Charity Earnshaw Also known as Charity Earnshaw

Charity Earnshaw is a domiciliary care service, supporting adults in the community who require assistance with personal care. This included people living with dementia, physical disabilities, mental health needs and sensory impairments. 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. At the time of our inspection there were seven people using the service.

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

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

At our previous inspection in April 2021 the provider did not have adequate systems in place to monitor and review the quality of care and ensure the service was meeting people’s needs safely and effectively. At this inspection this was no longer the case. Following our inspection in October 2020 positive conditions were place on the provider’s registration. Since this inspection CQC have received monthly documentation and audits from the provider.

The provider continued to act on feedback, advice and guidance from relevant health and social care professionals. They had a comprehensive on-going service improvement plan in place to continually strive to provide people with a safe and good quality service. The provider had continued to engage an external consultant to support them with this.

Systems were in place to monitor the quality and safety of the service. This included a comprehensive range of audits; observations and quality assurance questionnaires. Audits were completed on a regular basis as part of monitoring the service provided. Where actions were needed, these had been followed up. For example, care plans and risk assessments updated.

We discussed with the provider about their plans to grow the service. They explained that they would be taking on new packages of care slowly in order to test out their systems and processes to ensure they are robust enough and embedded in practice.

At our previous inspection in April 2021 risk assessments were not always consistent or accurate, which placed people at harm. At this inspection this was no longer the case. Risk assessments contained clear and detailed guidance for staff about how to minimise risks and were consistently in line with people’s care and support needs. For example, to mitigate risks around continence care, falls, nutrition and hydration and diabetes management.

Information in risk assessments correlated with that of people’s care plans and daily notes. Care plans contained information in line with and addressed people’s assessed risks, and how to reduce or prevent them. This enabled clear oversight and enabled changes in a person’s physical or mental health to be escalated to relevant health and social care professionals.

There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. The provider worked proactively with relevant health and social care professionals and acted upon feedback, guidance and advice to ensure people received safe care and support in line with best practice guidance.

At our previous inspection in April 2021 the provider had failed to establish and operate effective systems to prevent abuse to people. At this inspection this was no longer the case. The provider had continued to be proactive in liaising with the local authority and Care Quality Commission making timely safeguarding referrals in a consistent way. The provider and their staff team demonstrated an understanding of their safeguarding role and responsibilities. There were clear policies for staff to follow.

At our previous inspection in April 2021 the provider had failed to holistically assess people’s needs and develop accurate care plans. At this inspection this was no longer the case. The providers systems to assess people’s needs and develop care plans were effective. The information in care plans consistently reflected the information in assessments.

People felt safe and supported by staff in their homes. Comments included, “I feel safe with my carers” and “I have absolutely no concerns about my carers keeping me safe.” Information was available for people on adult safeguarding and how to raise concerns.

Medicines were safely managed on people’s behalf. Staff had received training in infection control. This helped them to follow good hygiene practices during care and support. Everyone said staff were following good personal protective equipment (PPE) guidelines in relation to the COVID-19 pandemic.

There were sufficient staff to meet people’s needs. People confirmed that staffing arrangements met their needs. People confirmed staff always stayed the allotted time. Comments included, “My carers always turn up on time and stay the correct time” and “I usually have the same carer.”

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

Staff spoke positively about communication and how the provider worked well with them and encouraged their professional development.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 June 2021) and there were breaches of regulation. 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.

This service has been in Special Measures since 3 December 2020. During this inspection the provider demonstrated that improvements have 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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charity Earnshaw on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Charity Earnshaw is a domiciliary care service, supporting adults in the community who require assistance with personal care. This included people living with dementia, physical disabilities, mental health needs and sensory impairments. At the time of our inspection there were nine people who used the service supported by six care staff and two office staff.

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

The service had been in a whole service safeguarding process with the local authority since 6 August 2020. This was ongoing. The suspension of local authority placements was still in place. The provider had decided not to take any new private placements whilst improvements were being made.

At our previous inspection in October 2020 we found people were at risk because the provider had no governance system in place to identify failings in the quality and safety of the service. At this inspection we found although systems were in place they were not yet established and embedded. In addition, staff responsible for key aspects of quality assurance had left the service or were off sick. This threatened to undermine the effectiveness of governance processes.

