Enabling Care for You Limited Head Office

Not everyone who used the service received support with their personal care needs. 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. 79 people were in receipt of personal care at the time of our inspection.

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

Risks were not always assessed, monitored or managed safely. Important information was missing from people’s care plans. The registered manager took immediate action to update care plans accordingly. Although medicine audits were completed, they did not maintain good oversight to identify errors so patterns and trends could be identified. Important information about when and how medicine required as and when (PRN) should be administered was missing from people’s care plans. We received mixed feedback from people and staff about the timing of care calls. Calls to people were planned in a way that did not account for travel time and overlapped. We found no evidence people had been harmed due to calls running late or being cut short. Staff had been recruited safely. People told us they felt safe and were able to report any concerns which they felt confident would be listened to. There were effective infection, prevention and control measures to keep people and staff safe.

Audits did not maintain a good oversight of all aspects of the service delivered to people. We received mixed feedback from staff about the culture and management of the service. The registered manager understood their responsibilities and reviewed information about the service so improvements could be made. The provider had a clear vision of providing high quality, person centred and responsive support. Staff and management worked in partnership with other professionals so good outcomes for people could be achieved.

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 09 December 2021). 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 the provider remained in breach of regulations.

The last rating for this service was requires improvement (published 09 December 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service on 27 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment and Good governance.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well led sections of this full report.

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 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 remained 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 Enabling Care For You Limited Head Office on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk and medicine management, staffing and how the service is checked for safety and quality at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

Enabling Care For You is a care at home service that provides personal care support in people’s homes to people with dementia, physical disabilities, diabetes and end of life care. At the time of the inspection there were 80 people being supported.

Not everyone who used the service received support with their personal care needs. 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.

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

Risks were not always assessed, monitored and managed safely. There was not enough guidance or information available in care plans and risk assessments about how to safely support people. Staff were unaware of available guidance about risks and supported people in different ways to each other to manage risks. We found no evidence people had been harmed. However, this increased the chance people may not get safe support. The provider acted during and after the inspection to address these issues.

People’s medicine support was not always accurately recorded or checked to see this was being provided safely. There were no formal quality assurance and governance systems in use and action had not always been taken to address any issues and risks in a timely manner. Some people’s care records were not always up to date or accurate. The provider had not always submitted notifications to CQC as required. The provider acted during and after the inspection to address these issues.

There were effective systems in place to protect people from abuse and improper treatment. The provider was acting to manage infection risks. During the COVID-19 pandemic additional infection prevention and control measures in line with Department of Health and Social care guidelines had been put in place to ensure people’s safety. There were enough staff to meet people’s needs safely.

Staff were offered training in relevant subjects and received regular spot checks and supervisions. People received effective support with their eating and drinking needs. Staff worked well with other agencies to support people to achieve good outcomes, including health related outcomes.

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. We received consistent positive feedback from all relatives, health and social care professionals and people using the service that we spoke with about how caring and responsive staff and management at the service were.

Staff received equality and diversity training and did not discriminate when assessing people’s needs or helping people achieve their care and support choices. Staff considered people’s individual needs and communicated with people in ways they understood.

The service provided end of life care to many clients at a consistently high standard. One relative’s feedback said, “The professionalism and dedication your team showed throughout the time they cared for [our family member at the end of their life] was exemplary. They gave them the dignity they deserved and made them feel they weren’t a problem for them and us”.

Staff were supported by the management and there was an inclusive and open culture at the service, where staff differences were respected. Staff worked well in partnership with other agencies to support people in the best possible way.

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 9 August 2019).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Enabling Care For You Ltd head office 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 safe care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Enabling Care For You is a domiciliary care agency providing support to people living in their own homes in the community. It provides personal care to children, young people, adults and families, those with physical or learning difficulties, mental illness and those who may just need practical support to see them through a particular crisis.

Not everyone using Enabling Care For You may receive a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care. At the time of the inspection, the service was supporting 49 people.

People’s experience of using this service:

The people confirmed that the service they receive had continued to be good. They said the staff were kind and caring, and they confirmed that all their current needs were being met.

People’s needs were assessed, and their care was delivered in line with current legislation. Needs were assessed before people started using the service to ensure that they were able to provide them with the care they required. This included information on religious and cultural needs. The service had policies in place to ensure that people’s rights were protected, and people were protected from discrimination.

People could involve relatives and others who were important to them when they chose the care they wanted.

