Enterprise Care Support Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Based on the findings of this assessment we found the service remains good. This meant people continued to be safe and protected from avoidable harm. However, although people received their prescribed medicines as and when they should, we found concerns in relation to how some medicines records were maintained. We recommend the provider consider recognised best practice on the safe management of medicines and take action to update their medicines recording and monitoring practices accordingly. You can find more details of our concerns in the evidence category findings below. The provider had a positive culture of learning lessons when things went wrong. Care plans were based on assessments conducted by the provider and various external health and social care professionals prior to people using the service. People were protected from the risk of harm and abuse. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to the registered manager and/or the office based staff. People were cared for and supported by staff who knew how to prevent and appropriately manage risks they might face. People received continuity of care from well-trained and supported staff who were familiar with the individual personal care needs, wishes and daily routines of the people they regularly supported. Staffs suitability and fitness to work as care workers in an adult social care setting had been thoroughly assessed by the provider. Staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us the provider learnt lessons when things went wrong and acknowledged when they could and should have done better. A relative told us, “In the past we raised concerns about new carers constantly turning up at our door. However, this was sorted and we now get the same group of carers who are familiar with my [family members] needs.” Another relative added, “In the past I complained about my [family member] not having regular carers, but this was resolved to our satisfaction when we complained. Lessons were learnt.”

The registered manager and staff told us incidents and accidents, safeguarding concerns and near misses involving the people they supported were always logged. They were also routinely reviewed to determine potential causes and to identify any actions they needed to take to reduce the likelihood of similar incidents reoccurring. Care staff confirmed information about any lessons learnt was always shared with them. The registered manager encouraged an open and transparent culture about safety at the service where people using the service, their representatives and staff could raise concerns without fear about what might happen.

The provider learnt lessons when things went wrong. The registered manager and office-based staff continually reviewed incidents and accidents, safeguarding concerns, complaints and near misses, to determine potential causes and identify any actions they needed to take to reduce the likelihood of reoccurrence and learn lessons. This information was shared and discussed with staff during team meetings and handovers.

People told us they were invited to participate in an assessment process prior to them receiving a service from this provider and generally received the care and support that was planned in accordance with their assessed needs and wishes.

The registered manager and staff told us people's personal care needs were assessed before they were offered a service which were used to develop each person’s individualised care plan. Care staff demonstrated good awareness of people’s individual support needs and preferences.

Most external health and social care professionals told us the provider collaborated with them to establish and maintain safe systems of care.

People's care plans included referral information from local authorities that commissioned care packages. The provider used this referral information to develop individual care plans and risk assessments. These included assessments of peoples care and support needs. The assessments included people’s life histories, health and social care contacts, health conditions, their communication needs, cultural, religious, and spiritual needs, relationships that were important to them, and their personal care needs. Care plans also included detailed information for staff about how to support people with their personal care and support needs. We saw care plans for everyone currently using the service were held at the providers registered offices in the London Borough of Merton. People we visited in-person at their home also had up to date copies of their care plan for staff to follow.

People told us they felt safe with the care staff who regularly supported them at home with their personal care. One person said, “I feel very safe and content with my regular carer.” A relative added, “My [family member] is kept very safe by the carers that come here. We get the same carers who know all about my [family members] needs and wishes.”

Staff understood how to recognise abuse and neglect, protect people from its different forms and to report any concerns to the office-based staff team. A member of staff told us, “I would let my field supervisor know straight away if I found out anyone we supported was being abused.” Another member of staff added, “I have received safeguarding training, so I know exactly how to recognise and report abuse, should I come across it.”

The provider's safeguarding policies and processes were up to date and in line with relevant legislation. The registered manager worked with external agencies and acted in a timely way to make sure people were safeguarded and protected from further risk.

People told us care staff knew how to support them in a safe way that helped prevent and/or minimise the risks they might face. One person said, “They [staff] know how to look after me and keep me safe. They help me with hoisting and are particularly good with that.” Another person added, “I have a care plan and staff follow what’s in it. Two staff help me to move around my house safely with a mobile hoist. They take good care of me.”

Care staff were aware of people's daily routines, preferences and needs, and knew what action to take to reduce or safely manage risks people they supported might face. One member of staff told us, “There is a client’s folder with their care plan in it which is always kept in the clients home. The care and risk management plans are accessible and clear. If there is anything I am unsure about, I just call the office. The managers always responds quickly and give us good advice.”

Care plans contained up to date risk assessments and management plans that covered every aspect of peoples personal and health care needs. This included risk assessments and management plans to safely manage medicines, prevent falls and pressure sores, control infection, and manage diabetes. These risk assessments and management plans were regularly reviewed and updated as people's needs changed. However, some risk management plans we looked at did not always contain enough detailed information to guide staff. For example, it was not clear how staff were expected to safely assist people with specific health and medical conditions. This meant care staff did not always have access to enough detailed information that made it clear what action they needed to take to keep the people they supported safe. We found no evidence that people had been harmed as a result of risk management plans not always being sufficiently detailed. However, this oversight had placed people at risk of harm. The provider did respond immediately during the inspection and on the last day when we revisited their offices we found the aforementioned risk management plans had been reviewed and updated to include enough detailed information to guide staff about how to prevent and/or manage these identified risks.

People told us staff from the office routinely came to visit them at home to check the equipment staff used to support them, such as mobile hoists, remained in good working order and were fit for purpose.

Health and safety risk assessments and management plans were conducted on the home environments where people using the service lived and the equipment staff used, such as mobile hoists.

