This comprehensive inspection took place on the 9 and 10 of October 2017. We last inspected the service in October 2016, this was following the service being rated as Inadequate in March 2016 and being placed in special measures. In October 2016 we found that the service had made improvements and they achieved a rating of requires improvement without any breaches of the Health and Social Care Act, 2008; 2015.

During this inspection, we found that the provider had significantly improved the culture and the running of the service. Improvements to the service had been sustained and there were elements of the service that were outstanding and we found that the service was “Outstanding” in the Well-led domain. The provider had plans in place to ensure that they continuously learnt, improved, and evolved as a service and they were now providing a service based on core shared values that were visible at all levels of staffing. This meant that the provider had created a firm foundation to work towards providing outstanding services in all areas.

At the time of inspection Essex Cares Mid were providing short, six week care to 38 people in their own homes. This was a new contract and the service worked within local hospitals, and with the local authority to support people leaving hospital until a permanent care package could be found or people were able to manage independently without support.

A registered manager was in place. 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 receiving a service could be assured that they were receiving care provided by staff that had an excellent understanding of individual risks and needs. Staff were recruited safely and had undergone a values based assessment to ensure that their own values matched that of the organisation. Staff had an excellent understanding of safeguarding vulnerable people.

Staff were trained to safely manage medications and peoples complex physical and mental health needs. The registered manager and health care professionals provided care staff with the tools and information they needed to provide safe care.

The provider had revised and developed training for all staff according to the changes to people’s physical and mental health needs. This ensured that care staff had the appropriate skills and knowledge to care for people effectively. People told us that staff had an excellent understanding of how to care for them.

Staff, managers, and the provider had very good understanding of the Mental Capacity Act, 2005. Clinical records evidenced that staff supported people’s wishes and preferences and they supported and encouraged and respected them.

The registered manager had excellent links with other health professionals within hospital and social care settings, working together to source the best care options for people referred to the service. Staff had access to a physiotherapist and occupational therapist. They were on hand to offer advice and support regarding peoples changing physical needs and equipment needs.

People told us that staff were caring and considerate and treated them with compassion. Staff promoted person centred care at all levels of seniority to ensure the best outcomes for people. People told us that staff treated them in a respectful and dignified way at all times.

People were involved in all aspects of their care. Care plans and risk assessments were thorough and focused on people’s individual goals, needs, and risks. The registered manager actively sought people’s views of their care at regular intervals and where people had complained about the service, the manager had acted appropriately and respectfully to investigate and provide a meaningful resol

We carried out this inspection by visiting the registered office for Essex Cares Mid region on the 11th and 12th of October 2016. We visited and telephoned people who used the service to get feedback about the service.

The inspection was carried out six months following a comprehensive rating inspection in March 2016, which found the service to be inadequate and it was consequently placed in special measures. We found during this inspection that the service had made significant improvements in all areas of concern and had plans in place to continue with improvements.

The service no longer provided re-enablement care. Consequently the number of people they offered care and support to had significantly decreased, and they now provided 21 care packages for those who urgent support which cannot be immediately found from other services.

The service did not have a registered manager in place, but had recruited someone who was experienced and was waiting for the necessary checks to be carried out by the commission in order to be classified as the registered manager for this service. 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.

During the inspection in March 2016, we found that many people had experienced both late and missed visits which had led to some people missing their prescribed medication and had impacted on their health and wellbeing. After our inspection we asked the provider to submit weekly reports detailing what missed visits had occurred. We found the service had significantly improved this area and systems were in place to reduce the risk of this happening again.

Safeguarding practices had improved and concerns were raised in a timely manner. Staff received regular support and we saw that supervision from their managers had significantly improved. They told us that the new management team were supportive and listened to their concerns. Regular meetings took place at all levels and the information as shared appropriately across the staff groups.

During the inspection in March, staff had not always received the correct training. However, this had also significantly improved. The training team were seeking out new and innovative ways to make sure that staff had the correct training.

We checked how the service followed the principles of the Mental Capacity Act 2005 (MCA). The MCA governs decision-making on behalf of adults who may not be able to make particular decisions. The requirements of the MCA were being followed, and the provider had implemented systems since our last inspection to ensure that people were protected and supported safely.

