This inspection took place on 26 September 2018 and was announced.

This was the fourth comprehensive inspection carried out at Ecton Brook since they registered with CQC on 2 November 2015.

Ecton Brook is a domiciliary care agency. It provides personal care to people living in supported living accommodation. On the day of our visit, they were providing care for two people.

The service had a registered manager. 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.

People received care from a regular group of staff who knew them well. People received care from staff that had received training and support to carry out their roles.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care. People were involved in the planning of their care which was person centred and updated regularly.

People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had access to their information through easy read formats and audio. Staff had a good understanding of people's needs and preferences.

People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place where complaints would be responded to appropriately.

The registered manager had systems and processes in place to assess and monitor the quality of the service. Staff had access to updated policies and guidance.

This inspection took place on 14 June 2017. Ecton Brook is a supported living service that provides support to people with their personal care. At the time of our inspection the service was supporting two people.

When we inspected the service in June 2016, we rated it as requiring improvement in order to be safe, effective, responsive and well-led. This had followed a previous inspection in November 2015 when the service was rated as 'inadequate’ due to serious concerns about the systems that were in place to ensure people’s safety. We then placed the service into 'special measures'. During this, our latest inspection, we found that improvements had been made but there were areas that required further improvement.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager did not always understand their responsibilities. They had not notified CQC of changes to their registered office or provided information when requested to do so.

The provider did not have suitable systems in place to assess, monitor or evaluate the quality of the service to drive improvement.

People’s care plans included risk assessments but these lacked detail about how people were protected from risk of harm during personal care routines. People were not supported to manage their finances effectively.

The provider’s recruitment procedures included carrying out all the required pre-employment checks, however, gaps in staff employment history were not always explained.

People were supported with their medicines but staff did not follow the medicines policy provided. The medicines policy was not suitable for the care setting. The provider did not have policies for all areas of care that informed staff on how to carry out their roles.

The provider had carried out assessments of people’s mental capacity to make decisions about their care and support in line with the Mental Capacity Act 2005.

People’s daily records were not always complete and the language used in daily records did not always show respect.

People were not supported to choose where they spent their days, no alternative options were offered to meet people’s particular needs.

A complaints procedure was in place but it was not in a format that was accessible to people with sight impairment.

There were sufficient staff to support people. Staff we spoke with were knowledgeable about the people they supported and people told us they got on well with the staff.

People’s healthcare needs were supported with health action plans. People were supported to access health services when the needed them. People’s nutritional needs were met and people had meals they enjoyed.

We identified that the provider was in breach of one of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3). You can see what action we told the provider to take at the back of the full version of the report.

This announced inspection took place on 22 June 2016. This supported living service provides support to people with their personal care. At the time of our inspection the service was supporting two people.

Following our inspection in November 2015, the service was rated Inadequate due to serious concerns about the systems that were in place to ensure people’s safety. The Care Quality Commission placed the service into Special Measures and the provider was given a condition of their registration not to accept any new care packages.

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 2008 and associated Regulations about how the service is run.

During this inspection we found that many improvements had been made but further work was required to strengthen the service people received and to ensure that all new systems and processes were continuously embedded into practice.

Improvements had been made to ensure people were protected from harm. Staff received training in safeguarding and understood the different types of abuse. The registered manager understood the requirement to report any concerns or allegations of harm to the local authority safeguarding team.

References and criminal background checks had also been completed on all staff however further improvements were required to ensure all measures were in place that suitable staff were employed by the service.

The risk assessment procedures in relation to supporting people to receive safe care had been improved with guidance to staff about how to manage people’s known risks. However the registered manager needed to further consider and strengthen these to ensure all aspects of people’s potential risks were recorded.

People were supported to safely have their medicines however the registered manager needed to ensure that the documentation regarding people’s medication only contained current and accurate information.

Improvements had been made to ensure people were supported to provide their consent to the care they received. People who were unable to provide their consent had mental capacity assessments and best interest decisions made to consider the needs and wishes of people and to provide them with safe care. However further action was required to ensure these were formalised in accordance with the Mental Capacity Act 2005 and the Court of Protection.

Staff received support and guidance from their manager on a daily basis and also as part of regular supervision meetings. However the registered manager needed to ensure that appraisals were arranged and completed for all staff.

Improvements had been made to people’s care plan to ensure they contained current information. New care plan formats had been introduced and these provided guidance to staff. Further action was required to strengthen these to ensure they contained sufficient detail and information about all aspects of people’s care.

Since the last inspection the manager had made improvements to the systems and processes in place to ensure that people’s care and support was in line with regulatory requirements. However further action was needed to ensure that these systems were embedded into practice and could identify any shortfalls. The registered manager would also benefit from working with external agencies and organisations to ensure people care and support specific to their needs was in accordance with best practice.

Improvements had been made to the providers record keeping. People’s care plans, staff files and the policies and procedures were stored in separate files and were easily accessible when required. The management had also implemented regular health and safety checks to ensure the environment and food storage was appropriate

This announced inspection took place on 9 November 2015.

At the time of our inspection the service supported 2 adults with learning disabilities.

The service had a registered manager. 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.

There was a registered manager in post; however, they had not ensured that there was an adequate infra-structure to ensure there were sufficient systems and procedures to adhere to the regulations.

The provider had not ensured there were effective processes in place to monitor, assess and evaluate the service. This had led to failings in areas such as safeguarding, recruitment and staff training. There were no systems in place to ensure that policies and procedures to guide staff were reviewed and updated.

People were not always protected from the risk of poor practice or potential abuse, staff had not received training in safeguarding in the last two years and there were no up to date guidelines or policy to provide instruction for staff to follow to contact relevant external agencies.

Recruitment systems were not effective, the provider did not have a clear record of staff employment records and none of the staff had undergone recent disclosure and barring checks that related to their employment at the service.

Although staff received informal training from staff that had in-depth knowledge of the people that used the service, staff had not received formal training in areas such as fire awareness, first aid, manual handling, food safety, infection control, and health and safety. People had health conditions which required specific knowledge and skills, but the staff had not received training in how to manage these conditions. Staff administered medicines in accordance with people’s prescriptions, but staff had not received training in medicines management.

People’s risk assessments had not been regularly reviewed and not all risk assessments in place were relevant as people’s needs had changed. Care plans did not always reflect the care that people received. People

The provider had not ensured that decisions about people’s care was provided following assessment of their mental capacity, best interest meetings or by making an application to the court of protection. Staff did not understand their role in acting in accordance with the Mental Capacity Act 2005 (MCA 2005).

The manager and staff knew the people well and had a good knowledge of people’s individual personal care needs that helped them to manage people’s complex behaviours. People had been with the service for many years, and relatives were happy with the environment and with the staff providing their care.

People’s routines were maintained which had a positive effect on their well-being. They had their own bedrooms and living spaces which reflected their own personalities. People were encouraged to take responsibilities and they were supported to maintain their relationships with their families. People received regular meals and were encouraged to maintain a healthy diet and staff involved them in choosing their menus and shopping.

There were enough staff allocated to provide care on all shifts, and staff were flexible in providing time to take people out. People received care from staff that had undergone a period of induction and staff received regular supervision with the manager and staff told us they felt supported.

Staff enabled people to attend their healthcare appointments by helping people to prepare for their appointments.

No complaints had been made by people who used the service or their relatives.

We identified that the provider was in breach of five of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and you can see at the end of this report the action we have asked them to take.

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.

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.