Essex Care Consortium - Colchester

Essex care Consortium – Colchester is a residential care home providing the regulated activity accommodation for people who require personal and nursing care to up to a maximum of 20 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 17 people using the service.

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.

The service was not consistently meeting the underpinning principles of Right support, right care, right culture. The service was not well led. The service had a range of managers responsible for the management and oversight of the service. However, systems and processes to assess, monitor and improve the quality and safety of the service were not identifying where improvements were needed. There was a lack of understanding of the risks and issues facing the service. Legal requirements were not always fully understood or met. The provider was not following their own policies and procedures, including safeguarding people and duty of candour.

Governance arrangements needed to improve to ensure effective oversight of the quality and safety of the service and used to identify and drive improvement. Failure to have oversight of all incidents occurring in the service placed people at a risk of harm, or a significant risk of harm occurring. Systems to log incidents, accidents, and safeguarding concerns were not effectively used to identify themes or trends. Where incidents had occurred, these had sometimes lacked the full rigour needed to thoroughly investigate the root cause or actions for improved practice to prevent any reoccurrence.

Right Support:

Essex Care Consortium – Colchester is made up of a series of houses in a campus style setting on the outskirts of the town of Colchester, which enables people to access the local community and its amenities. People had exclusive possession of their own rooms, in shared accommodation and access to shared gardens and woodlands. Internally the premises were well designed for the people living there.

The service had enough staff on duty to meet people’s needs, including additional staff 1-1 hours to support people to manage anxieties and have a good day, including accessing day care facilities and the community. People were provided with opportunities to gain new skills and become more independent. Staff were kind, and caring and as a result we saw people were at ease, happy, engaged and stimulated. Staff worked well with other professionals to ensure people received the right level of support to manage their health and manage signs of distress and or frustration.

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. However, further work was needed to ensure where people lacked capacity, the use of video monitors to detect seizure activity at night were granted under the Deprivation of Liberty Safeguards (DoLS). We have made a recommendation about making DoLS applications regarding people’s right to privacy.

Safeguarding concerns were not routinely being identified and reported to the appropriate authorities. Safeguarding incidents were not given sufficient priority to ensure concerns about people’s safety were investigated and lessons learned when things had gone wrong. Risks to people’s safety, were not managed well. Personal Emergency Evacuation Plan’s (PEEP’s) did not contain sufficient information for staff to safely evacuate people in the event of a fire or similar emergency.

Managers and staff were failing to properly assess and manage risks to people at risk of choking and mealtime behaviours, such as eating too quickly which placed them at risk of harm or exposed them to a significant risk of harm occurring. Information in peoples care records and in kitchens was inconsistent and did not provide clear guidance for staff on how to deliver safe care, including the safe consumption of food and drink. Staff had not received training to provide them with the knowledge and skills to safely prepare, cook and support people to eat and drink, in line with speech and language therapist (SaLT) recommendations. Staff had made decisions on people' s behalf about food choices where they did not have the capacity to make decisions or consent to all aspects of their care, which had placed them at risk of harm.

People’s medicines were being managed in line with the principles of Stopping over-medication of people with a learning disability, autism, or both (STOMP). However, improvements were needed to ensure people’s records contained accurate information about their medicines to ensure these were administered correctly and accounted for. We have made a recommendation about medicines management.

Effective recruitment systems were in place to ensure staff were suitable to work with people using the service.

Right Culture:

Improvements were needed to ensure the service was transparent, and open with all relevant external stakeholders and agencies, including the local authority safeguarding team, CQC and the police. Review of documentation identified allegations of physical abuse, a previous choking incident and where a person sustained a fractured ankle had not been reported to the appropriate authorities.

The registered manager and the assistant manager were passionate about the service, people, and the staff, but lacked support and direction by the nominated individual (NI) (responsible for supervising the management of the service on behalf of the provider) and general manager to ensure they were adhering to best practice, and legislation.

People, their representatives and staff provided positive feedback about the service. Staff told us they felt supported by the managers.

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 09 January 2020)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of choking. This inspection examined those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Immediately following the inspection, the registered manager confirmed PEEPs had been updated. The management team had worked well with CQC, the local authority's learning disability and speech and language therapy (SaLT) teams to make the required improvements to reduce the risk of further choking incidents. As of 1 December 2023, all staff had completed dysphagia training. The SaLT team had arranged to provide additional person specific training. Staff competency to prepare food and drink in line with SaLT guidance had been assessed to ensure they had the knowledge and skills to support people with dysphagia and associated choking risks. These measures ensured there were always suitably qualified and competent staff on duty to support people to eat and drink safely. The records for people at risk of choking had been reviewed to ensure these contained the correct information to guide staff in relation to safe consumption of food and drink.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, safe care and treatment and good governance at this inspection.

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. You can see what action we have asked the provider to take at the end of this full report. You can also read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Essex Care Consortium - Colchester on our website at www.cqc.org.uk.

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.

Special Measures

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 op

We found the following examples of good practice:

Personalised risk and needs assessments had been carried out to ensure people continued to have their needs met whilst remaining safe.

Staff had supported people in a person-centred manner to keep in touch with their families.

The provider had shared information about COVID-19 with people and their families in a supportive and accessible way.

