Date of assessment: 23 to 30 April 2025. Emezzions Care is a care at home service. They provide support to people living in their own homes, including at supported living schemes. No-one using their supported living schemes were receiving support with their personal care at the time of our assessment. Therefore, our assessment focused on the support provided to people as part of their outreach domiciliary care service. We undertook this assessment to follow up on the ratings issued at our last inspection and to follow up on previous breaches of regulation. This was a comprehensive assessment which included all quality statements. At this assessment sufficient action had been taken and the service was no longer in breach of regulation. Significant improvements had been undertaken to ensure the safety of service delivery and improve the quality of care provision. Care records had been updated and provided detail about people’s needs and wishes, including information about any risks to their safety. Information was included about the person, their likes and what was important to them. People were supported to identify goals and they were supported to work towards them. People’s individual needs and beliefs were respected and accommodated. Governance systems had been improved and there were now comprehensive assessments in place to review the quality and safety of care delivery. Where improvements were required, we saw action was taken to address those concerns. A new registered manager had been recruited who was dedicated to continuous improvement. They had built good working relationships with other health and social care professionals to ensure good joint working and information sharing. Safe recruitment practices were in place. Staff received regular training and were well supported in their roles. They were knowledgeable of, and adhered to, the Mental Capacity Act 2005, safeguarding adults’ procedures, incident and accident reporting. Appropriate procedures were in place regarding infection prevention and control, safe medicines management, and supporting people’s healthcare needs.
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Emezzions Care was rated Requires Improvement overall on its first CQC inspection, with breaches of Regulations 9, 12 and 17 identified relating to person-centred care, risk assessment and governance, including failing to notify CQC it was delivering a regulated activity. Caring was rated Good, with staff demonstrating kindness and respect, but significant shortfalls in care plan personalisation, risk management and organisational oversight undermined the safety and quality of the service.
Concerns (8)
criticalCare planning: “The person's care plan included information about their care and support needs, however, we found these were lacking in personalised information about their preferences.”
criticalGovernance: “The provider had not identified they were delivering Personal Care and had not informed CQC that they were delivering Personal Care during a period of time in which they had declared themselves to be dormant.”
criticalSafeguarding: “The provider did not always assess risks to ensure people were safe. Staff did not always take action to mitigate any identified risks.”
moderateRecord keeping: “There was no recorded information about their likes and dislikes in relation to their food.”
moderatePerson-centred care: “Care plan audits had been completed for the person in receipt of a regulated activity in September 2023 and these indicated there were no issues in their care plan.”
moderateIncident learning: “Systems were not robust enough to demonstrate service improvement was effectively managed. This was a breach of Regulation 17.”
moderateLeadership: “The registered manager and other senior staff were not always clear about their responsibilities in the running of the service.”
minorOther: “The provider did not fully understand their responsibilities under the duty of candour.”
Strengths
· Staff were caring and treated people with dignity and respect; the person felt safe and described staff as 'kind and helpful'.
· Medicines administration was managed safely with accurate digital records, competency checks and regular audits.
· Sufficient staffing levels were maintained with evidence of adequate rotas and positive feedback from the person and staff.
· Effective infection prevention and control practices were in place, including PPE provision and unannounced spot checks.
· Staff received regular training, induction following Care Certificate principles, and regular supervision sessions.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships, follow interests and take part in activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Continuous learning and improving care; managers and staff being clear about roles and regulatory requirementsRequires improvement
well-led: Working in partnership with othersRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood