The inspection took place between 26 October 2016 and 2 November 2016 and was announced.

Essex and Suffolk Quality Care provides care and support to people living in the Tendring area of Essex, covering Clacton-on-Sea, Brightlingsea, St Osyth and Jaywick. At the time of our inspection the agency provided a service for approximately 40 people.

At the time of our inspection there was no registered manager in post. The day-to-day running of the agency was carried out by a management team consisting of an acting manager and the provider. 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 were safe because staff understood their responsibilities to recognise abuse and keep people safe. People received safe care that met their assessed needs and staff knew how to manage risk.

There were sufficient staff who had been recruited safely and who had the correct skills to provide care and support in ways that people preferred.

The provider had improved systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People were supported effectively with their health needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and we found that the provider was following the MCA code of practice.

The management team supported staff to provide care that took people’s wishes into account and staff understood their responsibility to treat people as individuals.

People were treated with kindness and respect by staff who knew them well. Staff respected people’s choices and took their preferences into account when providing support.

Staff were supported by the management team to provide care that met people’s needs.

The provider had systems in place to check the quality of the service and take the views of people into account to make improvements to the service. There were systems in place for people to raise concerns and there were opportunities available for people to give their feedback about the service.

Staff were positive about teamwork.

During the inspection process we gathered comments from people and their relatives being provided care by Essex and Suffolk Quality Care, and from staff members providing care.

We asked people if they felt involved in the care they were provided by the service provider. We also asked whether they felt the care met their needs. One relative told us: "The carers are respectful and asks X about choices.”

People’s needs were not assessed and care and treatment was not planned and delivered in line with their individual care record.

People receiving care said they felt safe with the carers in their homes, and we saw staff had received training for the safeguarding of vulnerable adults that was up to date.

People were not protected against the risks associated with medicines because appropriate arrangements were not in place to manage medicines.

We found appropriate recruitment checks had been undertaken before staff started work for the service provider and they were supported through training to deliver care and treatment safely and to an appropriate standard.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

We found people were not protected from the risks of unsafe or inappropriate care and treatment because records were not maintained, and kept appropriately.

We spoke to three of the five people using the service. They told us that they were very pleased with the service. One person told us, "I've been with them for five years and I'm very satisfied." People were pleased with their care workers. They were usually supported by the same person and knew them well. One person told us that, "I chose my current care worker out of a number who had been helping me." One person said, "They are always there for me."

The service inducted and trained its staff to ensure that people were supported by competent care workers.

The service used appropriate methods to obtain the views of people using the service. The service responded to requests to change the service.

Essex and Suffolk Quality Care provides personal care and support for people living in their own homes. As part of this inspection we spoke with four people receiving support from the agency and nine relatives of people receiving a service from the agency. We also spoke with five members of care staff, the provider and a member of the management team.

We looked at people’s support records as well as information relating to the management of the agency including staff training and supervision records. We assessed the provider’s arrangements for managing people’s medicines and for monitoring the quality of the services provided.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Relatives told us that sometimes there had been missed calls and this could put people at risk. A relative told us that recently things had improved. They said, “Things have picked up in the last month. We are getting a bit more consistency from the same three care staff.” Another relative told us that they felt their relative was safe.

One relative told us that they had raised concerns about medication and they had not been addressed promptly which was not safe for their family member. Since this incident procedures around medication were improved and a process for monitoring medication was put in place. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Essex and Suffolk Quality Care had made improvements to systems in place to assist people with their medication safely but further improvements were needed to check that records relating to medicines were complete and accurate.

Is the service caring?

We found that improvements had been made so that people received a more consistent service. Further improvements are needed so that people can be confident that all staff provide care and support to a similar standard and that the recent improvements are sustained.

Feedback from people who used the service and from relatives was complimentary about some staff but less positive about others.

A relative told us that one member of staff was, “Very caring” and “Makes [my relative] laugh and cheers them up” but another member of staff, “Does not relate at all well” to the person. Another relative told us, “In general the staff are caring and respectful but for a couple of them their main objective is to move on as soon as possible.” Another relative told us that most of the staff were caring but some, “Rush in and rush out as quickly as possible.”

One person described staff as, “Very caring and helpful” and said, “They go over and above and go out of their way to help.”

Is the service effective?

Some people and relatives were happy that they had continuity of care, others were not happy about the changing care staff. One relative told us, “If [my relative] keeps getting new staff they don’t know, it’s very unsettling as they are on their own.” They added that continuity of care had been poor in the past but had improved recently.

A person who used the service told us, “In the past timing wasn’t always good but recently it has improved.”

There were procedures in place to provide staff with a range of training relevant to the needs of people who used the agency. This provided them with the information they required to provide safe and effective care and support to people who used the service.

Is the service responsive?

People said that the standard of care and support could vary. A relative told us that some of the staff were good but some were not always so good but the new person in the office was dealing with things better. They said, “Things have picked up in the last month. We are getting a bit more consistency from the same three care staff

A relative told us that a member of staff had telephoned the person’s GP a couple of times when they were not well. Another relative described how one member of staff stayed for an additional two hours when they were concerned about a person’s medical condition.

A person who used the service told us that staff were able to respond, “If I have differing need on different days.”

Is the service well-led?

Essex and Suffolk Quality Care had made changes to the management of the service and people told us that they felt communication had improved. Further improvements were necessary in processes to monitor the quality of the service so that the management team could demonstrate that they listened to people and took their views into account to make the service better. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

A relative told us some of the “Basic management” was not good but that it was improving. Two other relatives said that there had been poor communication from the office staff and a lack of organisation within the agency. Two people told us that care staff had not turned up in the past and that the office staff did not inform them or arrange for another member of staff to visit. A relative told us that there had been missed visits in the past but they felt that the provider did not always address the issue. They said, “It was the inconsistency more than anything, that was the problem, but that’s improving.”

A relative told us the new person in the office was “On the ball” and felt that had helped improve some of the issues. Another relative told us, “Recently some things have improved. In the past timing wasn’t always good but it has got better.”

The way that staff duty was managed had improved. One member of staff said that sometimes they would get called at short notice but on the whole they had notice of their shifts. Another member of staff said the management of rotas has improved, they were given more notice of shifts and their “off duty” time was more regular. They were having every other weekend off and this had had a good effect on morale.