At our previous inspection in October 2020 we found risk assessments did not consistently provide the information staff needed to understand and minimise risks. This was still the case. Risks associated with people's care had now been assessed but the assessments were not always accurate and did not consistently provide the guidance staff needed to support people safely.

When we last inspected, we found safeguarding concerns had not always been managed appropriately and had not been reported to the local authority or the Care Quality Commission. Safeguarding policies and procedures were out of date. At this inspection we found improvements had been made but further improvements were still needed. Although the provider had been proactive in raising safeguarding concerns, this was not consistent. Safeguarding policies and processes had been reviewed but did not always provide staff with the information they needed to raise a concern.

Some people and staff spoke highly of the provider and the way the service was managed. Others found the providers management style challenging. The provider was aware of this and told us, “I am very approachable with our staff and service users. I have gone above and beyond to try to make them happy… I do know my direct way of speaking is not always taken well and I try to moderate this, but this is my nature.”

At our previous inspection in October 2020 we found the administration of medicines was not safe. This was no longer the case. Staff now had the necessary training and their competency checked. The provider regularly reminded staff about safe medicines administration. Robust quality assurance checks were in place.

When we last inspected, we found concerns about people's health and safety had not always been escalated by staff, and the systems for doing so were not fully established. At this inspection we found systems were in place to identify and escalate concerns and inform the staff team about changes to people’s needs or risks. Written feedback from external health professionals confirmed these systems were effective. Comments included;” I know they will always contact us if they feel a client has issues or need support outside of their job role, this is done in a timely manner and by effective communication.”

Emergency plans had been developed to manage issues potentially affecting service provision, such as adverse weather conditions or staff sickness.

We found people were now supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. This had not been the case at the previous inspection in October 2020.

At our previous inspection in October 2020 we found staff had not received the necessary induction, training and support required for their role. The provider did not have the knowledge and skills to ensure care delivered by their staff group was in line with good practice standards, guidance and the law. Improvements had been made, which meant staff now received the training and support they needed. The provider had responded positively to feedback and improved their knowledge and skills. This enabled them to better monitor staff practice and support the staff team. A relative said, “Staff are generally very good. [Registered provider] is very particular about the training.”

At our previous inspection in October 2020 there were concerns about risks related to infection prevention and COVID 19 because not all staff had completed the required training. At this inspection all but one member of staff had completed the necessary training. Government guidance was being followed and staff had received their vaccinations.

The provider was continuing to work with the local authority safeguarding team and quality assurance and improvement team (QAIT) to improve the management of the service.

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

Rating at previous inspection in October 2020 (and update)

The last rating for this service was inadequate (published 3 December 2020) and there were multiple breaches of regulation. Positive conditions were placed on the providers registration. Since this inspection CQC has received monthly documentation and audits showing continuing improvement. However, at this inspection we found not enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 3 December 2020. During this inspection the provider demonstrated that although improvements have been made, further improvements are needed.

Why we inspected

We carried out an announced focussed inspection of this service on 9 October 2020. Breaches of legal requirements were found. The provider completed an action plan after the previous inspection in October 2020 to show what they would do and by when to improve staffing and notifications of other incidents. Conditions were placed on the providers registration related to governance; care plans and risk assessments; consent and decision-making documentation; medicine administration; staff training, supervision and competency checks.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charity Earnshaw on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management; safeguarding; the assessment of people’s needs and governance.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

Charity Earnshaw is a domiciliary care service, supporting adults in the community who require assistance with personal care. This included people living with dementia, physical disabilities, mental health needs and sensory impairments. At the time of our inspection there were 24 people who used the service supported by 14 staff.

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

Prior to our inspection we found peoples experience of the service was poor and made a number of safeguarding referrals. A whole service safeguarding enquiry was in progress with the local authority. A suspension of local authority placements was in place, and a voluntary suspension of new private placements.

Risks were not well managed. Risk assessments did not consistently provide the information staff needed to understand and minimise risks. There were no systems in place to ensure people would not be placed at risk if there were any problems affecting service provision, such as Covid-19, staff sickness or adverse weather conditions.

