Enigma Clinical Solutions Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. We previously identified a breach of the legal regulations in relation to good governance. 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 the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.
 

This service scored 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The aims and objectives of the service focused on providing a high quality service which focused on individual’s rights and choices and maintaining or improving people’s health, wellbeing and quality of life. The aims and objectives were clearly described in the provider’s statement of purpose. The organisation’s culture reflected the provider’s values and focused on supporting people in the way they wanted.

The management team were very committed to the service, and staff we spoke with were proud to work for Enigma Clinical Solutions Ltd. One staff member said, “They are a good company to work for. We are good at what we do.” Staff and leaders were keen to ensure there was trust and understanding between them and people using the service.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff told us managers were available and approachable. We saw ways in which they led by example, for example by supporting staff with visits, carrying out spot checks and providing regular supervision. Staff felt members of the management team had appropriate knowledge, experience and skills. One staff member said, “If I have any concerns, I just need to ask for help. They really care about it. [Registered manager] knows how to handle things.” A relative told us, “On the phone, the manager has been absolutely brilliant.”

The management team worked together to ensure the organisation’s aims and objectives could be delivered. Since our last inspection, the provider had continued to recruit to roles which supported oversight, governance and quality assurance across the organisation.

The registered manager understood their responsibilities under the duty of candour, which is a legal requirement for health and social care providers to be open and transparent when things go wrong.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they felt confident to raise concerns and share their feedback. They told us the registered manager was approachable, and telephone support was available at any time. Regular formal supervision, appraisals, and team meetings also supported staff to make suggestions and ensure their voices were heard.

Staff completed a feedback survey each month and responses were positive. We suggested it may be more effective to use a more focused survey less frequently, with questions targeted at specific areas such as staff wellbeing, training needs, and service improvements. The management team was already considering reducing the frequency of staff surveys.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The management team and staff told us about ways in which they supported staff who required flexible working arrangements or reasonable adjustments to be made. Staff told us they felt able to discuss their needs with the management team. Adjustments and flexibility supported staff to effectively carry out their roles.

The provider sponsored the visa of staff from other countries, and they were valued members of the team. Staff came from a diverse range of backgrounds, ages and experience. Staff told us the culture of the service was fair and inclusive, and they shared no concerns about discrimination.

The provider was aware of legislation relevant to workforce equality, diversity and inclusion, such as the Equality Act. Legislation was reflected appropriately in the provider’s policies and procedures.

The provider had clear responsibilities, roles and systems of accountability. During this inspection we found some shortfalls with oversight and governance. The provider usually acted on information about risk, performance and outcomes, and shared this securely with others when appropriate.

Since the last inspection, governance frameworks and quality assurance processes had been put in place or improved. However, these had not always been effective in identifying the shortfalls we found. This meant there had been poor oversight in some areas, such as inconsistencies in care records as previously described.

Audits covering a wide range of topics were completed regularly. For example, accidents and incidents, safeguarding and medicines. However, some audits had not been effective in recognising the issues we found or identifying areas for improvement. In some cases, audit tasks had been marked as ‘met’ when they were not applicable to the service. We discussed this with the management team, who told us they planned to review the tools and how audits were completed. They shared copies of new audit tools after the inspection.

The registered manager understood their regulatory responsibilities. Notifications were submitted as required to the Care Quality Commission (CQC) and referrals made to local authorities when concerns arose.

The provider had a carbon reduction plan in place which demonstrated leaders’ understanding of how to manage the environmental impact of the service.

Contingency plans were in place to ensure care could continue in circumstances such as staff sickness or adverse weather conditions.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. The provider shared information and learning with partners and collaborated for improvement. However, we received some mixed feedback about the effectiveness of this.

The management team and staff shared information with others to improve outcomes for people and keep them safe. Referrals were made to other services or local groups as relevant, although professionals noted communication with them could be more proactive.

Most of the relatives we spoke with told us they supported their family member when support was needed from other services, and so this was not something they needed Enigma Clinical Solutions to be involved with.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Since our last inspection, the provider had made several changes to systems and practice to improve the service people received and their overall experience. For example, by developing digital systems and expanding the staff team. The management team had also engaged a compliance consultant to support them with reviewing systems and processes and putting actions in place to meet all required standards.

The management team were open and transparent during this inspection. There was a commitment to developing the service and the team were open to suggestions and feedback. When we highlighted shortfalls or made suggestions, these were followed up and action taken as necessary. Following our feedback, a new service improvement plan was put in place to monitor progress with the ongoing development of the service.