Enabling Others 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 was the first assessment for the supported living aspect of this service. This key question has been rated Inadequate. This meant people were not safe and were at risk of avoidable harm. The service was in breach of legal regulation in relation to people’s safe care and treatment, staffing, and fit and proper persons employed.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always protected by effective systems and processes. Lessons were not learnt to continually identify and embed good practice.

The providers systems and processes for reviewing and analysing incidents were not effective at identifying safety issues and ensuring improvements to people’s care and safety. For example, we observed staff respond to a person experiencing an epileptic seizure in an unsafe way. The staff moved the person during a seizure and did not make use us of the recovery position at the appropriate time to minimise risk of choking. The providers incident analysis did not identify the safety concerns and failed to identify essential required improvements. This meant the person was exposed to further potential risk of harm. We raised these concerns with the provider, and they took prompt action to improve processes and ensure the person’s immediate safety. However, the providers systems and processes had failed to identify these concerns independently to ensure safe care and treatment.

Where physical interventions were used by staff to support people with distressed behaviour, incident records did not always evidence the least restrictive option was used or that de-escalation techniques had been considered. The providers processes for reviewing these incidents had not identified these shortfalls and therefore, had not ensured people’s safety through a positive learning culture.

We received mixed feedback from staff. Some staff felt that incidents were well managed. For example, 1 staff member told us, “Things are dealt with promptly when raised. After management deal with it they call staff to have debrief with the staff on shift regarding the incident.” However, another staff member we spoke with told us that concerns about process were not always acknowledged or taken seriously.

Leaders at the service engaged with external health and social care professionals to ensure continuity of care for people during transitions between services. This included where people started using the service for first time and during temporary suspension such as being admitted to hospital. However, inconsistencies with people’s assessments and care planning indicated the providers systems and processes were not always thorough and did not establish and maintain safe systems of care, in which safety was well managed or monitored.

One relative told us they felt their family member was very well supported by commissioning authorities to transition into receiving care and treatment from Enabling Others Limited. They told us “The family were engaged and involved throughout the transition process. Enabling Others management team was also involved.”

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not establish effective safeguarding systems to ensure people were protected from the potential risk of avoidable harm. Where people were deprived of their liberty, there was not always suitable assessments in place to ensure least restrictive practices.

The providers systems and processes for ensuring safeguarding concerns were identified and reported were not effective. For example, as part of this assessment we identified multiple safeguarding concerns in relation to poor care for a person experiencing epilepsy seizures, and people were exposed to the potential risk of avoidable harm through the use of non-prescribed physical interventions that were not well evidenced to be the least restrictive option.

People were restrained by staff during periods of emotional distress to prevent causing physical injury to themselves or others. In some instances, court of protection authorisations were in place to support the use of restraint. However, these were often out of date, and the provider had not always taken appropriate action to communicate with commissioners to prompt review.This meant the provider could not be fully assured people were always supported in the least restrictive manner. In one instance, there was no evidence a court of protection application had been made, and the required legal authorisation for the use of restrictive practices had not been obtained.Following this assessment, action had been taken by the provider and evidence of an interim order had been obtained. However, we remained concerned this evidence was not available at the time of our assessment.

Despite our findings, feedback and observations indicated people felt safe and well supported by staff. We observed people were relaxed and engaging positively with staff.

Staff received training on safeguarding and understood how to recognise and report signs of abuse. Staff told us they thought people were kept safe and protected from harm. Staff told us they felt comfortable raising concerns with the provider and felt action would be taken to keep people safe.

The provider did not always work well with people to understand and manage risks. Staff did not always provide required care to meet people’s needs safely.

People did not always receive the care and monitoring required to ensure they were protected from the potential risk of harm. For example, daily skin integrity checks were not always completed in line with people’s care plans. One person required their feet to be bathed regularly to minimise the risk of developing infections. This was not always completed in line with care planned guidance.

People were not kept safe through effective risk management. For example, risk assessments for 1 person indicated they were at potential risk of harm through choking. The guidance in place had not considered the person’s specific health requirements to ensure interventions were safe and appropriate to their needs. Guidance also instructed staff to call 911 which is not a valid emergency telephone number in the United Kingdom.