A member of staff described how the management team had been supportive throughout the pandemic., this included helping staff understand the changing guidance and how it affected their role.

Essex Care Consortium is a residential care home, providing personal care and accommodation for up to 20 people who may have a learning disability, autism and or complex/physical health needs. On the day of our inspection 17 people were living at the service accommodated over two separate buildings and three single apartments.

The service has been developed and re-designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and /or autism to live meaningful lives that include control, choice and independence. People using the service receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service:

People were safe living in the service. Risks had been identified and people were looked after safely.

Staff were kind and caring and supported people to be as independent as possible.

People had access to healthcare professionals when required.

Staff knew how to care for people. Staff used their skills and the resources and equipment provided so the risk of accidental harm or infections was reduced. Staff had developed effective skills to meet the complex needs of the people at the service.

People were supported to have their prescribed medicines safely to remain well.

People were supported to eat and drink. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service had a well-defined management structure. The registered manager had clear oversight of the service and worked alongside staff. Staff were respectful of the register manager and told us they were approachable and supportive.

Audits were in place and people were encouraged to give their feedback about the service. Regular surveys were carried out with a range of people, relatives, staff and professionals. Information was used to make improvements to the service.

Rating at last inspection:

Good date of the last report published was (04th May 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor this service in line with our re-inspection schedule for those services rated as Good.

When we last inspected the service in April 2016, we had concerns and found the service to be in breach of several regulations these are referred to throughout the report. We had therefore asked the provider to send us an action plan detailing how they were going to ensure they were meeting the outlined regulations.

The provider had sent us a detailed action plan. Therefore part of this inspection was to ensure that they had carried out the necessary actions detailed in the plan. We were happy that they had made improvements and were now meeting these regulations.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associate Regulations about how the service is run.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were sufficient numbers of care staff on shift with the correct skills and knowledge to keep people safe. There were appropriate arrangements in place for medicines to be stored and administered safely.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. People and their relatives were involved in making decisions about their care and support.

Care plans were individual and contained information about how people preferred to communicate and their ability to make decisions.

People were encouraged to take part in activities that they enjoyed, and were supported to keep in contact with family members. When needed, they were supported to see health professionals and referrals were put through to ensure they had the appropriate care and treatment.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

The management team had systems in place to monitor the quality and safety of the service provided.

Cedar House provides accommodation for up to 12 people who have high dependency needs due to learning and physical disabilities.

Birch House offers residential placements for up to eight people who require a high level of support, and who are less dependent on staff for support in aspects of daily living. People living at both houses need support to achieve their potential, develop their basic skills, and access the wider community.

This is the first inspection of the service under the new ratings system. The service was last inspected on the 18 February 2014 and was found to be compliant with the regulations.

At the time of inspection, the service was caring for 16 people across two houses and had four vacancies. They employed 21 permanent staff across the two house’s, seven of which were new members of staff undertaking their probation period and care certificate induction. The provider had a number of services in the near vicinity and consequently staff from their other services sometimes covered regular staff vacancies at the Birch site. The service used agency when shifts could not be filled.

At the time of inspection the service had 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.

The service was rated requirements improvement overall, with an inadequate rating in safe.

The premises were not fully maintained and the environment was not clean. Risks in the environment were not managed to reduce the possibility of harm to people. Where the registered manager identified that the service did not have enough cleaning staff they had not advertised for additional staff or informed the provider. Care staff carried out some of the cleaning but staff and relatives told us this detracted from time spent with people at the service.

We observed that staff did not always manage behaviours that challenged well, and that due to a lack of understanding of how to communicate with people with these behaviours, used PRN (as required medication) to reduce people’s agitation. However, staff managed regular medicines safely carrying out daily medication checks across both houses and the manager carried out regular medication audits to ensure that medicines were being administered correctly. Staff did have training in administrating specialist medication to manage epilepsy and this was in line with NICE guidance, (National Institute for Clinical Excellence).

The registered manager carried out a variety of Mental Capacity Assessments for people at the service. However, these were not completed in line with best practice. People at the service were not supported in making decisions about their care and treatment and those who might have advocate on their behalf were not always consulted.

Staff did not always have the skills to support people with communication difficulties and behaviours that challenged in line with best practice.

People at the service were not always treated with dignity and respect. Staff did not always have the communication skills needed to support people with communication barriers and behaviours that challenge.

Care plans were not always person centred and risk management plans for non-physical health related care needs were not thorough. However, the service worked collaboratively with health and social care professionals to meet people’s health needs. In addition, we saw that physical health care plans were robust.

The registered manager had not made appropriate safeguarding referrals to the local authority or to the Care Quality Commission as legally bound under the Care Quality Commission (Registration) Regulations 2009 (Part 4).

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). You can see what action we told the provider to take at the back of the full version of the report.

We saw that care and treatment for each person was planned and reviewed with their involvement and consent as far as possible. Risks to the health, welfare and safety of people using the service were identified and managed.

People's medicines were managed safely by competent staff. Good records were maintained but we found that minor improvements could be made to enhance the systems already in place.

We found that staff were trained and well supported to care for people properly and to keep them safe.

People were able to express their views about the service and had access to a complaints process.

During our inspection we spoke with one person who told us they liked living at Essex Care Consortium Colchester. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home.