People were protected from abuse and the risk of harm. There were safeguarding policies in place and the registered manager and staff knew how to identify and report concerns. Risks to the person had been assessed and there was a plan in place to minimise these risks. Care was provided by staff who were able to meet the person’s needs.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and was aware of the person’s decisions and respected their choices.

People were fully involved in their care planning and received information in a way that they understood.

Care planning informed staff what people could do independently and what staff needed to do to support people. The care plans used were consistently reviewed and updated.

There were policies and procedures to ensure that peoples medicines were managed safely.

People had good relationships with staff, who were knowledgeable of their support needs, as well as likes, dislikes and interests. Staff were responsive to changes in people's health needs. If needed, they sought advice from relevant professionals.

Staff supported people to maintain a balanced diet and monitor their nutritional health when needed. People had access to GP’s and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

People were treated with respect and kindness. Privacy was respected, and they were supported in a dignified way. People were supported to maintain and increase their independence where appropriate

People were protected by the prevention and control of infection.

People said they felt comfortable raising any complaints or concerns with staff and the registered manager.

The registered manager recruited staff with relevant experience and the right attitude to work with people. New staff were given an induction and all staff received on-going training. There were enough staff to keep people safe and meet their needs.

The provider and registered manager made sure they monitored the service in various ways to ensure they continued to provide a good quality service that maintained people’s safety.

People were asked for feedback about the service they received.

Accidents and incidents were reported by staff in line with the provider’s policy, and the registered manager took steps to ensure that lessons were learned when things went wrong.

The registered manager attended networking events to share learning and best practice.

The provider, registered manager and staff were working with a clear vision for the service. The registered manager had the skills and knowledge they needed to support people.

Rating at last inspection:

This service was rated, ‘Good’ at the last inspection (published on 18 January 2017).

At this inspection, we found the service met the characteristics of ‘Good’ in all domains.

Why we inspected:

This was a comprehensive inspection scheduled based on the previous rating.

Follow up:

We will continue to monitor the service.

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

Enabling Care for You Limited Head Office is a domiciliary care agency providing personal care and support to children, young people and older people living with physical or learning disabilities in their own homes, in the South East area. Eighty people received care from the agency at the time of our inspection, 40 of who were children and young people aged from three to18. The agency had just moved into a new office at the time of the inspection.

There was a registered manager in post who had registered with the Care Quality Commission to manage the service in November 2016. Like registered providers, registered managers 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of re-occurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs and travel time was taken into account to reduce lateness of visiting calls. The registered manager followed safe recruitment practices.

Staff were trained in the safe administration of medicines. Records relevant to the administration of medicines were monitored to ensure they were accurately kept and medicines were administered safely to people according to their needs.

Staff knew each person well and understood how to meet their support needs. People told us, “They are dependable, reliable, responsive and they look after my children very well.” Each person’s needs and personal preferences had been assessed before care and support were provided and these were continually reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training specific to the needs of the people they supported, such as in respiratory care. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs.

All care staff and management were trained in the principles of the Mental Capacity Act 2005 (MCA) and were knowledgeable about the requirements of the legislation.

Staff sought and obtained people’s consent before they provided care. When people declined, their wishes were respected and staff reported this to the registered manager so that people’s refusals were recorded and monitored.

Staff supported some children, young people and older people with serving their meals and knew about people’s dietary preferences and restrictions.

Relatives told us that staff communicated effectively with their loved ones, responded to their needs promptly and treated them with kindness and respect. Satisfaction surveys and feedback indicated people were very satisfied with how care and support were delivered.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs when they had visual impairment. Care plans were available in a pictorial format to help children understand.

People’s privacy was respected and children young people and older people were assisted with their personal care needs in a way that respected their dignity.

People were referred to health care professionals when needed and in a timely way. Personal records included people’s individual plans of care, likes and dislikes and preferred activities. The staff promoted people’s independence and supported them during activities. They encouraged people to do as much as possible for themselves.

Children, young people and older people’s individual assessments and care plans were reviewed regularly with their participation or their representatives’ involvement. Care plans were updated when needs changed to ensure these were met in practice by staff.

The registered manager took account of people’s complaints, comments and suggestions. People’s views were sought, considered and acted upon. The provider sent questionnaires regularly to people to obtain their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued under the manager’s leadership. The manager notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and the manager had an action plan for making the improvements.