Eniola Care Ltd

Updated 14 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. The current manager was overseeing the service but did not intend to register with the Commission.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection.

Inspection activity started on 14 September 2022 and ended on 22 September 2022. We visited the office on the 21 and 22 September 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 16 August 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with 15 members of staff including the manager, two office staff, 11 carers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with four people that used the service, eight relatives and seven professionals.

We looked at a range of documents including seven care plans, medicine records, six staff files and policy and procedure documents relating to safeguarding, complaints , accidents and incidents. We also looked at documents relating to quality assurance, auditing and contingency planning.

Updated 14 December 2022

About the service

Eniola Care Ltd is a domiciliary care agency. The agency provides care to people living in their own homes. At the time of the inspection, care was being provided to 53 people. Some people lived with dementia and some people had support needs relating to their mobility or other health needs. Some people were in receipt of end of life care.

People’s experience of using this service and what we found

The service was overseen by a manager who was not registered with CQC. The manager had not notified CQC of incidents and events that they were legally obliged to, for example, safeguarding issues. There were no auditing processes in place and quality assurance processes were inconsistent with no analysis of the views of people or their relatives. Similarly, there were no processes in place to capture staff feedback. Supervision meetings were inconsistent, and few records kept. We were shown team meeting agendas but no minutes or actions were recorded.

Staff knowledge of what safeguarding meant and steps they would take if a person was at risk was lacking. Although most people told us they felt safe this was not reflected in what we heard listening to the manager and staff. The manager told us that no safeguarding issues had been raised by the service however we were told by the local authority that four had been raised in the past 18 months. Not all risk assessments were in place to help staff manage risks. For example, dementia, Parkinson’s disease and diabetes assessments were missing in some people’s care plans. Medicines were not always safely managed with information absent about what the medicines were for and no risk assessments to manage side effects. Not all accidents and incidents had been recorded and no patterns or trends had been identified.

When agreeing to support new people the manager had not thoroughly assessed people’s needs. For example some people used urinary catheters but staff had not been trained in catheter management. Staff received a three day induction which included some basic training modules. There was no evidence to suggest any further, effective training was provided for staff after their induction.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People had not been supported to attend health and social care appointments but the manager told us the service could provide this support if required.

Some people told us that they had requested female carers but this had never been provided despite repeated requests. Sections within care plans were headed ‘About me’ but in all cases these were blank.

People told us that the length of care calls varied and that they were not always informed if carers were running late. Care plans were not person centred. Each section began with a heading, ‘What I can do.’ However, there was no information describing what people could do for themselves but a description of the support needed. A complaints policy was in place but not everyone we spoke to knew how to raise a complaint or concern. Four complaints were recorded, all related to late calls. Some people supported were towards the end of their lives. There were no end of life care plans and staff had not been trained in end of life care.

There were enough staff and staff had been recruited safely. Infection prevention and control measures were in place. People told us that they were treated with dignity and respect and that their independence was encouraged without compromising their safety. People’s privacy was respected. Some people did tell us that they thought the manager was helpful and some staff told us that the manager had supported them well. Some contingency plans were in place and the manager had developed some positive relationships with health and social care professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good. (Report published 19 April 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eniola Care Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding, risk, medicines, training and ongoing staff support, mental capacity assessments, statutory notifications, auditing and quality assurance. We served a regulation 17 warning notice to the provider to be complied with by 30 December 2022.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.