This comprehensive inspection took place on the 10, 11 and 26 of October 2017. We last inspected the service in September 2016 following the service being rated as Inadequate in March 2016 and placed in special measures. In September 2016 we found that the service had made improvements and they achieved a requires improvement rating without breaching the Health and Social Care Act. We found further improvements were needed to medicines management and care plans. During this inspection, we found that the provider had improved these processes and had made significant improvements to the running of the service.

At this inspection we found there were elements of the service that were outstanding. We found that the service was “Outstanding” in the Well-led domain this was because the provider had plans in place to ensure that they continuously learnt and improved. The service was based on core values that were visible at all levels of staffing. This meant that they had created a firm foundation to work towards providing an outstanding service in all areas.

Essex Cares West were providing short six week care packages to 20 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.

The safety of people who used the service was taken very seriously and the provider, the registered manager and staff were aware of their responsibility to protect people’s health and wellbeing. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

People told us they felt safe. Staff had undertaken training on safeguarding adults from abuse, and put their knowledge into practice. Where staff had raised alerts the service managed the concerns promptly and where required, carrying out thorough investigations to protect people.

We saw that staffing levels were suitable to meet the assessed needs of people in the service. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people.

People unanimously told us that staff consulted them about how they wanted their care to be provided. People's needs, preferences and goals were recorded in their care plans for staff to consult.

The provider had developed strong links with the local community. They worked alongside other organisations to ensure they followed current good practice in the delivery of people's care.

The provider valued their staff and saw them as an asset to deliver high quality care to people. They appreciated that people wanted consistency in their care and that the way to achieve this was through staff retention. To achieve this they had identified a range of ways to retain their staff, which enabled them to attract and retain good quality staff to deliver high quality care to people.

Staff were encouraged to be involved and help drive continuous improvements. This helped ensure positive progress was made in the delivery of care and support provided by the service.

The inspection took place on 26 September 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary service in people’s own homes and we needed to be sure that someone would be present at the service’s office.

Essex Cares provides personal care to people in their own homes. At the time of inspection up to 20 people were using the service at Essex Cares West.

Essex Cares West was inspected in March 2016 and was rated inadequate. We took enforcement action and required the provider to make significant improvements in a number of areas. The provider sent us regular information and records about actions taken to make improvements following our inspection and the enforcement action.

At this inspection, we found significant improvements had been made in relation to people's safe care and treatment, staffing, training, people's records and arrangements to monitor the quality of the service. However, there were still areas which required addressing.

Medicines management had improved but there were still some areas which needed to be addressed. We found gaps and omissions on medication administration charts that had not been thoroughly investigated.

People had risk assessments in place but some risk assessments lacked detail and did not always provide staff with sufficient guidance on how to minimise risk.

The provider undertook an assessment of people's needs to ensure these could be met. Some information such as desired outcomes for people's care and support were generic rather than specific to the person.

The service had significantly reduced the amount of care they provided, but continued to provide personal care to people.

At the time of inspection there was 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 and associated Regulations about how the service is run.

Staff had access to relevant training and regular supervision to equip them with the knowledge and skills to care and support people effectively.

The legal requirements of the Mental Capacity Act 2005 (MCA) were followed when people were unable to make specific decisions about their care. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.

People were supported to have enough to eat and drink which met their personal preferences and any health needs. The service worked with health and social care professionals when staff had concerns about people’s health and wellbeing.

Staff were kind and caring and treated people with dignity and respect.

There were systems in place to support people if they wished to complain or raise concerns about the service.

The provider had systems in place to monitor the quality and safety of the service provided.

We carried out this inspection by visiting the registered office for Essex Cares West on 2 March 2016; Between this date and 17 March 2016, we spoke with care staff, visited and telephoned people who used the service to get feedback about the service. We gave the provider 48 hours’ notice that we would be visiting the office to make sure that the appropriate people were there during the visit.

Essex Cares provides personal care to people in their own homes. At the time of inspection up to 130 people were using the service at Essex Cares West and some people were vulnerable due to their age and frailty, and in some cases have specific and complex health care needs.

We completed this inspection after receiving concerns about 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.

The service provided‘re-enablement’ support to people in their own homes usually for a period 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 either 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 required the service to take care packages for people where the Local Authority had been unable to secure the required care provision.

There has not been a registered manager in post since August 2015. An acting Manager was in post at the time of our inspection but had not submitted an application to register yet. 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. You can see what action we told the provider to take at the back of the full version of the report.

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 th