Background to this inspection
Updated
28 March 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by 1 inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. Inspection activity started on 25 November 2022 and ended on 7 December 2022. We visited the location’s office on 29 November 2022.
What we did before the inspection
We reviewed information we had received about the service, we sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 2 people who used the service and 3 relatives. We spoke with 6 members of staff which included the registered manager. We reviewed a range of records. This included 5 people's care records. We looked at 3 staff files in relation to recruitment. We looked at staff training and induction records. A variety of records relating to the management of the service and quality assurance were reviewed including policies and procedures and audits. We sought feedback from professionals who work with the service.
Updated
28 March 2023
About the service
Enigma Clinical Solutions Ltd is a domiciliary care service providing personal care to adults with a range of support needs including people living with dementia. At the time of the inspection the service was providing personal care to 12 people living in their own homes in the local community.
Not everyone who used the service received personal care. 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
People and their relatives told us the service was not always well managed. We found shortfalls with the management of people’s risks, medicines, person centred care and quality assurances systems which placed people at increased risk of harm.
The service had systems in place to monitor the quality and safety of the service, however they did not identify the issues we found during the inspection.
Some risks to people had not been sufficiently assessed and documented in their care records. Where people received support with medicines, this was not managed safely in line with national guidance.
People and relatives told us care visits were often late and people were not kept updated when delays occurred. We found people’s care plans were lacking in personalised information. People and their relatives told us staff were not always sufficiently skilled and knowledgeable.
People and their relatives told us staff were mostly kind and caring, however staff interactions with people were limited. We received mixed feedback as to whether staff maintained people’s dignity and independence.
Staff spoke positively of their work and told us there was good communication with managers. People were supported by staff who had completed training and felt well supported by the management team.
People were supported by staff who had been assessed as safe to work with vulnerable adults and who understood their responsibility to report any concerns.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 20 September 2021 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We have found evidence that the provider needs to make improvements.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
We have identified breaches in relation to safe care and treatment, person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
We have made recommendations about monitoring care visits and the management of complaints.
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.