Essex Care Consortium - Marks Tey

Essex Care Consortium – Marks Tey is a residential care home providing the regulated activity, accommodation for people who require personal and nursing care to up to a maximum of 13 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 13 people using the service.

People’s experience of the 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Essex Care Consortium – Marks Tey had been developed and designed in line with the principles and values that underpin the Right support, right care, right culture guidance. The service is in a rural position and fits in the local residential area. There was nothing outside to show it was a care home. The building was a similar size to other properties with a large garden, which people had access to. Internally the premises were well designed for the people living there.

Staff showed a genuine interest in people's well-being and quality of life. 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. People were provided with as many opportunities as possible to gain new skills and become more independent.

Staff were kind, caring and nurturing and as a result we saw people were at ease, happy, engaged and stimulated. They worked well with other professionals to ensure people received the right level of support to manage signs of distress and or frustration. Staff were aware of subtle changes in people's behaviours and took action to diffuse incidents quickly.

Right Care

Systems to manage risks to people’s safety, the living environment and equipment needed to improve. People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. Staff had received training on how to recognise and report abuse. However, the provider did not have robust systems in place to ensure all safeguarding incidents were robustly investigated and learnt from.

The service had enough staff to meet people’s needs, including additional 1-1 hours to manage anxieties and access the community. However, improvements were needed to ensure the service had staff, with the right mix of skills, competence, and experience to support people to stay safe. Staff had received a wide range of relevant training. However, systems to assess staff’s understanding of training, including those whose first language was not English, needed to improve to ensure they had understood the training, and were competent to carry out their roles. Record keeping needed to improve to ensure staff recruitment documentation was complete and held centrally in one place and accessible.

We have made a recommendation about safe recruitment and induction training for new staff.

People's care plans were personalised, covering all aspects of their needs, including their physical and mental health needs. Staff delivered care in line with information in people's care plans and recognised models of care for people with a learning disability or autistic people. This ensured people were receiving care tailored to them which promoted a good quality of life. Staff understood people's individual communication styles and we saw they had developed a good rapport with them.

The service had effective infection, prevention and control measures to keep people safe, including good arrangements for keeping the premises clean and hygienic.

Right Culture

Staff understood their role in making sure that people were always put first. They provided person centred care and sought to protect and promote people's rights.

The service does not currently have a registered manager in post. The service has had 3 managers in the last 19 months. The frequent changes in management had impacted on staff morale and the quality of the service provided. Governance arrangements in place needed to improve to ensure effective oversight of the quality and safety of the service and used to identify and drive improvement.

People and their relatives were provided with the opportunity to be involved in decisions about their home and the support they received. Regular residents' meetings took place for people to have their say about how the service was run.

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 08 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the recruitment of staff and the management of medicines. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question 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 Essex Care Consortium – Marks Tey on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Essex Care Consourtium – Marks Tey is a residential care home registered to provide accommodation with personal care for up to 13 people with learning disabilities, those with autistic spectrum disorder and dementia. At the time of the inspection 13 people were living at the service. The service does not provide nursing care.

The service has been developed and 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 is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. Thirteen people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People using the service were supported to stay safe. Staff had good understanding of safeguarding procedures and how to report concerns. Risks to people were assessed and managed well.

Staff had the support they needed to manage people’s anxieties and behaviours in a positive way. The service had worked well liaising with other professionals and services to ensure people received the support they needed to stay safe.

Sufficient numbers of staff were employed and adjusted when needed to meet people’s complex needs. The recruitment, induction and training processes in place ensured staff had the right skills and experience and were suitable to work with people who used the service.

Systems were in place to ensure people’s medicines were managed safely and prevent the spread of infection. The premises were clean, tidy and homely, with a rolling programme of maintenance.

People had access to food and drink of their choice and were supported to live a healthy lifestyle.

People using the service were cared for by staff that knew them well. People’s privacy, dignity and independence was promoted and respected. People were receiving personalised care responsive to their needs, including access to health care services. Any changes in people’s care and support needs were identified and responded to promptly.

The requirements of the MCA and DoLS were understood and managed in line with relevant guidance and legislation. 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.

The service always applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s communication needs had been assessed and were meeting the requirements of the Accessible Information Standards. This set of standards sets out the specific, approach for providers of health and social care to meet the communication needs of people with a disability, impairment or sensory loss.

Work was in progress to develop end of life care plans to ensure people’s wishes will be taken into account at such time, and ensure they experience a pain free and comfortable death.

Staff were not aware of the vison and values of the company, but intuitively applied these in their day to day roles ensuring person received person centred care. People, their relatives and staff were involved in the service, and feedback was used to improve the service provided.

Systems were in place to assess the quality of the service and ensure risks and regulatory requirements were being understood and managed. Where things had gone wrong, systems were in place to learn from such incidents and improvements made.

Rating at last inspection: Good (Report published 24 November 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about this service to ensure that the next planned inspection is scheduled accordingly.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Essex Care Consourtium – Marks Tey on our website at www.cqc.org.uk.

This inspection took place on 7 September 2016 and was unannounced. The service provides accommodation and personal care for up to 13 people with a learning disability or autistic spectrum disorder. On the day of the inspection there were 11 people using the service.

The service has 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.

People felt safe and they were protected from the possible risk of harm. Risks to individuals had been assessed and managed appropriately. There were sufficient numbers of experienced and skilled staff to care for people safely. Medicines were managed appropriately and people received their medicines regularly and as prescribed.

People received care and support from staff who were competent in their roles. Staff had received relevant training and support for the work they performed. They understood the requirements of the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. They were aware of how to support people who lacked mental capacity. People’s nutritional and health care needs were met. They were supported to maintain their health and wellbeing and had access to other health care professionals and services.

The experiences of people who lived at the home were positive. They were treated with kindness and compassion and they had been involved in decisions about their care where possible. People were treated with respect and their privacy and dignity was promoted.

People’s care needs were assessed, reviewed and delivered in a way that promoted their wellbeing. They were supported to pursue their leisure activities both outside the home and to join in activities provided at the home. An effective complaints procedure was in place.

There was a caring culture within the service and effective systems in operation to seek the views of people and other stakeholders in order to assess and monitor the quality of service provision.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff and the registered manager. Staff told us that there was always a sufficient number of staff on duty to meet people's needs. We examined the rota which confirmed what we were told.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people's care was regularly reviewed and that additional provisions to support their care were provided where required.

We found that the provider had systems in place to effectively respond to complaints. Whilst the service had not received any complaints the registered manager and staff were clear on how complaints should be handled. People who used the service and their families were also provided with information on how to make a complaint.

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