Enterprise Care Support Limited

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Based on the findings of this assessment we found the service remains good. This meant the service continued to be consistently well-managed and led. However, we did identify some concerns in relation to the providers understanding of their notifiable incident reporting responsibilities and how they operated their governance systems. During this assessment we found the provider had failed to notify us without delay multiple times about the occurrence of some safeguarding incidents and serious injuries involving people using the service. This had placed people at risk of harm and represented a breach of Regulation 18 (Notification of other incidents) of the Health and Social Care Act 2008 (Registration) Regulations 2009. We also found the providers established governance systems were not always being operated effectively. This was because they had failed to pick up and/or address a number of issues we identified during this assessment including, failing to always report notifiable incidents to the CQC in a timely manner and maintain accurate medicines records and sufficiently detailed risk management plans. We recommend the provider considers recognised best practice in relation to good governance and take action to update their quality monitoring systems accordingly. You can find more details of our concerns in the evidence category findings below. The registered manager and office-based staff had the right levels of skills, knowledge, experience to lead effectively. The provider’s culture was positive, open, and honest, with leadership and management that was clearly identifiable and transparent. People's concerns and complaints were well-managed. The provider recognised the importance of learning lessons when things went wrong. The provider worked collaboratively with most external health and social care agencies and professionals to plan and deliver people’s home care packages.

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.

The registered manager and staff told us they aimed to meet the personal care needs of the people they supported in a person-centred way. The registered manager, office-based staff and care staff in the field all worked well-together to achieve this aim. The registered manager told us they had a clear vision for the service and told us they routinely used individual supervision and group team meetings to remind staff about the provider’s underlying core values and principles.

The service aimed to give people consistently good person-centred care and staff worked together to try and achieve this. Individual staff supervision and group team meetings were used by the provider to remind staff about their organisations underlying core values and principles.

Staff told us the service was well-managed by the registered manager and office-based staff. They said they received all the support they needed from their line managers. A member of staff remarked, “I like working for this agency. Its fantastically well-managed by someone who really cares about the people we support.” Another member of staff said, “All the office-based staff are approachable and always at the end of the telephone if you ever need them.”

The registered manager had the relevant skills, knowledge, and experience to effectively lead the service, which they did so with integrity, openness and honesty.

The provider valued and listened to the views of staff. Staff told us they were encouraged to contribute their ideas about what the service did well and what they could do better during regular meetings with their managers and fellow co-workers. The registered manager told us the provider had a complaints policy which detailed how people could raise concerns if they were dissatisfied with the service they received and the process for dealing with their concerns.

The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives, and staff who worked for them. They used a range of methods to gather people’s views and find out what they thought about the quality of the home care service they received from this provider. For example, people using the service and their relatives had numerous opportunities to express their views about the agency through regular contact with the office-based staff, either in-person during a home visit and/or by telephone. People were also asked to routinely complete the providers own customer satisfaction surveys. In addition, the provider had a complaints policy which detailed how people could raise concerns if they were dissatisfied with the service they received and the process for dealing with their concerns. People were aware that if they wished to complain they were able to contact the office-based staff and most felt their complaint or concern would be taken seriously and looked into. A person using the service told us, “I know how to complain if I am not happy with the service I receive. I would just call the office and I am sure they would sort it out for me.”

Care staff told us the registered manager and senior office-based staff treated them well. They said they got all the support and guidance they needed from them. For example, one member of staff remarked, “I have no issues or complaints about how the registered manager and staff in the office treat us,” while another added, “The office staff and managers do listen to us and always respect our equality and diversity. We are a diverse bunch.”

Staff had ongoing opportunities to reflect on their working practices and professional development including, regular individual and group meetings with managers and their fellow co-workers. The provider valued and listened to the views of staff and they were encouraged to contribute their ideas about what the service did well and what they could do better at the aforementioned meetings.

Staff told us they were in regular contact with the registered manager and the office based staff through regular telephone and in-person observations of their working practices during call visits. A member of staff said, “The office staff often conduct random checks on us during our calls to see how the people we support are getting on and if we’re okay. This is something they do really well.”

The provider notified most of the relevant external agencies in a timely manner including, local authority safeguarding teams, about the occurrence of any safeguarding incidents involving people using the service. However, the provider had failed to always notify the CQC about these safeguarding incidents, as well as a significant injury sustained by one person they supported, contrary to their own incident reporting procedures and the regulations. An external social care professional told us, “We are aware this provider had not notified safeguarding concerns to the CQC.” The CQC must be notified without delay about such occurrences, so where needed, appropriate follow-up action can be taken. The provider had well-established governance and monitoring systems in place. The quality and safety of the service people received was routinely monitored by the office-based staff who conducted regular audits and checks. For example, the office-based staff were in regular contact with the people they supported through telephone and in-person home monitoring visits, which include observing care staff's working practices. The outcome of all the aforementioned audits and checks were routinely analysed to identify issues, learn lessons and develop action plans to improve the home care service they provided people. However, we found the providers governance systems were not always effectively operated. This was because these systems had failed to pick up and/or take appropriate action to address a number of issues we identified during our assessment including, how the provider reported significant incidents to the CQC and maintained some people’s medicines administration records.

People told us staff supported them to stay healthy and well. People said staff were good at helping them access external health and social care professionals as and when they needed them and collaborated well with these community health and social professionals and agencies.

The registered manager and staff told us they regularly liaised with these external bodies and professionals, welcomed their views and advice, and shared best practice ideas with their staff team. A member of staff told us, “I work closely with a lot of professionals like GPs, district nurses and occupational therapists [OT]. These community professionals give me all the advice I need so I can give my client the best support I can.” Another member of staff said, “Sometimes I work closely with district nurses, dieticians and physio therapists. They often ask if they can join me on my call visits so I can explain to them face-to-face exactly what’s been going on with the people I regularly support. I think this multi-agency approach to reviewing the support needs of people I regularly visit works really well.”

Most external health and social care professionals told us they had a close working relationship with this provider. We received some negative comments from social care professionals about how this home care agency was managed, but most said they had a good working relationship with the registered manager who led the service well. Typical feedback we received included, “The provider has generally been pretty responsive and timely in responding to any concerns we might have and providing further information as requested,” “They [provider] is willing to work with us” and “The staff from the office and the registered manager are very approachable, responsive and cooperative.”

The provider worked closely with various external agencies including, GPs, district nurses, occupational therapists, social workers and Local Authorities. This was underpinned by a policy of relevant information being shared with appropriate services within the community or elsewhere.

It was clear from the feedback we received from the registered manager and staff they recognised the importance of learning lessons when things went wrong and continuously improving the service they provided people they supported. A member of staff told us, “I’ve had to raise an issue before when colleagues were turning up late for a double-up care visit. It caused an issue with the rest of my visits as this one delay meant I would be late for my next few visits. Since I did this, the staff in the office have instructed us to turn up 10-15 minutes earlier for this particular call, which has resolved the problem.”

Safeguarding concerns, complaints, accidents, incidents and near misses were reviewed, analysed, and responded to with emerging themes identified, necessary action taken and ways of avoiding them from happening again looked at. Audits and checks, and the gathering of stakeholder feedback was routinely conducted by managers and senior staff in the office to monitor and learn how to improve the quality and safety of the service they provided people.