Enigma Clinical Solutions Ltd

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.

At our last assessment we rated this key question requires improvement. We previously identified a breach of the legal regulations in relation to safe care and treatment, specifically regarding risk management plans and the safe management of medicines. Improvements were found at this assessment and the provider was no longer in breach of this regulation. The rating for this key question has changed to good. This meant people were safe and protected from avoidable harm.
 

This service scored 69 (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 investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The relatives we spoke to said they were able to raise safety concerns and they were confident action would be taken. However, one person told us they had not seen sufficient change in response to their concerns. We discussed this with the management team so they could review the concerns and take any actions needed.

Procedures were in place for staff to report safety incidents or accidents, and staff told us they knew how to do this. They felt able to raise concerns and were confident the registered manager would take action as necessary. The registered manager told us they monitored and reviewed incident reports for actions, themes and trends.

We saw lessons learned were shared with staff to help reduce future risks, maintain people’s safety and continue to improve the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. We found no evidence that people had been harmed, but there were some inconsistencies in some initial assessments. The provider made sure there was continuity of care, including when people moved between different services.

We found some of the initial assessments contained contradictory information. For example, one assessment described a person’s walking aids when it was previously identified that no such equipment was required. We highlighted this to the registered manager, who reviewed all initial assessments to ensure they were accurate and reflected people’s needs.

Relatives told us the registered manager met with them before they started to receive support from the service. This was to ensure their family member’s individual needs could be met. In this meeting, needs were identified and an initial plan developed. One relative explained, “They involved me in care planning right at the beginning, so now we work together and have an open understanding of what needs to be done.”

Professionals told us the service responded quickly to requests and this helped to ensure new referrals were actioned without delay.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and relatives told us they felt safe, particularly with their regular staff. One person explained their experience could depend on the staff member, and a relative added that their family member felt more comfortable with certain staff members. Another relative told us, “I have not had any feedback to make me feel they are not safe.”

Some people had been assessed as not having the capacity to make some decisions. Where necessary, staff liaised with people’s family or other professionals to make decisions in the person’s best interests in order to keep them safe.

Staff received training in safeguarding and were able to describe the action they would take if they had concerns. One staff member said, “I would notice if there was anything unusual or any changes in a person. I would call the office or an ambulance if that is what was needed. If there were safeguarding concerns I would contact a manager, I did that once before.”

A log was in place to record safeguarding concerns, monitor themes and review actions taken. The registered manager understood their responsibilities to report concerns promptly to other agencies.

The provider worked with people to understand and manage risks by thinking holistically. However, these risks were not always recorded consistently. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them and relatives told us their family member felt safe when supported by staff who knew them. One relative told us, “They are very good with [Name] and I am confident in staffs’ ability to provide safe care”.

Since the last inspection, improvements had been made to key risk assessments and these were completed routinely for everyone. For example, assessments of risks associated with moving and positioning, medicines, pressure care and the home environment. These were consistently completed, but information in some risk assessments was confusing or contradictory. In some cases, specific assessments had not been completed for individual risks, such as diabetes care. We highlighted this to the registered manager, who took immediate action to create new templates and clearly document specific risks to ensure staff had sufficient guidance about how best to support people safely.

Staff told us they always read risk assessments and care plans to ensure they understood people’s needs, strengths and risks, particularly if they had not supported a person before. One staff member said, “When I first see a new person, there will always be a care plan in place first. The manager sends the care plan to me on the app before I meet the person. The manager will have gone to assess the person first.” Risk information and changes could be accessed remotely by staff at any time and they told us they found this useful.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider was not responsible for the premises because they supported people in their own homes. The registered manager carried out assessments of people’s homes to identify and understand risks or hazards and help support staff to deliver safe and effective care. This included risks relating to fire, security and the presence of pets in the home.
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We received mixed feedback from people and their relatives about staff skills and abilities. Most people were happy with staff and felt they were well trained and competent. Comments included, “I have no problems with what they do and they are doing well” and “Yes, I believe staff are well trained.” However, one relative said they weren’t sure if all staff knew how to safely use their family member’s equipment. They planned to raise this directly with the registered manager.

Improvements had been made since our last inspection and a system was in place to monitor people’s care visits. This included whether staff arrived on time and stayed for the full duration of the visit. The records we reviewed showed 93% of visits were on time and rotas appeared to be planned well. A small number of visits were not recorded or were shorter than planned, and the registered manager planned to review these to understand the reasons. One person told us staff had arrived late on several occasions, but a relative said, “Mostly staff arrive on time and stay the full duration. If they have to depend on public transport, they can have delays but it’s generally fine.”

Staff told us they usually had enough time to travel between visits, but acknowledged this could be challenging if they relied on public transport. One staff member explained, “Some of the places we go are remote places. We get to know where they are and how to get there.” Staff told us more people who could drive had recently been employed, which was positive.

Staff told us they felt supported and had access to training to ensure they were skilled and knowledgeable. Records showed staff received regular supervision and appraisal, and the staff we spoke with confirmed this. Training was repeated regularly to ensure staff remained up to date and the registered manager carried out spot checks and competency monitoring.

Staff were recruited safely by the provider and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people.

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.

At our last inspection, some people and relatives told us staff did not always use personal protective equipment (PPE) as required. At this inspection, people and relatives told us staff always used PPE and followed infection prevention and control measures. Audits were in place to monitor standards and compliance, and regular spot checks were carried out.

Staff received training in infection prevention and control and food hygiene. Policies were in place to provide guidance relating to infection prevention and control, management of outbreaks and cleaning and waste disposal.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At the last inspection we found medicines were not safely monitored and managed in line with national guidance. Improvements had been made and an electronic system supported staff to manage medicines safely, in line with guidance and people’s needs and preferences. Compliance was monitored by the management team.

Medicines care plans and risk assessments were in place and regularly updated. Medicines risk assessments and care plans gave staff useful information about how to safely support people with their medicines. For example, one person’s risk assessment gave specific guidance about reasons when their medicines should not be given.

Staff completed training in medicines administration and their competency was checked to ensure they continued to work safely and in line with current guidance and legislation.