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Inspection Summary


Overall summary & rating

Inadequate

Updated 14 February 2018

This inspection took place over three days on 29, 30 November 2017 and 01 December 2017. We gave the service 24 hours’ notice.

Enterprise Homecare is a domiciliary care service providing personal care and support to people living in their own homes. The length of visits for care and support vary depending on the assessed needs of people, with calls ranging from 15 minutes or more. At the time of this inspection, 202 people were in receipt of service. However, not everyone using Enterprise Homecare receives regulated activity; the Care Quality Commission (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 provided.

We last inspected Enterprise Homecare in March 2017. The service was rated ‘requires improvement’ overall and ‘inadequate’ in the key question of well-led. At the last inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safeguarding people from abuse; receiving and acting on complaints; and good governance.

Following the last inspection, we met with the provider and sought assurance that sufficient improvements would be made and sustained, to ensure the quality of the service improved to attain a rating of at least ‘Good’ at this inspection. However, this has not been the case. During this inspection we found continued systemic failures and multiple breaches of regulations. We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment; dignity and respect; person-centred care; complaints; staffing; fit and proper persons; and good governance. We have also made a recommendation with regards to consent and mental capacity.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with 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. However, the continued and multiple breaches of regulations identified during this inspection, demonstrated that systems and process were not operated effectively to ensure compliance.

We looked at people’s care records to ensure the care and support which people needed was being delivered safely and that risks to people's health and wellbeing were appropriately managed. At the last inspection we acknowledged some improvements had been made in this area but during this inspection, we found these improvements had not been sustained.

We found where a person who used the service was deemed to be a ‘high risk’ for a particular care related activity, such as risks associated with moving and handling, eating and drinking or pressure area care, there was little or no information about how the service sought to mitigate such risks. Risk assessments were too subjective and generic and not based on a formalised assessment or scoring tool. We also found that reviews of risk were not completed in a timely manner.

We reviewed how the service sought to ensure the people’s medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found improvements had not been sustained and medicines were not always managed safely. Issues identified included the timeliness of administering ‘time critical’ medicines, the availability of a medicines support plan in a person’s own home, procedures for when medicines were seen to not be taken and the competency and training of staff.

We looked at how the service sought to ensure newly recruited staff were suitable to work with vulnerable people. We looked at a sample of recruitment records and found a variety of issues including incomplete application forms with some sections completely blank, unaccounted employment gaps and missing employment references. This meant the service was not able to consistently demonstrate the suitability of candidates to work with vulnerable groups before an offer of employment was made.

At this inspection we saw that the provider had invested in mobile telephones for staff to improve call monitoring. We looked at a number of records in relation to call monitoring and saw that call logging had improved. Electronic call monitoring records we looked at reflected that staff were not always staying for the full commissioned time with people, however we were assured that visits had taken place.

Electronic visit schedules were sent to all care workers via their mobile phone handsets and important information, for example about risks posed to people receiving a service, was included. We evidenced that information was not always added to the system once identified and there was no electronic audit trail with regards to people’s changes in need. We were not always assured that staff were provided with the most current information in relation to the person’s health condition and risks.

Enterprise Homecare provided a service to people who lacked capacity. For example, people living with a diagnosis of dementia. However, we were not assured that people were always supported to have maximum choice and control of their lives and we were not assured that staff always supported people by the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We checked to ensure staff were receiving regular supervision sessions. Staff supervision provides a framework for managers and staff to share key information, promote good practice and challenge poor practice. We found the completion of supervision sessions to be sporadic and not in line with company policy. When performance issues were identified, these were not always addressed.

Enterprise Homecare served a diverse and multi-cultural community in and around central and south Manchester and the client base was reflective of this. However, we found equality, diversity and human rights had not been embedded into everyday practice. One person who used the service was living with a visual impairment but we found the service had failed to provide information in an accessible format.

People were not always involved in decisions about how their care package should be organised. Records were not sufficiently detailed to demonstrate how and when people may have been involved, or indeed, if they had chosen to not be involved.

The service was unable to demonstrate effectively that care and support was delivered to people in a person-centred way. We found an unacceptable variation in the quality of care plans and plans were too task orientated and lacked meaningful information about the person.

In order for any service to be considered ‘well-led’, good governance is fundamental. At this inspection we found continued systemic failures, with no tangible improvements. In particular, in respect of the overarching governance of this service.

We found no progress had been made with regards to improving audit, quality assurance and questioning of practice. We looked at records that were described as ‘quality assurance’ but these were not fit for purpose and did not demonstrate how the registered manager maintained oversight of the service. Furthermore, we found governance arrangements in respect of the registered provider to be non-existent and no evidence could be provided to demonstrate how they maintained oversight of the quality of services being delivered from this location.

The overall rating for this service is ‘Inadequate’ and the service continues to be in ‘special measures’. This is the third consecutive inspection where one or more of the five key questions has been rated as ‘Inadequate.’ We are therefore reviewing our enforcement options. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Inspection areas

Safe

Inadequate

Updated 14 February 2018

The service was not safe.

Risks to people who used the service were adequately assessed, risks were not always mitigated, and reviews of risk assessments were not always completed.

The service had failed to make sustained improves to ensure people’s medicines were managed safely.

Procedures for the safe recruitment and selection of staff were not always adhered to.

Effective

Requires improvement

Updated 14 February 2018

The service was not consistently effective.

The principles of the Mental Capacity Act 2005 were not adhered to. The service did not effectively consider the needs of people who may lack capacity. In particular, people living with dementia.

Some people who used the service did not consider all staff to be suitably trained to carry out their role.

Staff supervision and questioning of practice was not effective.

Caring

Requires improvement

Updated 14 February 2018

The service was not consistently caring.

People who used the service told us they considered the vast majority of staff to be caring. However, some people told us they were not always treated with dignity and respect.

Equality, diversity and human rights was not embedded into everyday practice and the ethos and culture within the service was reflective of this.

People and their loved ones or lawful representatives were not always involved in decisions about care.

Responsive

Inadequate

Updated 14 February 2018

The service was not responsive.

Care and support was not delivered in a person-centred way and was too task orientated.

The management of complaints continued to be ineffective.

Well-led

Inadequate

Updated 14 February 2018

The service was not well-led.

Improvements had not been made or sustained to ensure the safety and quality of services being provided were complaint with regulations.

Overarching governance remained inadequate at both registered manager and provider level. In particular for audit, quality assurance and questioning of practice.