Enable Care And Support Limited

On this page

• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulations in relation to management of people’s medicines and staff recruitment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and were aware of process to report safety events.Staff were aware how report and record any incidents or accidents. There was a system in place for recording accidents and incidents. The registered manager explained the process how they reviewed these events and information sharing with other agencies and professionals.Accidents and incidents were reported and discussed at handovers, team meetings and in supervision sessions. Staff said they always talked to the people involved afterwards to reinforce positives and offered praise when people responded calmly. Staff talked about how they had seen growth and changes in people’s wellbeing and felt as an organisation they were doing well. The management team, staff and people working together helped consider any risks associated with closed cultures, so these were identified and mitigated. A professional added, “The service maintains a strong and proactive culture of safety…I have found them transparent and cooperative in multidisciplinary discussions, particularly around risk management and safeguarding procedures.”The registered manager was clear about their role in regard to the duty of candour. We discussed the duty of candour and what incidents were required to be notified to the Care Quality Commission. The provider had a policy for actions that staff should take in situations where the duty of candour would apply.

The provider worked with people, families and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when and if people would need to move between different services.People and their relatives were involved in the planning and reviewing of their care and informed and supported by the registered manager and the staff team. Staff spoke positively about positive changes people achieved to improve their mental health and emotional wellbeing. This showed staff considered and embraced people’s skills to promote and help them improve confidence and independence. The provider was flexible and pro-active when people’s needs changed. Other professionals such as community nurses, mental health support and GP were contacted appropriately and in a timely manner to support continuity of care. A professional added, “Communication with external agencies—including community mental health teams, GPs, and social care—is timely and constructive. Staff members are well-informed about [people’s] care plans and demonstrate an understanding of the principles of capacity and best-interest decision-making.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff knew how to recognise abuse, and report concerns and were confident the registered manager would act on any concerns reported to ensure people's safety. The registered manager understood their responsibilities in regard to safeguarding people and reporting concerns to external professionals accordingly such as the local authority, police and the Care Quality Commission. Staff felt people were safe and were treated with care and respect. Both staff and the registered manager supported and protected people safely without any inappropriate restrictions or use of restraint.When we spoke to people, they said they felt safe when receiving care. Feedback from relatives was mixed and some felt the support could be better at times. We raised this with the provider and the registered manager. They provided information how issues were managed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. At the time of assessment, one person had this in place. 3 other people had applications made to the court, awaiting hearings, to ensure the deprivation of their liberty or any restrictions placed on them were lawful.

The provider did not always oversee people’s records to understand and manage risks. People had care plans and risk assessments describing support and care needed care in a safe and person-centred way, based on their needs and the support they required. However, some of the records did not always contain clear guidance or information for staff on how to protect people from risks. Although staff demonstrated they were aware of specific needs of people. However, some of the information had not always been reviewed or updated as required. Therefore, there was a risk staff may not always have up to date information to provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. For example, one person did not have a risk assessment to assess and review any risks related to epilepsy. Another person had a specific condition needing specific medicine, and brief details were noted how to support the person with it. However, the risk assessment was not completed. This meant any risks relating to specific condition were not considered including any specific mitigation which could delay support to the person. Another person was at risk of missing their medicine, but it was not always clear what measures were in place to monitor it, support the person and address it in timely manner. This meant people could be at risk of avoidable harm or injury because the provider and the registered manager did not always ensure risk records were reviewed and reassessed. We considered this under the question whether the service was well-led. We found that people’s footcare was completed by staff who had no qualifications to complete such tasks. There was no clear guidance, assessment or process on how to manage this safely. This meant people were at risk of injury that could lead to further infection and deterioration of health. We asked this to be stopped and seek support from an appropriate professional. Provider informed us of the action taken that the practice was stopped. The service had business continuity plans to ensure the service could continue in the event of an emergency.

