EJS Quatro House

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.

This was our first inspection of this service which has been registered with the Care Quality Commission [CQC] since May 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger people. The location office is situated in the centre of York. At the time of our inspection there were 16 people receiving a service.

Not everyone using Kings House receives 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 consider any wider social care provided.

The service is required to have a registered manager. At the time of the inspection there was a manager in post. The manager had applied to the CQC to be a registered manager. 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.

Care plans were in place for people. However, we found records of associated identified risks were not robust or available in all the files we looked at. This meant the provider failed to maintain accurate records for each person using the service.

The manager had a clear understanding of the Mental Capacity Act 2008 and had completed assessments of people’s capacity to consent to their care and support.

Relatives deemed to have a Lasting Power of Attorney (LPA) had signed their consent on behalf of people but audits had failed to check the scope or authorisation of the LPA which meant the relative may not be acting in the person’s best interest.

People were protected from avoidable abuse and staff who had received safeguarding training understood how to escalate their concerns for further investigation.

People received their medicines as prescribed. However, associated guidance required updating to ensure it reflected national best practice for staff to follow.

Appropriate pre-employment checks were completed and sufficient staff were employed to meet people’s individual needs.

Care workers had an induction, received training and attended supervision to support them to provide effective care and support.

Care plans were based on the individual and included information to ensure that any personal preferences, wishes or religious needs were recorded and upheld. A minimum annual evaluation of people’s care and support was completed with more frequent reviews where people’s needs changed.

People confirmed they received support as assessed to maintain a healthy balanced diet and fluid intake. Care plans included guidance to ensure people maintained their relationships with friends and family and they were supported to access healthcare services if necessary.

There was a manager in post who had applied to be registered with the CQC and we received positive feedback from people using the service and staff about their management of the service.

The registered manager had implemented quality assurance processes and sought feedback from people and staff to monitor and improve the care and support provided.

The provider was in breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17: Good Governance.

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