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Inspection carried out on 20 November 2019

During a routine inspection

About the service

Thurrock Care at Home is a domiciliary care agency that provides personal care to people living in their own homes. At the time of inspection 108 people were using the service.

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

People were very positive about the quality of the care and management of the service. People received a safe service as staff were knowledgeable about safeguarding procedures. Risks to people's safety were assessed, recorded and appropriate action was taken to keep people safe.

There were enough staff deployed to meet people's needs. The correct recruitment procedures were followed to ensure staff were suitably employed to work with people in their own homes.

People’s medicines were administered and managed safely by trained and competent staff, and people received them as prescribed. Correct infection control procedures were followed. Lessons were learnt, and the service had been improved when things had gone wrong.

The service assessed people’s needs and worked in line with current good practice. Staff were trained and supported to ensure they delivered effective care and support to people. People received consistent and timely care which met their needs and circumstances. Where support was provided with food and drink, people had choice over their meals.

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.

People told us they felt very cared for by staff who were caring, kind and considerate. Staff understood the importance of involving people in their care and promoting their independence. They enabled people to live in their own homes with confidence. People received an individualised service and their privacy and dignity was respected. Staff had developed positive relationships with people and their families.

People's care plans were personalised and contained all relevant information to respond to their needs. Reviews of people’s care were undertaken to ensure they were up to date. People knew how to make a complaint about the service. People received thoughtful and respectful end of life care.

The service was managed and led by an efficient and robust management team. Staff were valued and respected and clear about their roles and responsibilities. A quality assurance process was in place which ensured oversight of all aspects of the service. The service worked well with other professionals to ensure people received personalised and high quality care.

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

Rating at last inspection.

The last rating for this service was Requires improvement (published 24 September 2018) and there were multiple breaches of regulation. 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

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 28 June 2018

During a routine inspection

This comprehensive inspection took place on the 28, 29 June and 3 July 2018 which was announced; the inspection team consisted of one inspector on all three days.

Thurrock Care at home is run by Thurrock Borough council and provides care services to people within their own homes. Care services include personal care, a sitting service and domestic services. The service is funded by social services. The service delivers across Thurrock. At the time of our inspection the service was providing support to 133 people.

The service was first registered with the Care Quality Commission on the 31 May 2017.

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.

Medication practice required improvement to ensure that people received their medication as prescribed. The auditing system needed to be improved to ensure that it is effective in all areas of the service including medication management.

The registered manager had systems in place to identify and monitor the safety and quality of the service however they had proved to be ineffective as they either did not recognise the shortfalls, or when they did there was a lack of action to rectify them.

Views about staffing levels were mixed and some people felt that there was not enough trained and experienced staff available to meet their needs. We also found that people or their relatives were not fully involved in planning and making decisions about their care. The service was not responsive in identifying and meeting people's individual care needs.

The manager could not demonstrate how the service was being run in the best interests of people using the service. Arrangements in place to keep the provider up to date with what was happening in the service were not effective. As a result, there was a lack of positive leadership and managerial oversight. Systems in place to identify and monitor the safety and quality of the service were ineffective as they either did not recognise the shortfalls or when they did there was a lack of action to rectify them.

We found that staff did not always have enough time to spend with people to provide reassurance, interest and stimulation. There was a lack of knowledge around supporting and caring for people living with dementia including understanding how it affected people differently and how each individual should be cared for to promote their wellbeing as far as possible.

Whilst staff were able to recognise poor practice, suitable arrangements were not in place to respond appropriately where an allegation of abuse had been made.

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