The inspection took place on 7 and 8 November 2016 and was announced to ensure staff we needed to speak with were available. Enviva Care Limited provides a live-in care service to people in their own homes. It is registered to provide personal care to older people, people living with dementia, people with a physical disability or sensory impairment and younger adults. At the time of the inspection they were providing the regulated activity of personal care to 41 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 2008 and associated Regulations about how the service is run.
People and their relatives told us they felt safe. A social worker confirmed the registered manager took the correct actions and reported any safeguarding concerns about people to ensure their on-going safety. Staff had undertaken relevant training to enable them to understand their role and responsibilities in relation to safeguarding people. Processes were in place to safeguard people from the risk of abuse.
Processes were in place to identify and manage risks to people. Staff underwent relevant training and people’s care plans were detailed and applied professional guidance to ensure risks to people were managed safely. People’s care was provided in a way that recognised and managed risks to their safety but also respected and upheld their rights to make their own decisions.
Arrangements were in place to ensure staff were always available to provide people’s care at short notice. Staff had undergone the required pre-employment checks to ensure their suitability for their role. The provider had acted upon people’s feedback and taken appropriate measures to robustly assess staff’s written and verbal English skills as part of their recruitment process. This ensured staff were recruited who had the required level of English skills to enable them to communicate effectively with people.
Staff received training in medicines management and their competency to administer people’s medicines was assessed as part of their training. There was clear written guidance for staff in relation to obtaining, administering, disposing and recording peoples’ medicines. People received their medicines safely.
People were cared for by staff who received a thorough induction to their role. Records demonstrated that live-in carers received a high level of supervision in accordance with the provider’s supervision policy. Staff were supported to undertake professional qualifications to develop their skills and understanding. People were cared for by staff who were well supported in their role which enabled them to provide people’s care effectively
Staff had undertaken relevant training on the Mental Capacity Act 2005 and understood its application in their daily work with people. The registered manager took immediate action to ensure copies of people’s power of attorney documentation were obtained where relevant; to enable them to check legal requirements were being met for people.
People’s preference regarding the type of meals they enjoyed and their preferred level of involvement in meal preparation were clearly recorded. Processes were in place to record and monitor what people were eating, this ensured their dietary needs were being met.
People had regular contact with a range of health care professionals such as GP’s, district nurses, chiropodists, dentists, occupational therapists, speech and language therapists and physiotherapists. Staff supported people to access health care professionals as required.
At all levels of the service the staffs focus was on putting people first and ensuring they felt cared about and that they mattered. A nurse and a social care assistant both told us staff ‘Always went the extra mile’ for people.
The person centred culture which the provider promoted had resulted in processes that enabled the care managers to make decisions about which staff to place with people. This was based on their knowledge of the person’s preferences about the live-in carer they wanted and the personalities, skills and strengths of the live-in carers. This minimised the risk of people not forming a positive relationship with their live-in carer and of the placement subsequently breaking down.
People told us they experienced that staff always sought their views. Staff ensured they supported people to express their views and to exercise control over their lives to and to make choices about their care. People were enabled and supported by staff to live the life of their choosing.
People told us staff upheld their privacy and dignity. Staff learnt about how to uphold people’s privacy and dignity during their induction and this training was re-enforced through training updates, newsletters and staff monitoring. Staff had an in-depth appreciation of the need to respect that they were living in people’s homes and of people’s need for space and privacy in addition to care.
People, their relatives and professionals told us; staff fully involved them in the assessment process and used the information gathered to ensure they had an excellent understanding of people’s needs as individuals.
The service was highly responsive and flexible in their approach to when people required urgent care. Swift interventions and innovative solutions had enabled people living with dementia to be supported to return promptly to their own home rather than requiring 24 hour care in a residential home.
The provider’s interventions had included placing a live-in carer on-hand in local accommodation where the person had struggled to initially accept their need for a live-in carer.
People and their representatives told us the provision of the care had resulted in people experiencing an enhanced quality of life and well-being. As a result of the care provided by staff people’s health and welfare had improved.
Staff interventions had enabled people living with dementia to attend activities in their community and to have a community presence in ways that they might not otherwise have experienced. For example, due to staff actively seeking out appropriate groups and working with the community to ensure groups were set up where they had not previously existed for people living with dementia.
People received high quality care as there were robust processes in place. To ensure thorough handovers took place between live-in carers and to monitor people’s care, consult with people and listen to their experiences and views of the service provided.
The provider had a clear set of values that were embedded at all levels of the organisation. Staffs’ application of these values in their work resulted in people receiving high quality compassionate care. Staff were proud to work for the provider. A care manager told us “We all love what we do and do our best to ensure people get good care.”
There was a strong emphasis on quality and continual improvement and this was reflected in the culture of the service. Staff were committed to continually improve the service people received, which enabled them to deliver ever higher quality care to people.
The provider valued people’s feedback and recognised their comments, complaints or concerns provided an opportunity to further improve the service for people. As a result of people’s feedback improvements had been made to the service such as ensuring live-in care staff had the level of culinary skills people required of them. Staff felt able to express their views and changes had been made to staff training as a result. This had enhanced staff skills and peoples’ experience of the service.
Processes had been introduced which had resulted in a greater level of scrutiny of the quality of people’s care records and this had resulted in improvements to the standard of record keeping for people.
People, relatives and staff consistently told us the service was well-led. The registered manager and the provider worked together and in collaboration with the senior management team and staff to ensure people received a high quality service. The service was actively involved in working with like-minded providers to support each other and was participating in research to actively improve the quality of service provided to people. The provider celebrated staff’s commitment to people and highlighted to other staff where their intervention had positively impacted upon people, to encourage these behaviours and values amongst all staff.