The provider detected and controlled potential risks in the care environment. They made sure any equipment, facilities and technology supported the delivery of safe care.The service supported people to oversee and manage potential risks in their home environment.Staff carried out different tasks and checks to keep environment clean and safe such as health and safety checks. Staff confirmed they completed regular welfare checks throughout the shifts for those who required this. Staff noted if they were worried about people, they would report this to the registered manager to ensure timely response. People were involved in making sure their place of living safe but also homely and according to their wishes. Staff completed fire drills and evacuation practice. Senior management also visited the services to check safety of premises. They noted the staff were very good at reporting any issues.

The provider and the registered manager did not always follow safe recruitment procedures to ensure people were supported by staff who were of good character, suitable for their role and had appropriate experience.We found some gaps and inaccuracies in employment histories. Where required, the provider had not always obtained satisfactory evidence of an applicants’ conduct in prior employment working in health or social care. They did not consistently seek verification of the reasons why the employment ended. Right to work checks were not always completed in time.Two staff’s Disclosure and Barring Service (DBS) checks were not completed before they started supporting people. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. By failing to obtain all required recruitment information before staff started work, the provider put people at risk of being supported by unsuitable staff.

The provider did not always make sure there were enough qualified, skilled and experienced staff. We reviewed training matrix and information. Not all staff were up to date with all required training. For example, some people needed support to use equipment and transfers from one place to another. However, practical assessments for moving and handling to check staff's competency were not completed. One person needed to have PRN medicine to manage a condition. However, 3 out of 9 staff did not refresh the training on how to manage this medicine. Staff supported people with specific needs such as catheter care and use of epipen but the training matrix did not demonstrate training for these topics was provided. Some people were at risk of skin integrity issues but there was lack of training around the topic. Senior staff assessing medicine competencies did not have appropriate training to check staff's competencies. Although staff felt they had enough training to do their job effectively, and they were able to demonstrate knowledge about people’s needs. However, lack of training in specific areas could put people at risk of receiving incorrect care or left with unanswered needs.We considered this under the question whether the service was well-led.

Staff confirmed they had received an induction prior to providing care covering all of health and safety, policies and procedures, people’s information and provider’s expectations. Staff said induction was followed by shadowing which lasted from a few days to a week dependant on their experience and the support which they were offering people. Staff told us they had the training they needed to do their job. Staff confirmed they had formal supervision with either their team leader or a manager.Staff said supervision was useful and supportive. Staff working different shift patterns had the same opportunities to access supervisions and team meetings.Team leaders completed the staffing rota for each service which staff said was flexible and took into account personal requests. Staff were supportive of each other to work through the shifts. Staff felt there were enough staff on duty to support people with activities they enjoyed. All staff said the managers were supportive, especially the registered manager. People told us they were happy with their staff. They said, “Yes, [staff] are good and consistent, and they look after us” and “[Staff] are good, they help me and take me out”.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff were provided with and used personal protective equipment to prevent the spread of infection where needed. Information of any infections would be reported to the registered manager or senior staff to ensure timely response and support to the person. Staff received training in infection control and followed the provider's policies and procedures on this.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The provider needed to make some improvements to the management of medicines.People were supported by staff to receive and store their medicines. However, the completion of the medicines management records needed reviewing and improving to be in line with provider's policy and current best practice guidance. For example, we found gaps in medicine administration record (MAR) charts. When people had ‘as required’ (PRN) medicine, not all had a protocol in place to ensure staff had clear guidance when to administer it.When people received PRN medicine, staff did not consistently record information about the date or reason for it on the back of the MAR chart.Some PRN medicine had variable doses. There was no further clear guidance when to give 1 or 2 tablets as the staff were not clinically trained to make such decisions.Some people had medicine bought over the counter (also known as ‘homely remedies’) but there was no clear guidance on how and when to use it. Some people had paraffin-based creams, but the risk assessments were not completed at that time of the assessment to support safe usage. Once we raised this with the registered manager, these were completed. There was a potential risk to the safe management of medicines. This meant we could not always be assured people received their medicines safely and as prescribed and this placed people at risk of harm.