Enliven Social Care Limited

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• 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 is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 63 (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 always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. Some processes, designed to give the registered manager an overview of incidents across the service needed to be further developed and embedded.

We reviewed falls between October 2025 – December 2025. Incidents/accidents and falls were recorded. Staff had mitigated immediate risks such as calling next of kin and emergency services. However, documentation was not always robust. For example there was a number of falls which stated there was an injury to the shoulder, there was no further information to advise the severity or size of the injury or whether the injury had improved. Therefore, opportunities for learning may have been missed to identify themes and trends.

Where lessons learned were identified, these were shared with staff during team meetings. One staff member told us, “One service-user had a sore from lying down a long time and so we had another training on pressure sores” the staff member added the provider had discussed “The different degrees (for repositioning) and to report any incidents as soon as possible to the district nurse and manager and do a incident report form.”

During our visit the registered manager was open and honest. They acknowledged records were not always robust and record keeping needed to be improved.

Relatives confirmed they had no safety concerns and were informed of any falls or accidents involving their family member.

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.

People and their relatives we spoke to told us they were involved in establishing what care and support people needed and where required the provider had taken steps to help ease the transition of care. One relative told us, “We had shared [Person] was very anxious, they brought the specific carer with them so they could meet each other.” Another relative said, “They included [Person] in the conversation and went through all their preferences and needs.”

A staff member responsible for completing initial assessments told us that part of the process involved ensuring people received safe care. This included reviewing any required equipment and making referrals to relevant health professionals, such as Occupational Therapists or dietitians. We saw evidence that this had been carried out.

The registered manager explained when a person had been discharged from hospital, they reviewed any changes in need such as medication and where required liaised on behalf of people with the GP to ensure medication was in place.

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 however these were not always done appropriately.

People and their relatives were positive about the way their safety was considered. One relative said, “They (Enliven) have done everything they can to make sure [relative] is safe staying at home. I am very grateful to them for stepping in so quickly.”

Staff demonstrated they understood their responsibilities in safeguarding people. One staff member told us, “Safeguarding is about making sure service users are protected from harm and their rights are taken into consideration. If I see bruises on the skin which cause alarm then it’s a safeguarding issue.”

Safeguarding policies and procedures were in place and staff had undertaken safeguarding training.

At the time of our inspection, one person had an application made to the Court of Protection for a Community Deprivation of Liberty Safeguard (DoLS). This occurs when a person lacks capacity to consent to their care and treatment. It protects people who can’t protect themselves.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found improvements were needed around the documentation relating to managing risks to people.

Some people communicated their needs emotionally and physically. One person’s care records was not robust and did not always detail strategies to help guide staff and provide support safely and consistently.

One person was supported with their Catheter. Care records lacked detail around the risk of infection and did not always detail the signs and symptoms to look out for. However, records showed staff did understand signs and symptoms and had reported to a healthcare professionals so appropriate treatment could be provided.

One person was supported with their percutaneous endoscopic gastrostomy (PEG) tube (a system to deliver nutrition, fluids and medication directly into the stomach via a tube). The PEG tube had been regularly flushed with water to keep it functional (as is required); staff had recorded daily rotation of the tube and checks to ensure the stoma site was clean and healthy. However, when we reviewed daily notes, it was not clear if trained staff completed this need. We discussed this with the manager and staff who assured us only trained staff were completing particular functions. Records needed to be improved to ensure staff fully understood risks and clear and accurate records were kept.

The registered manager assured us following feedback from the inspection that risk assessments would be reviewed and updated to reflect the risks and how to meet people’s needs.

People using the service and their relatives’ felt risks were well managed. One relative said, “If [Person] is having a bad day with their dementia, the carers don’t usually have a problem washing, but changing clothes can be a struggle. They let me know if there is a problem, but mainly they convince [Person].”

Whilst some care plans lacked clear guidance, some staff had good knowledge of people's care needs this included managing people’s needs when they became distressed and risks associated with people’s Catheter.

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

Environmental risks within people’s homes were identified during the person’s initial assessment process. This included potential trip hazards such as rugs or trailing cables and any pets.

Information was included in people’s care records about any actions staff should take to keep themselves and people safe.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Whilst the majority of people we spoke to raised no issues around their call times. One relative had said, “Calls were set up to get [Person] up for meals, but that isn’t happening now, so carers arriving at 2.15pm for the 1.30pm call which meant we were both unsettled until they arrived.” We found examples of where calls were shorter than the planned commissioned times. Staff were logged into 2 calls simultaneously and some calls were manually logged, therefore, we could not be assured staff always arrived at the agreed times or stayed for the agreed length of time.

Not all staff had been trained in meeting people’s health needs. For example, Catheter and PEG care. The registered manager told us that further training was planned for these staff to complete by February 2026 in these areas. Although records reviewed showed people were always supported by at least 1 trained member of staff. A review of care records over a three month period showed which staff attended people’s care calls. For one person with a catheter, 67% of the staff who attended had not completed the required training. For another person requiring PEG support, 36% of attending staff had not received the appropriate training.

Staff received regular supervision to support them and to ensure they were competent to carry out their roles. This was completed through observed practice and 1 to 1 supervisions. The registered manager shared staff were supported to complete Level 3/ level 5 Diploma in Adult social care. Staff we spoke to confirmed this, one staff member said through further training and development offered by the provider they had developed into a higher role in the company and shared training had helped develop their managerial skills.

The provider held regular staff meetings. Staff informed us they had the opportunity to discuss and understand changes in the service.

The provider operated safe recruitment processes. Safe recruitment checks included undertaking checks such as references and Disclosure and Barring Service (DBS) checks and right to work documentation. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

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 and their relatives told us staff wore Personal Protective Equipment (PPE). One person and their relative said, “PPE is stored on site and is there to use. A carer will use a mask too if they have a sniffle, which we are grateful for.”

Staff had completed Infection Prevention and Control training and demonstrated an understanding of how to reduce the risks of infection. One staff member explained how they changed their PPE between different care tasks to reduce the risk of contamination.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People told us they received their medicine when required. We found some improvements were required in the way some people’s medicine were administered. In those examples, we could not be confident people received their medicines safely and as prescribed. However, people had not come to harm. For example, some people had time specific medication which required 30 minutes before food. This is important because not allowing a sufficient gap can reduce the absorption of the medication, making it less effective. Staff administering medication were not recording the times medication was administered. The majority of staff we had spoken to did not recognise time critical medication. When we asked staff who supported particular people with these types of medication whether time critical medication was given responses we received were “No I don’t” “No” “Sorry I don’t remember.”

Protocols for medicines prescribed as and when required (PRN) included guidance in terms of medicine to be administered, reason for administration, and the maximum dose to be taken in 24 hours. We reviewed a person’s Medication Administration Record (MAR) chart for December; medication had been administered but there was no protocol in place for their paracetamol. The registered manager assured us a protocol would be added.

Some people were administered their medicine through a patch which was directly applied to their skin. There was guidance in place to guide staff were to apply this. MAR’s were marked with the day on which they should be given. However, staff had not recorded where the patch had been applied. This was important to ensure the patch was rotated and did not cause any negative reaction on the person’s skin.

When supporting people with the application of external medicines, such as creams and ointments, there was not always clear guidance of where the cream should be applied. This is important so staff know where to apply the medicine on the body and they are applied to the frequency as prescribed.

Staff confirmed they completed appropriate training and had regular competency assessments when involved in the handling of medicines.

The registered manager assured us following feedback from the inspection that discussions had taken place with staff around the areas we identified relating to medication and they were in the process of amending and updating their processes.