Concerns about people’s health and safety had not always been escalated by staff, and not all staff we spoke with were aware of the processes for doing so. External health professionals and relatives told us the provider did not always work effectively with other agencies to provide safe and effective care. Safeguarding concerns had not always been managed appropriately and had not been reported to the local authority or the Care Quality Commission. Safeguarding policies and procedures were out of date.

The administration of medicines was not safe because staff had not always had the necessary training or their competency checked. There were no processes in place to audit the safety of medicines administration. This meant medication errors had not always been identified or reported to safeguarding as required.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff had not received the induction, training and support required to develop and maintain their professional skills. Not all staff, including the provider, had completed training in infection control, and there had been a significant delay before staff received specific Covid 19 infection control training. The provider had not maintained their knowledge and skills or kept themselves up to date with best practice guidance. This meant they were unable to ensure care delivered by their staff group was in line with good practice standards, guidance and the law.

The provider did not have adequate systems in place to monitor and review the quality of care and ensure the service was meeting people's needs safely and effectively. Policies and procedures were out of date and not always relevant to the type of service being provided. They were not always well understood and followed by staff.

The service had expanded significantly since the last inspection. When we inspected in June 2019, 18 people were being supported. By August 2020 this had increased to 33 people. The staff team had increased from five to 14. The provider told us the training and development of the staff team and service had been delayed as a result of the pandemic and lock down.

The provider and staff team were committed to improving the quality and safety of the service. One member of staff told us, “A lot of things need to be updated. I know the provider is doing their utmost to get everything in place. I’m happy now it’s being put in place. It’s improving.”

The provider was working with the local authority quality assurance and improvement team (QAIT) to identify and make the necessary improvements. They had drawn up a service improvement plan. This identified the actions needed, who was responsible for them and the progress being made. New policies and procedures were being introduced and quality assurance tools developed.

Staff were in the process of completing relevant training. Spot checks and staff supervisions had recently begun. Risk assessments, care plans and mental capacity act assessments were being reviewed by the newly recruited senior carer.

Overall people spoke positively about the service. However, although there were some recent improvements in the way the service was managed and run, these were not effective or embedded.

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 (published 11 July 2019)

Why we inspected:

We undertook this targeted inspection to follow up on specific concerns we had received about the safety and quality of the service. These concerns were subject to individual and whole service safeguarding investigations. A decision was made for us to inspect and focus on the management of risk, staff training, medicines administration and quality assurance. During the inspection, we found additional concerns related to protecting people’s human rights; the management of safeguarding and the knowledge and skills of the provider. We therefore widened the scope to become a focused inspection which included the key questions of Safe, Effective and Well-led.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charity Earnshaw on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We found the issues identified were not caused by the pandemic.

We identified five breaches in relation to risk management; the administration of medicines; staff training and support; consent; working with other agencies; notifications and overall governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

Charity Earnshaw is a domiciliary care service covering Newton Poppleford, Sidmouth and the surrounding areas in Devon. 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. When we visited, the service had 18 clients, provided 130 hours of care each week and employed five staff.

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

People praised the quality of service they received and told us they would recommend it to other people who required this type of support. People said they felt safe and well cared for and that the service was reliable.

Staff had received safeguarding training and knew about the different types of abuse, and ways to protect people. Staff supported some people to eat and drink enough to maintain a balanced diet and to ensure they received their medicines safely and on time.

People were supported by a small group of staff who they were able to build trusting relationships with. People told us they received consistent support from well-trained care staff who knew them well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff made sure people’s legal rights were respected.

People received a caring service and said staff treated them with dignity and respect. They were comfortable and relaxed with staff who visited them and had developed positive and caring relationships with staff. People received personalised care.

People’s care was personalised to their wishes and preferences and took account of their personal circumstances, interests and hobbies. People were consulted and involved in decisions about their care. Complaints and incidents were opportunities to learn and improve.

The agency was well led by a provider who worked alongside staff in day to day practice. They sought feedback from people and continually improved the care provided. The provider worked with other professionals and organisations to promote people’s health and independence.

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

Why we inspected

This was a planned inspection. This service was registered with us on 28 June 2018 and this was the first 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.