Home Instead Also known as Essex Senior Care Limited, Epping

Home Instead is a domiciliary care service providing personal care to adults who live in their own houses and flats. At the time of our inspection, 97 people were receiving personal care.

Not everyone who uses domiciliary care services receives 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

People's medicines were not always managed safely and the provider's processes for checking the accuracy of people's medicines records were not always robust.

The registered managers governance arrangements did not always provide assurance the service was well led. Quality assurance systems were not robust and had not identified the shortfalls we found during our inspection.

Effective arrangements were in place to ensure recruitment checks on staff were safe. Minor improvements were required to staff recruitment files. We have made a recommendation about the management of staff recruitment files.

There was limited information in the support plans we reviewed relating to people’s end of life wishes. We have made a recommendation about end of life wishes.

We received positive feedback on the service. One person said, ''The registered manager is very kind and considerate, and the staff always go above and beyond and treat [relative] like family".

Risks to people had been assessed, reviewed, and updated in people's care plans when their needs changed. Staff had access to personal protective equipment (PPE) and there were effective infection prevention control measures in place.

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. Staff had a good understanding of people's preference of care, staff promoted people's independence.

People and their relatives were involved in the planning and review of their care. The registered managers had effective policies to respond to complaints and these were handled well.

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 outstanding (published 27 October 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report

Enforcement and recommendations

We have identified breaches in relation to medicines management, good governance, and the notification of incidents. We have a made a recommendation about staff recruitment files and end of life wishes.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The inspection of this service took place on 28 29 30 June 2017 and was announced. There was a registered manager in post and they were present at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, registered managers 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.

People told us they felt safe receiving care in their homes and they did not have any concerns about the care they received. Caregivers and office staff were knowledgeable in what constituted abuse and their responsibilities in reporting any concerns they had internally and externally to local safeguarding authorities.

Care plans were personalised to each individual and contained information to assist caregivers to provide care in a way they wished to receive care. The service operated a matching service where caregivers with similar interests, hobbies and personalities were matched to people, therefore people always received consistent care and support from the same caregivers. All people spoken with agreed they always received support from caregivers they knew well.

People who received care and support from Home instead Senior Care said they were very happy with the service provided. Everybody said the caregivers went above and beyond what was expected of them. The service had gone the 'extra mile' by considering the needs of people and their caregivers, by holding various events and competitions to further promote and develop positive relationships with people and their family members.

People and their relatives were actively encouraged to make their views known and were involved in making decisions about their care. Caregivers had a very good understanding about what was important to people and went to considerable lengths to ensure people's needs and wishes were met.

Senior staff were passionate about the agency and valued caregivers. They had a very good knowledge and understanding of people's care needs, interests and how they liked their care to be provided. They spoke warmly about the people and their families who used the service and it was clear from our visits that people liked and trusted them and were at ease in their presence.

A dementia café was held every month so caregivers, people that used the service and families could get together. The service worked within the local community to promote awareness of the effects of living with dementia. The service had two dementia friends’ champions that had been trained as volunteers by the Alzheimer’s society. Dementia friends’ champions are volunteers who encourage others to make a positive difference to people living with dementia in their community. They do this by giving them information about the personal impact of dementia, and what they can do to help. The champions had delivered sessions to all staff at the service and had plans to hold sessions for people that used the service and their families.

The provider had up to date complaints and whistleblowing policies and procedures which gave information for staff to follow and time scales to adhere to. This helped to assure people and caregivers that their concerns were taken seriously and addressed quickly.

Systems and processes were in place to ensure the safe recruitment of staff with sufficient numbers of staff employed to safely meet people’s needs.

The provider had quality assurance systems in place to monitor the quality of service people received. The provider undertook various audits and the national office conducted an annual audit; this included scrutinising all aspects of the business. The last audit in May and June 2017 was positive, with some best practice suggestions made.

We looked at records which showed that people's care and support needs had been assessed, documented and reviewed. They were personalised and gave staff clear guidance on how to meet people's individual requirements. One person told us, 'They [staff] are brilliant and I can't praise them enough. They do everything I need and more. They are very helpful and nothing is too much trouble.'

People who used the service had been protected from the risk of abuse. Published guidance about safeguarding vulnerable people had been made available to staff and put into practice. A relative commented, 'My [family member] trusts the staff, has confidence in them and has told me [they] always feel safe in their hands.'

Records showed that effective recruitment procedures were in place to ensure that staff were fit, able and properly trained to meet people's needs. This included carrying out appropriate checks before staff began work. Suitable arrangements were also in place to ensure staff had been appropriately supported to perform their roles.

We looked at records which showed that systems were in place to regularly assess and monitor the quality of services provided.