People told us that carers were respectful and kind and often went that extra mile to support them.

When the service had been given detailed information from other professionals, care records lacked detail and were not person centred.

At the time of this inspection support plans and risk assessments did not always document identified risks or people’s individual needs, level of independence, preferences, and choices. They were not reviewed in a timely way. However, new internal quality monitoring by the service had also identified these issues and plans were in place to improve this area. We also saw that whilst support plans and risk assessments were poor, that communication records demonstrated that staff were safely meeting people’s needs, often going the extra mile to do so. The service had improved its continuity of care, ensuring that people received a regular core team of staff to support them. Consequently, they had been able to develop relationships with people, and understood their personal preferences.

The provider had significantly improved the procedure for handling com

We carried out this inspection by visiting the registered office for Essex Cares Mid region on the 11th of March 2016. We gave the provider 24 hours’ notice that we would be visiting the office to make sure that the appropriate people were there during the visit. Between the date of the visit and 24th March 2016, we visited and telephoned people who used the service to get feedback about the service. We spoke to 11 people that used the service and three relatives.

The inspection was carried out following the receipt of concerning information related to missed and late visits, and people being left without care and support. Concerns included people’s personal care needs not being met; people not receiving their medicines at the prescribed times, and in some cases people being unable to access food and drink because of the lack of support.

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

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Essex Cares provides personal care to people in their own homes. At the time of inspection, up to 190 people were using the service at Essex Cares Mid. Some of these people are vulnerable due to their age and frailty, and in some cases have specific and complex health care needs.

The service provided ‘re-enablement’ support to people in their own homes for up to of 6 weeks. Re-enablement is a service that supports people to rebuild their confidence to cope at home following their discharge from hospital .At which point the person is ‘reassessed’ and leaves the service having achieved their agreed independency levels or if they required on-going support they may be transferred to an alternative provider. However if suitable alternative care provision cannot be sourced the person will stay with the service under their other contract ‘Resource of last resort’. This was an additional contract, which required the service to take care packages for people where the Local authority had been unable to secure the required care provision.

The service had a registered manager in place. 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.

Although people told us they found the staff who delivered their care to be respectful and kind, many people had experienced both late and missed visits which had led to some people missing their prescribed medication and impacting on their health and wellbeing

We looked at 15 care files and found that people’s needs had not always been assessed prior to receiving a

At the time of our inspection there were 116 people who used the service. We focused on the reablement aspect of the service. People were supported for an average of six weeks by the reablement team within the service usually after a stay in hospital or an episode of illness or injury to recover and regain their independence. We spoke with 11 people who used the service and two relatives of people who used the service on the phone. We also spoke with four care workers, a support lead, the clinical lead, the deputy manager and the registered manager of the service.

People told us that they were satisfied with the service that they were provided with and that their care workers treated them with care and compassion. One person said, "I am very pleased with them." Another person told us, "Wonderful service. I cannot emphasise it enough."

We looked at the care records of 10 people who used the service and found that the records showed the care and support people required and that people experienced care, treatment and support that met their needs and protected their rights.

We looked at the personnel records of five care workers. We found that staff were well supported, supervised and trained to perform their duties safely.

As part of our inspection we spoke with three people who were receiving or had recently received a service from the agency and one relative of a person who had received a service. On first receiving the reablement service some people had not understood that they would be receiving a support service, to help them regain independent living, rather than a care service. The manager said that they would be reviewing the information and the way it was provided in hospital to ensure that the service matched people’s understanding and expectations.

The main service provided by the agency was reablement but they also provided a crisis response service and a private care service. The crisis response service was provided for a period of two weeks and had the aim of preventing hospital admissions. There were good systems in place to evaluate the effectiveness of the support being provided.

People told us that they were involved in decisions about the support provided by the reablement service. They had gained confidence, were more independent and felt that the service was generally meeting their needs. One person said “They helped me to regain my independence, which was so important to me.” Another told us “The staff were all very good and seemed very able.” People all said that they were happy with the overall service.