About the service: Essex Cares South West is a domiciliary care agency providing personal care to people in their own homes. Some people received long term care and support however the majority of people benefitted from short term care packages of up to six weeks aimed at promoting independence and reducing the need for long term care. At the time of inspection, the service had just taken on a new contract with the local authority, resulting in the transition of people and staff from another service. This meant the numbers of people and staff at the service had significantly increased with the number of people using the service doubling from 35 to 70.

People’s experience of using this service:

The service benefited from outstanding leadership. The management team demonstrated a commitment to continuous learning and development to drive improvements and deliver an excellent service. Lessons had been learned from past failings and robust systems and processes were in place to ensure the quality and safety of the service. The provider recognised that the retention of staff had a positive impact on the quality of care people received so had introduced various incentive schemes to recognise good practice and show staff they were valued. Consequently, people received support from a well trained staff team who were motivated and committed to providing good quality care.

Staff shared the same vision and positive values, were kind and caring and regularly went the extra mile. People were spoken to courteously and treated with dignity and respect. People were included in decisions around their care and support and received regular reviews of their support package.

The provider was committed to protecting people from harm and abuse with excellent safeguarding mechanisms in place. Risks to people had been identified and staff had a good knowledge of how to keep people safe from avoidable harm. People were supported to take their medicines in a safe way by staff who had been trained and assessed as competent.

Support was planned and delivered in a structured way to ensure people's safety and welfare needs were met. Staff had access to up to date information about how to support people safely and effectively and to promote their independence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We made a recommendation about mental capacity assessments.

The service demonstrated a positive and open approach to concerns and complaints which were taken very seriously and thoroughly investigated. The service was committed to ensuring people were happy with the service they received.

There was a high level of engagement by the provider with people, commissioners and staff. Feedback from people and staff was regularly sought and used to drive improvements in safety and quality.

Rating at last inspection:

Good (report published 27 May 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The overall rating is Good.

Follow up:

We will continue to monitor the service through the information we receive.

This inspection took place over two days 13 and 18 April

Essex Care South West provides a number of different services. This includes providing care and support within people’s homes and a reablement service for up to six weeks for people who have been discharged from hospital. At the time of our inspection they were providing a service to eighty eight people. The focus of their support is to rehabilitate people back to independence. They provide personal care and support to adults who live in their own homes in the geographical areas of Basildon, Wickford and Billericay. The service also has ten residential reablement beds in a care home in the local area whom they work in close partnership with.

The service is also a ‘provider of last resorts (POLR).’ This is where Essex County Council are unable to find another contracted service to provide care and ECL will then assist with the care (short term) until another provider can be found.

The service has a registered manager in post. 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.

Staff had good knowledge of safeguarding procedures and were clear about the actions they would take to help protect people. Where safeguarding concerns had been identified the service had made the appropriate referrals and was open and transparent. Risk assessments had been completed to help staff to support people with everyday risks and help to keep them safe.

Systems were in place to assist people with the management of their medication and to help ensure people received their medication as prescribed. Recruitment checks had been carried out before staff started work to ensure that they were suitable to work in a care setting. Staff told us that they felt well supported to carry out their work and had received regular support and training.

There were sufficient numbers of staff, with the right competencies, skills and experience available to help meet the needs of the people who used the service.

Where needed people were supported to eat and drink sufficient amounts to help meet their nutritional needs and staff knew who to speak with if they had any concerns around people’s nutrition. People were supported by staff to maintain good healthcare and were assisted to gain access to healthcare providers where possible.

People had agreed to their care and been asked how they would like this provided. People said they had been treated with dignity and respect and that staff provided their care in a kind and caring manner. Assessments had been carried out and care plans had been developed around each individual’s needs. People had also made ‘goals’ to achieve to assist them in regaining their independence.

The registered manager had a good understanding of Mental Capacity Act 2005 and who to approach if they had any concerns and the appropriate government body if people were not able to make decisions for themselves.

People knew who to raise complaints or concerns to. The service had a clear complaints procedure in place and people had been provided with this information as part of the assessment process. This included information on the process and also any timespan for response. We saw that complaints had been appropriately investigated and recorded.

The service had an effective quality assurance system and had regular contact with people who used the service. People felt listened to and that their views and opinions had been sought. The quality assurance system was effective and improvements had been made as a result of learning from people’s views and opinions.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We used postal surveys, telephone interviews and home visits to people who use the service and to their main carers (relatives or friends) to gain views about the service.

We visited three people in their homes and all three told us that they were very happy with the service they received from the agency. Other comments about quality were received through the telephone interviews and included: “Well, all I can say is that they are all very nice, and they’ve really helped me,” “They are wonderful, and they can’t do enough for me” and “They are all very nice girls, but I now just use the service once a day, as I’m a lot better, but still need a little help.’

We talked on the phone to 15 people and all were positive about the quality of care they received. People stated they felt respected and were treated in a dignified way, with many adding that their care was carried out to a high standard.

People confirmed that where possible they had been fully involved in setting up their programme of care. Care plans were viewed during visits to people and these contained information required for care workers to provide the required care.

People told us they felt safe and protected by the care workers who were providing their support.

All the people we spoke with confirmed that visits to check quality were regular and they had been asked about the quality of service.

People who received a service were positive about their care. They all confirmed that they had been involved in decisions on how they wanted their care provided and they had been fully involved in setting up their programme of care. Whilst looking in one person’s file it was clear that they had been listened to when they had requested a change in the time they received a visit and the care notes showed that this had been implemented straight away.

People spoken with did not raise any concerns about the care they received and were complimentary about the care staff. They expressed that they were happy with their care and support. Most reported they had regular carers and that they arrived around the same time each day. They all reported that the care staff encouraged them to do as much as they could for themselves and they had seen improvement in their abilities as each day passed. It was noted that those who required assistance after the six weeks had been referred on for long term help and further assistance.

When looking at the feedback from the provider’s own quality assurance questionnaires comments included, “What a marvellous group of ladies and gentlemen. I have not worried whilst in their hands” and “Looking back now I am sure that my recovery went smoothly because of the help I received. Keep doing this great job, your team is making such a difference to all.”