East Office

Updated 27 January 2024

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 Care Act 2014.

Inspection team

This inspection was carried out by 3 inspectors and a specialist advisor. 2 inspectors undertook the site visit and 1 inspector reviewed care records and risk assessments. The specialist advisor's specialism was nursing people with complex healthcare needs.

Service and service type

This service is a domiciliary care agency. It provides personal, and nursing, care to people living in their own houses and flats.

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. We gave a short period notice of the inspection because some of the people using it could not consent to telephone calls from inspectors. This meant that we had to arrange for a 'best interests' decision about this and who was best placed to speak on the person's behalf, such as a parent or court appointed deputy. We also wanted assurance the registered manager would be in.

Inspection activity started on 21 December 2023 and ended on 8 January 2024. We undertook some of this inspection remotely using telephone calls and virtual technology. We visited the office location on 21 December 2023 and provided initial feedback about our findings on 11 January 2024.

What we did before the inspection

We reviewed information we had received about the service since our previous inspection. We used the information the provider sent us in the provider information return (PIR). A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. This information helps support our inspections. We contacted 4 Integrated Care Boards (ICBs), a GP practice, the local safeguarding authority and received feedback from them. We used all of this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service and 6 relatives about their experience of the care provided. We spoke with 15 members of staff including the registered manager, a quality manager, the deputy manager and care support workers. We also spoke with the nominated individual by telephone. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 6 people's care and treatment records and 3 people’s medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were also reviewed, including training records, competence assessments, quality monitoring records, compliments and complaints, various policies and procedures.

Updated 27 January 2024

About the service

East Office is a domiciliary care agency registered to provide personal and nursing care to people living in their own homes. Most people due to the complexity of their care and treatment needs had 24/7 care, or care for a large proportion of the day and night.

The service is able to support children up to 18 years of age, younger and older adults, people with a learning disability or autistic people, and people living with dementia, a physical disability and/or sensory impairment. At the time of the inspection, 39 people were using the service, all of whom received personal, and/or nursing, care.

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

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.

At the time of the inspection, the location did not care or support for anyone whose primary care need was for a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support

Staff were knowledgeable and skilled in applying safeguarding procedures and knew to whom they could report any concerns. The provider acted effectively where safeguarding issues or allegations were identified. People received their medicines as prescribed by trained and competent staff.

The service and the staff team took on board learning when things went wrong and effective changes were implemented. Enough skilled and suitable staff had been recruited and most recruitment records showed the provider had checked they were safe to work with people. However, best practice guidance for checks for staff from outside the UK did not always include a police check. We were assured this would be addressed. A relative said there was enough staff cover, and only in exceptional circumstances did they have to support their family member's care needs until replacement staff arrived.

Right Care

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. A person told us they chose when to have their medicines and how. Other professionals were involved so people’s care and treatment was always in their best interests.

Risks to people were identified and safely managed. Staff knew how to keep people safe, such as when using medical equipment and hoist and slings used to support people to reposition. Staff adhered to good infection prevention and control practices. A person told us staff always washed their hands between each care task.

Right Culture

In the main, quality monitoring systems, oversight and governance was effective in driving improvements. Although there were some missed opportunities to improve the accuracy and details in people’s records. The registered manager led by example and had fostered an open and honest staff team culture. Staff put people’s needs at the forefront of their care and treatment needs and staff upheld people’s human rights to have a good quality of life.

People, their relatives and staff had a say in how the service was provided. The provider worked well with other organisations, and this helped people live a full meaningful life. A person had praised the provider for standing up for their human rights so they could live more independently at home. Another person had, for the first time ever, been on a holiday which they had thoroughly enjoyed.

Why we inspected

The inspection was prompted in part due to concerns we received about safeguarding and risks to people, the culture and management of the service. A decision was made for us to inspect and examine those risks. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for East Office on our website at www.cqc.org.uk.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led section of this report. The overall rating for the service has remained good. This is based on the findings at this inspection.

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 Good (published 29 April 2022).

Follow up

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