Enabling Others Limited

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This was the first assessment for the supported living aspect of this service. This key question has been rated Requires Improvement This meant people’s needs were not always met. The service was in breach of legal regulation in relation to person-centred care.

This service scored 46 (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 did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We found guidance in place for staff on how to meet people’s communication needs was not always consistent. For example, 1 person’s health action plan stated they communicated via pictures, symbols and objects. However, their communication care plan stated they communicated verbally. This meant the provider could not always be assured that staff have access to suitable guidance to ensure people’s communication needs were consistently met.

People’s care records were not always updated when their needs changed. For example, we found some people’s records made reference to the use of mobility aids when these were no longer required.

Some people were supported through the use of safe holds by staff when they became distressed. However, at times there was a lack of detailed guidance and risk management in place to ensure safe holds were fully assessed and maintained least restrictive practice. This meant the provider could not be assured that the use of safe holds was person-centred or lawful.

Personal emergency evacuation plans were not always consistent with people’s care records to ensure people received appropriate support in the event of emergency.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider did not always work effectively with health and social care professionals, commissioners, or other relevant stake holders to ensure that continuity of care was managed. For example, we found instances where treatment decisions regarding people’s care had been made by the provider without consulting professionals with appropriate clinical training. In another instance, the provider had authorised repairs at a person’s property when this responsibility sat with the landlord. We also found where people’s Court of Protection orders had expired, the provider had not raised awareness to or consulted with commissioners as we would expect. This meant the provider could not always be assured care provisions were appropriate and maintained continuity.

The provider could not be assured appropriate, accurate and up-to-date information was always supplied in formats that were tailored and appropriate to individual needs.

The provider failed to ensure people’s level of understanding was thoroughly assessed through the use of mental capacity assessments. This meant the provider could not be assured that information provided was suitable, tailored to their needs, or that required support was provided.

Staff appeared to understand people well, however, they did not always have access to clear and accurate guidance on how to meet people’s communication needs. This meant the provider could not be assured that staff provided consistent and appropriate support.

The provider mostly made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. However, not everyone was satisfied that prompt action was taken when concerns were raised. Staff involved people in day-to-day decisions about their care.

Effective processes were in place to enable people to share feedback about their care or raise complaints. However, we received mixed from people’s relatives. Feedback shared with the CQC prior to this assessment indicated people’s relatives were not always satisfied that appropriate action was taken when concerns were raised. One relative told us they had repeatedly raised concerns with the provider, but nothing had changed. Another relative told us, “The family had opportunity to express their views and did. They were taken into consideration.”

We observed staff engaged with people during their care to enable them to make day-to-day decisions. For example, we observed people who were supported to attend a group gathering and birthday celebration at the providers office.

Through observation it appeared people felt comfortable with support staff and were able to voice their opinion and raise concerns. For example, during a visit to 1 person’s property, we observed they were confident at advocating their wishes and raising concerns to their care staff.

Leaders worked with people, listened to their views, and respected their choices. For example, leaders supported people to engage with this regulatory assessment but respected their choices when they refused.

The provider mostly made sure that people could access the care, support and treatment when they needed it. However, we found the provider made decisions about people’s care treatment without consulting professionals with the required clinical expertise.

Care delivery was flexible to ensure it was tailored to people’s needs and personal requirements. For example, staff shift patterns were tailored to people’s daily support needs and extra staff were made available for specific events or medical appointments.

Care staff understood how to recognise barriers to people’s care and when to raise concerns with leaders.

Feedback from 1 relative indicated care and support for their relative was flexible and enabled their freedom to access their home and local community. They went on to describe what mobility aids were in place and how the home was made suitable for their relative.

In some instances, the provider made decisions about people’s treatment without consulting professionals with the required clinical expertise. For example, 2 people were being supported to staff to monitor their blood pressure with non-prescribed apparatus. There was no evidence to indicate this practice was necessary or had been commissioned by a clinically trained health professional.

People were mostly supported to achieve good outcomes. However, this was not always supported by the providers systems and processes.

Care routines for some people had enabled them to achieve good outcomes in relation to their healthcare. For example, 1 person’s dependency on medication to manage their diabetic health needs had significantly reduced through effective care and support. However, the providers processes were not always effective at monitoring risks related to people’s care and treatment. For example, risks related to support for people when having an epileptic seizure. This meant the provider could not always be fully assured equity of experience was maintained.

Feedback gained from commissioners, relatives and the local authority as part of this assessment supported the judgement that people were supported to achieve good outcomes through care.

People were sometimes supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. However, the provider did not always maximise this through the use of effective assessments.

Despite there being some inconsistencies with people’s care plans and other documentation, we found the provider had engaged and recorded some people’s wishes and life choices well. This included decisions around people’s future, and how they wished to be cared for. However, there were significant gaps or inconsistencies in some people’s assessment records, preventing the provider from fully exploring people’s future with them to minimise their dependence on care and maximise their independence.