Despite our assessment findings, feedback from 1 relative indicated they felt risk was mostly well managed. They described how the provider had put a detailed plan in place to support a particular area of their relative’s care and treatment.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider supported people in their own homes and was responsible for ensuring repairs were reported to the landlord. A communication system was in place that was used by staff to report repairs to the provider, who was then accountable for passing this information on to the landlord. However, the communication system was not effective at enabling staff on site to maintain suitable oversight of repairs; to ensure maintenance repairs were reported, logged, and appropriate action was taken. This prevented staff from ensuring people’s environments were well managed and safe. For example, we identified a ceiling light repair that had been reported by staff, but no repairs have been completed. As staff on site did not have access to an effective maintenance system, they were unable to monitor and follow up accordingly to ensure this repair was completed in a timely manner.

People’s homes were kept clean, and there was evidence environmental risks associated with the care people received were considered. People appeared to be comfortable, relaxed and settled in their homes.

The provider did not ensure that all staff were appropriately trained, compotent and experienced in order to provide support to people. The recruitment checks in some staff files were not thorough.

Staff received a range of training relevant to their role and needs of the people they were supporting. However, staff did not always receive adequate training related to delegated health care tasks, and we found staff did not always demonstrate suitable competence to deliver safe care. For example, records indicated that staff did not always follow best practice when obtaining blood pressure readings and did not utilise de-escalation or block techniques before using physical restraint when people became distressed. Records and our observations also indicated staff did not always follow best practice in the event of a person experiencing an epileptic seizure which put the person at potential risk of harm. The providers processes failed to identify that staff needed more support in these areas and ensure adequate training and guidance was put in place. During our regulatory quality checks at the end of this assessment process, the provider evidenced that in response to these concerns, additional training had been put in place in relation to completing basic clinical observations.

The providers recruitment checks were not always completed in line with their policy. For example, some staff members had started employment before appropriate reference checks had been obtained. There were also some examples where the provider had not obtained full employment histories or ensured identity checks had been thoroughly completed. This meant the provider could not be assured that employed staff had the relevant skills and experience to fulfil their role.

Despite our findings, observations of staff interactions with people indicated people felt comfortable with the support they received and had developed positive working relationships with staff. Feedback from 1 relative indicated they felt staff were well trained. Sufficient staff were available to provide support to people and staffing rotas were followed. Feedback from staff was positive about the training they received. One staff member told us, “The training and induction was very useful and good.”

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.

People’s care plans and risk assessments considered potential risk associated with infection control. Guidance was in place for staff to ensure support manage safety in this area.

Staff told us they use personal protective equipment whilst supporting people with personal care. The provider’s policies and processes supported effective infection prevention and control.

The provider did not make sure that medicines were managed safely.

Medicines were not always being administered as prescribed. For example, 1 person was prescribed daily medicine to help with regular bowel movements. However, this was being administered on an as and when required basis.

The provider had failed to ensure where people required specialist tailored support with medicines, these procedures had been reviewed and authorised by medical professionals. For example, 1 person required staff to crush their medicines and mix with water. Assessment records and care plans indicated that this was in accordance with their personal needs and preferences. However, prescribed instructions stated that some medicines should not be crushed and should be swallowed whole. This meant that the provider could not be assured that these medicines were effective. We raised these concerns with the provider, and they consulted medical professionals for advice.

Medicines were not always stored safely. For example, 1 person’s risk assessments stated that all medicines need to be locked away to minimise the risk of harm. However, we found that 1 medicine was freely accessible within the person’s fridge. In addition, we found an insulin pen in use for daily administrations had not been dated to signify when it was first used. This was important because it manufactures guidelines stated that medicines need to be discarded after at a certain period once first used. This put the person at risk of potentially receiving spoiled medicines that had the potential to become ineffective.

The providers systems and processes for ensuring safe handling administration of medicines were not effective, as they had failed to identify the aforementioned shortfalls and safeguard people from the potential risk of harm.

People were supported by staff who were trained and assessed to be competent in medicines. However, a number of the shortfalls identified as part of this assessment should have been detected and reported by staff when supporting people with their daily medicines. For example, staff should have recognised that administration instructions did not always match people’s personal routines.