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.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm. The[MP1] provider was previously in breach of the legal regulations in relation to safe care and treatment, fit and proper persons and staffing. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

This service scored 75 (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 made improvements since our last assessment to develop a more 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. A relative told us, “Things have improved since the last time CQC came out. Incidents and near misses were swept under the carpet before, particularly around medication. I feel they [provider] have learnt lessons and made improvements. We are having more positive, open communication and better systems put in to reduce medicine errors and improve staff approaches which reassures us.”
Learning was shared with staff through team meetings, supervision, and updates to risk assessments and support plans. Where accidents or incidents occurred, these were recorded and reviewed by the service management team to identify for themes, trends and lessons learnt. For example, strategies, interventions and risk assessments were reviewed following incidents where people had become distressed. Where required, concerns were escalated to external healthcare professionals for assessment.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.
The provider had developed more effective systems to manage risks during pre-assessment processes, admissions, and transitions. Risk assessments and care records had been updated and showed changes in health needs and updated clinical guidance were accurately recorded to help promote good outcomes for people. Care plans included clear protocols for managing risks, such as epilepsy, with relevant information shared with professionals to ensure continuity of care. There were detailed hospital passports in use to support any planned or unplanned hospital admissions. These processes supported safe transitions and reduced the risk of avoidable harm.
 

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.
We saw people looked happy and relaxed in their homes and in the company of staff. Relatives told us they felt reassured their family members were kept safe. Their comments included, “Yes [Name] is safe, there has been no indication otherwise. They always have the staff they need to keep them safe,” and “[Name] understands why they have constant staff around and why there are locks on their doors to keep them safe. They know they can ask staff to unlock them when needed.” Safeguarding policies were clear, and records showed concerns were escalated promptly and managed with the local authority. Staff worked with people, relatives and professionals to understand what feeling safe meant for each person and to put suitable measures in place. A staff member told us, “People are safe because we know them very well and can de-escalate their distress and identify when they are at risk. Communication with [leaders] has improved which in turn has improved reporting and recording.” People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In supported living services, this is normally completed by the local authority through the Court of Protection. We saw evidence that applications for Community Deprivation of Liberty Safeguards (DoLS) authorisations had been escalated to the local authority or to the court by the service when required. Staff knew when restrictions were necessary and involved people, relatives and professionals in decisions about care. They also ensured the impact of restrictions on people was minimised using least restrictive approaches.
 

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider used a person‑centred approach to risk management. Risk assessments had been significantly improved and were tailored to each person’s needs and developed jointly with them. For example, staff had developed detailed and robust care plans and risk assessments around the monitoring and management of epilepsy. This helped to reduce risks related to seizures for people and gave clear guidance for staff on how to manage and respond in the event of a seizure happening.

Staff involved people in everyday decisions and encouraged participation in activities that mattered to them, such as preparing their own breakfast and drinks, which supported independence and confidence. The service worked with people to balance safety with choice. They supported people, relatives and professionals in informed decision making and agreed clear roles within each risk management plan. A person told us, “Staff are good; they help me to understand the risks I am taking. They know it’s my choice, but they do try and keep me safe.” A relative told us, “There are always 2 staff to help keep [Name] safe and meet their needs.”

Care plans set out clear actions of goals and objectives, risk management, and de-escalation strategies in line with positive behaviour support (PBS) and least restrictive practice. Positive behaviour support focuses on understanding the causes of distress, teaching new skills, and creating supportive environments, rather than simply trying to reduce behaviours. This helped keep people safe both in their homes and when they went out into the community.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We visited some people in their own homes and this together with feedback from people and relatives assured us people were supported in a safe environment. The provider assessed people’s home environments, including risks related to falls and general home safety. They liaised with landlords to ensure repairs and maintenance were undertaken. Staff understood how to respond in the event of a fire, and each person had a personal emergency evacuation plan to support their safe exit if needed.

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.

People told us they were happy with their staff. A person said, “I like my staff; they are nice and calm.” Relative’s comments included, “There have been some staff changes, natural turnover. There are key staff who are consistent and this is important to an autistic person” and “We have not always had transparency from staff, but [Managers] are addressing this now.”

Staffing was deployed based on people’s individual funded hours and the provider aimed to ensure compatibility between people and staff. For example, a person needed quiet, calm staff whilst another person needed energetic and motivating staff. We saw staff were well matched during our visits to people’s homes. Staff received appropriate training, covering topics such as safeguarding, positive behaviour support and mandatory training required on learning disabilities and autism. Staff competency was monitored through supervision, observation, and refresher training. There was an induction in place for new staff. Staff told us, “The training is very good. We have online and face to face training which is regularly updated. Our induction included shadow shifts to give us time to get to know people and for them to get used to us.” The provider had introduced more robust recruitment processes which were followed to ensure staff were safe to work with people. This included requesting and receiving references and checks with the disclosure and barring service (DBS). DBS checks are carried out to confirm whether prospective new staff had a criminal record or were barred from working with people.

The provider assessed and managed the risk of infection. We received feedback from people and relatives who were satisfied with the infection control measures employed by the service. Daily care records showed regular cleaning being undertaken by staff as agreed in people’s care plans. Staff had access to personal protective equipment (PPE). Staff received training in infection, prevention and control and food hygiene to support good practice in this area.

The provider had made significant improvements to ensure medicines and treatments were safe and met people’s needs, capacities and preferences.
Staff involved people in planning, including when changes happened. A relative told us, “We had a lot of concerns previously around [Name’s] medicines and staff errors, not recognising when pain relief was needed. There is now continuous monitoring in place and (managers) have better oversight of medicines which reassures us.” The provider had appointed medicines lead who maintained oversight of people’s medicines, stock checks and spot audits. This had resulted in improved compliance and safety in the administration and storage of people’s medicines. During our visits, we saw medicines were locked away safely and records showed daily stock counts and checks together with random medicine checks as part of the provider quality assurance systems.
The provider worked in line with STOMP, which is national best practice guidance on Stopping the Over-Medication of People with a learning disability and or autistic people. There were systems to make sure people’s distressed behaviour was not inappropriately controlled by medicines. A staff member told us, “We noticed [Name] was sleeping more and we felt this was because their medicine was making them drowsy. We discussed this with the prescriber who reduced the medicine and this has suited [Name] who is now more alert and engaged.” The service worked closely with healthcare professionals to ensure medicines were used appropriately and reviewed regularly. Staff were trained to administer medicines. Staff had to undertake training before they could administer medicines and received competency checks to ensure they administered medicines safely. We saw records that supported this. A staff member told us, “We have better support with all areas of medicines which helps us to get administration correct.”