People told us staff who supported them at home never missed their scheduled call visits, were usually on time, and would always let them know if they were running late. People also said staff always stayed and completed all the tasks they were supposed to do as identified in their care plan. One person remarked, “They [care staff] always come on time and will let me know if they’re going to be late, which is a rare occurrence.” Another person said, “There are no issues with staff’s time keeping.” An external social care professional added, “The providers electronic call monitoring system indicates they are currently 95% compliant, which means the vast majority of care staff arrive and leave their call visits for our clients on time as scheduled.” Furthermore, people told us they received continuity of care from a regular group of care staff who were familiar with their personal care needs, preferences and daily routines. A relative said, “My [family member] always gets the same carers.” Another relative added, “My [family member] has the same regular carers who understand what she wants and needs in terms of her personal care.” People were also positive about staffs knowledge and skills and said they were always kind and friendly. A relative told us, “The way they [care staff] work, it’s clear to me that they are well-trained. They certainly know what they’re doing and come across as confident and competent at what they do.” Another relative added, “They [staff] definitely have the right skills to do an excellent job. I’ve noticed new staff are always accompanied by an experienced carer as well.”

Staff told us their scheduled call visits were well-managed by the office-based staff. One member of staff said, “Our visits are well-coordinated by the staff in the office. They check the proximity between each of my clients and work out the correct amount of travel time it will take me to get to my next visit on time. They do an excellent job because I’m hardly ever late.” Staff told us they had a dedicated group of people they regularly supported. They also said the staff in the office made sure the people they supported lived in close proximity to one another in a relatively small geographical area to ease the pressure on travel time between call visits. A member of staff said, “I have the same small group of 3 to 4 clients I regularly support everyday which means I have got to know them really well in terms of their needs and daily routines.” The training staff received was always relevant to their role as care workers and was routinely refreshed to ensure their knowledge and skills remained up to date. Staff demonstrated good awareness of their working roles and responsibilities. A member of staff told us, “We receive lots of in-person and online training which is refreshed at regular intervals.” Staff had ongoing opportunities to reflect on their working practices and to identify any further training or learning they might need. This included regular supervision, team and work performance appraisal meetings with their managers and other co-workers. A member of staff said, "I do feel supported by all the staff in the office and the senior care staff who regularly come out to see us during our visits.” Another member of staff added, “We have regular individual and group meetings with our line managers. They are involved and supportive, and help us improve our working practices.”

The provider’s electronic call monitoring (ECM) systems were used effectively to coordinate and monitor staffs scheduled call visit times. These systems electronically logged the exact times staff arrived and left their calls. ECM data was routinely analysed by the provider and reflected the dates and times staff were scheduled to conduct their call visits. To ensure people received continuity of care from staff who understood their individual needs, preferences and daily routines the office-based staff always took into account where people using the service and care staff lived and what languages they all spoke. For example, if people using the service did not speak English the provider would where possible try and match care staff from their ethnically diverse staff team who could understood their language and culture. The provider also respected the wish of people who had expressed a desire to have only female care staff support them at home. Training records showed us staff attended relevant courses to support them to meet a range of people’s needs. Training was refreshed at regular intervals so that staff stayed up to date with recognised best care practice. The training of new staff included a comprehensive induction programme, which was mapped to the Care Certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in health and social care sectors. It is made up of 15 minimum standards that should form part of a robust induction programme. New staff shadowed more experienced ones as part of their induction. The provider’s staff recruitment processes were thorough, and records demonstrated that they were followed. The provider conducted thorough pre-employment checks to ensure the suitability of staff for their role.

People told us staff who provided their care and support always wore appropriate personal protective equipment [PPE]. A relative said, “Our carers always wear gloves and an apron when they provide my [family member] with any personal care.” We observed staff wear appropriate levels of PPE including, gloves and aprons, as they prepared to provide personal care to people they were supporting. We also saw there were ample supplies of PPE stored in people’s homes and at the providers registered offices in Mitcham.

Managers and staff told us they had received up to date infection control and food hygiene training. A member of staff said, “The office provides us with all the PPE we need to prevent infection including, facemasks, gloves, shoe-covers, aprons and hand sanitiser. If we run out of supplies, we can put it on the group chat and then someone will drop some more PPE off.” The manager also told us they had ample stocks of PPE which they kept in their various offices located throughout London including, their two satellite offices in Camden and Bromley. This meant care staff working in these areas could access PPE quickly as and when they needed it.

The provider followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. The provider had an up to date infection prevention and control policy in place.

People told us they received their medicines as they were prescribed. A relative said, “They [staff] have a system in place for managing medicine’s safely for each person they support…Staff are very on the ball with medicines.” Another relative added, “Medicines are monitored very professionally by staff. I can see what medicines are given, when and by whom as they [staff] always keep good medicines records.”

Staff were clear about their roles and responsibilities in relation to the safe management of medicines. Staff received medicines training and their competency to continue doing so safely was routinely assessed by their line managers. One member of staff told us, “I’ve received medicines training, which is routinely refreshed, so I remain very clear what processes I need to follow to continue administering and recording medicines safely.”

Medicines systems were well-organised. Medicines were safely administered, appropriately stored, disposed of, and regularly audited by the office-based staff. People’s care plans included detailed guidance for staff about their prescribed medicines and how they needed and preferred them to be administered. However, medicines administration record sheets were not always accurately maintained by staff. We found a number of errors and omissions on medicines administration records (MAR) sheets where staff had failed to sign for medicines given or had signed for medicines which had not been given because people were away. This meant it was unclear if these medicines people had been prescribed had been given on time or missed. We recommend the provider reviews its processes around staff recording on MAR charts.