this service and what we found

Safeguarding concerns were reported to the relevant authorities, but the registered manager did not implement any requirements to protect people from future risk of abuse. Risks to people and details around their health were not appropriately recorded, and the recording and auditing of medicines was also inadequate. The provider was unable to provide evidence that staff had been safely recruited, and rotas showed that staff were allocated to provide support to two people in their separate homes at the same time.

People’s rights were not always protected in line with the principles of the Mental Capacity Act 2005. Staff members had completed ten training modules in one day, and people and relatives felt that staff were not well trained. Staff told us they found it increasingly difficult to contact the registered manager. The service did not follow national guidance and best practice.

People and relatives gave us varied feedback regarding the kindness of staff and around their dignity being respected. The registered manager did not request reviews when people’s needs changed, and any reviews that did take place were not formally recorded.

Care plans were not personalised to reflect people’s needs and did not include information on how to support people with their medical conditions. At the time of our inspection, two people were receiving end of life care. However, care plans did not include people’s end of life wishes. Complaints were not dealt in line with the provider’s policy.

People, relatives and staff felt the service was not well led. Staff informed us that they had not been paid for months and were not given a reason for this. The registered manager only completed audits around medicines, but issues identified in this had not been resolved. The registered manager had not resolved issues identified in a quality assurance visit completed by the local authority. People and relatives and staff were rarely given the opportunity to feedback their thoughts on the service. There were links to local organisations where knowledge and training resources could be gained, but these were not being utilised. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

This service was previously registered in Yorkshire under the name Kings House, and on their last inspection received the rating Requires Improvement (26 June 2018). The service moved location to their current address in February 2019. We were not informed of this until 27 March 2019. Providers are legally obliged to inform us of the location they are operating from so that it can be registered with us.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will follow up on recommendations made and any improvements required at our next inspection.

Enforcement

We have identified eight breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, safeguarding, staffing deployment and recruitment, need for consent, delivering personalised care and good governance.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.