Essex/London

Essex/London is a domiciliary care agency which provides personal care to people in their own home. The service supports some people on a 24-hour basis and others who may require support with personal care needs at specific times during the day and /or night. The service was supporting people with personal care at the time of our inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. At the time of our inspection the service was providing support packages to four people.

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

The registered manager demonstrated a commitment to improving outcomes for people and responding to concerns raised at the last inspection. Support had been given by an external consultant. A family member told us, “I have definitely noticed a difference in the last few months there is a lot more paperwork, the staff are always writing things down that they have done.”

Feedback from people we spoke to was positive. People had been fully communicated with the outcomes of the last inspection and the necessary improvements the registered manager needed to make.

The registered manager had improved people’s care plans. Clear risk assessments were in place along with people’s likes dislikes and health needs. Quality assurance processes were in place and audits were carried out and outcomes actioned. However time was needed to ensure these improvements were sustainable.

Recruitment processes had been improved so people received safe support from people when they needed it. However, staff personnel files were disorganised and did not contain all of the relevant information required.

The administration of medicines was safer than at our last inspection. Staff had been re-trained and there were effective audits in place to pick up any errors. However, these had not always been effective in picking up a recording issue on the medicine administration record sheet ( MARS).

Staff had received some training to enable them to have the right skills and experience to meet people's needs. However, some training had yet to be arranged.

Assessments were carried out to ensure people's needs could be met.

Staff understood people's likes, dislikes and preferences and people told us they were offered choices about their care.

People were supported to eat and drink in line with their preferences.

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

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.

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

Rating at last inspection inadequate. (published 18 June 2019)

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.

The service had been in Special Measures since 18 June 2019. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection.

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.

Not everyone who used the service received 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

There was no system to ensure quality and safety monitoring of the service was carried out. This meant the registered manager who was also the registered provider did not identify the shortfalls we found during this inspection.

Not everyone who used the service had a care plan in place with evidence risks to their health, wellbeing and safety had been considered. We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed. This placed people at risk of harm.

Medicines were not managed safely. Care staff were assisting people to take their medicines but had not received any formal training or had their competency checked. Where people were supported by staff with administration of their medicines, there was no recorded evidence of when administration had taken place as required. We could not be assured people received their medicines as prescribed.

Recruitment procedures were not operated effectively to protect people from unsuitable people being employed. The registered manager did not recruit new staff in accordance with their own policy.

There was no structured plan or system to identify staff training needs and ensure their ongoing training and development. There was some evidence in records that showed staff received supervision but no spot checks to review their competence.

People's capacity in relation to day to day decisions had not been assessed. It was not evident whether people had agreed or consented to their care and treatment.

People told us staff were caring in their manner towards them, worked flexibly and met their cultural needs.

People were supported to access health care services when they needed. People and their relatives told us referrals had been made to the local health and social care teams.

The registered manager had a system for recording and managing complaints but had not received any since the last inspection. People, their relatives and staff were all complimentary about the registered manager and staff who supported them. However, we found a lack of overall governance. The registered manager told us they were committed to improving the service, but their focus had been on delivering care directly to people rather than the management side of the business.

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 (report published 24 November 2016). The overall rating for this service has deteriorated to Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We found four breaches of The Health and Social Care Act 2008 during this inspection.

Enforcement: The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

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

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.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Essex/London is registered to provide people with personal care within their own homes. They currently care for one person who has a learning disability and is on the autistic spectrum. The service provides this person with personal care and also supports them to access the community throughout the day, they currently support this person for approximately 12 hours each weekday.

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 took steps to ensure people were safe. Systems were in place to record and report incidents and accidents, including incidents of potential abuse. Risks were fully assessed and regularly reviewed, to ensure staff had an awareness of the best ways to control risks, whilst still promoting the person's independence. There were enough staff to meet the person's needs and staff members had background checks completed to ensure they were safe to work with people and of good character and were provided with training to enable them to administer people's medicines safely.

Staff also received general training and supervisions, to help them perform their roles. These helped the service to ensure staff had the skills they needed to meet the person's needs. The person were encouraged to make choices and provide consent to their care and support arrangements and there were systems in place to ensure the service followed the principles of the Mental Capacity Act 2005, if they were unable to make these decisions. The service encouraged the person to be as independent as possible with food and drink preparation, but were also able to provide support to ensure they received adequate nutrition. Staff supported the person to book and attend appointments with relevant healthcare professionals.

The person were treated with kindness and compassion by staff at the service. They worked hard to get to know the person and their families and to build strong professional relationships with them. Care plans were written with as much input as possible from the person and their families and they were involved in making decisions about the way care was provide. The service took steps to ensure that the person were treated with dignity and respect.

Care plans were person-centred. They were based upon the specific needs of the person and reflected their wishes and goals. Staff members worked to make sure people's care reflected these care plans and that care was provided in the way they wanted it to be. The provider welcomed people's feedback and there were systems in place to receive and act on comments or complaints raised.

There was a positive and open culture at the service. The provider was motivated by helping the person gain increased independence and achieving their goals. The person and their family member were aware of who the registered manager was and had regular access to them. The registered manager had also carried out quality assurance procedures to help them review and improve the quality of care provided. They had clear goals about the development of the service, but would only expand their service delivery if it did not have an impact on the person they currently cared for.

The service was effective as it had put in place systems for monitoring the quality of the service provided. There was an accessible complaints policy and procedure should the service fall below expectation. There was a procedure to make sure only suitable staff were employed, and a staff rota showing adequate staff cover at all times and suitable on-call arrangements for emergency cover. This meant there were systems in place to ensure the service was well managed and responsive to people's needs.