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Enterprise Care Support Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 27 October 2018

This inspection was conducted over three days on 27 and 28 September and 2 October 2018.

Enterprise Care Support Limited is a home care agency. It provides personal care to people living in their own homes in the community. At the time of our inspection this agency was providing a home care service to approximately 90 older people living in the London Boroughs of Camden, Merton, Wandsworth and Lambeth, as well as the home county of Surrey. People receiving a home care service from this agency had a range of personal and health care needs. The agency also specialised in providing a home care service, although not exclusively, to people who spoke a range of Asian languages.

The service continued to have a registered manager in post who was also the owner. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the service’s last two CQC inspections, which we carried out in November 2016 and 2017, we found staff had failed to follow best practice guidelines for the recording of the administration of medicines. This meant it was unclear if people had received their medicines and if they had, who had administered them. This repeated failure to identify and address these on-going medicines recording issues also indicated the provider’s management oversight and scrutiny arrangements were not being operated effectively. Consequently, we rated the service ‘Requires Improvement’ overall and for the key questions, Is the service safe and well-led?

At this inspection we found the provider had made improvements and now met the regulations and fundamental standards. We have therefore rated them 'Good' overall and for all five key questions, Is the service safe, effective, caring, responsive and well-led? This was because the provider had improved its governance systems. Quality assurance records showed field supervisors now routinely assessed staff’s medicines recording practice as part of their bi-monthly spot checks on staff during their scheduled visits. Consequently, we found no gaps or omissions on medicine's administration records (MAR) sheets we looked at. This meant we could also be assured people received their medicines as prescribed.

Staff continued to receive appropriate training and support to ensure they had the right knowledge and skills to effectively meet most people's needs. However, records showed staff who regularly supported people with a learning disability or mental ill health needs had not received any additional training in understanding how to meet these individual’s specific needs. This meant some staff might not have the right mix of competencies to effectively perform their roles and responsibilities. We have made a recommendation for staff training about people living with a learning disability or autism and mental ill health.

Furthermore, although people had been given essential information about the service, we found the service users’ guide, the provider’s complaints procedure and people’s care plans were not always available in easy to understand pictorial formats for people with learning disabilities or sensory impairments. This meant some people might not be able to understand all the information they were given about the agency, which could limit their opportunities to be actively involved in making decisions about the home care and support they received. We discussed this issue with the registered manager/owner who agreed where appropriate easy to understand pictorial, large print and audio versions of these documents should be available for people with specific communication needs. Progress made by the provider to achieve this stated aim will be assessed at their next inspection.

The comments above notw

Inspection areas

Safe

Good

Updated 27 October 2018

The service has improved from 'Requires Improvement' to 'Good' and is now considered safe.

This was because the provider had improved the way they managed and recorded medicines they handled on behalf of the people they supported. We found no gaps or omissions on MAR sheets we looked at. This meant we could be assured people now received their medicines as prescribed and in a safe way.

There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse.

The provider assessed and managed risks to people's safety in a way that considered their individual needs.

Staff recruitment procedures were designed to prevent people from being cared for by unsuitable staff. There were enough competent staff available who could be matched with people using the service to ensure their needs were met.

Effective

Good

Updated 27 October 2018

The service continues to be effective and retains its �Good� rating for this key question.

Staff continued to receive appropriate training and support to ensure they had the right knowledge and skills to effectively meet most people's needs.

However, staff who regularly supported people with a learning disability or mental ill health needs had not received any additional training in understanding how to meet these individual�s specific needs. We have made a recommendation about staff training on the subjects described above.

Staff were aware of their responsibilities in relation to the MCA. People were supported to eat healthily, where the service was responsible for this. Staff also took account of people's food and drink preferences when they prepared meals.

People were supported to stay healthy and well. If staff had any concerns about a person's health appropriate support was sought.

Caring

Good

Updated 27 October 2018

The service continues to be caring and retains its �Good� rating for this key question.

People said staff were kind, caring and respectful. Staff were thoughtful and considerate when delivering care to people. They ensured people's right to privacy and to be treated with dignity was maintained, particularly when receiving personal care.

People received continuity of care from a small group of designated staff who were familiar with their needs, daily routines and preferences. Staff communicated with people in appropriate and accessible ways.

People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

When people were nearing the end of their life, they received compassionate and supportive care.

Responsive

Good

Updated 27 October 2018

The service continues to be caring and retains its �Good� rating for this key question.

People were involved in discussions and decisions about their care and support needs.

People�s care plans reflected people's choices and preferences for how care was provided. These were reviewed regularly.

People with a learning disability or sensory impairment could not always access information they might find useful because it was not available in easy to understand formats.

People knew how to make a complaint if they were dissatisfied with the service they received. The provider had arrangements in place to deal with people's concerns and complaints in an appropriate way.

Well-led

Good

Updated 27 October 2018

The service has improved from 'Requires Improvement' to 'Good' and is now considered well-led.

This was because we found the provider had improved their governance systems since our last inspection. Field supervisors now routinely assessed staff�s punctuality, care practices and record keeping as part of their bi-monthly spot checks on staff during their scheduled visits. Managers and senior staff provided good leadership.

The provider routinely gathered feedback from people using the service, their relatives and staff. This feedback alongside the provider's own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.