Archived: Enablement Service

This inspection took place on 7 and 14 March 2018 and was announced. The provider was given 48 hours’ because the location provides a service to people in their own homes and we needed to be sure staff would be available at the location to speak with us. Two inspectors carried out this inspection.

At the previous inspection in January 2017, the service was rated as “Requires Improvement” overall. This was because, although significant changes and improvements had been made to the service, these had not yet been fully embedded. During this inspection, we found the improvements had been sustained.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe using the service. Staff knew how to report abuse if they were concerned a person was at risk of harm and abuse. People had risk assessments in place and management plans to mitigate the risks they may face. The provider completed appropriate checks when recruiting new staff. There were enough staff employed to ensure people’s visits were punctual and lasted for the required amount of time. The provider’s contingency plan ensured the service would continue if an emergency occurred. People were protected from the risk of the spread of infection. Staff told us they had access to plenty of gloves and aprons.

The provider carried out an assessment of needs before people began to use the service to ensure their needs could be met. Staff received regular supervisions and a range of training opportunities appropriate for their role. The provider worked jointly with healthcare professionals to ensure people’s health needs were met. The provider had systems in place to ensure there was good communication within the service. People gave their consent before staff gave them care. Staff were knowledgeable about their responsibilities under the Mental Health Act (2005).

People thought staff were caring. Staff were knowledgeable about developing positive relationships with people. People were involved in planning the care they received. Staff showed they understood about equality and diversity issues. People’s privacy and dignity was respected. In line with the aim of the service, staff supported people to regain their independence.

Staff knew how to deliver a personalised care service. Care plans were personalised and contained a detailed goal plan. People confirmed they received care in line with their preferences. Care plans were reviewed after the first week of service provision to determine people’s satisfaction with their support and at week three or four to determine if ongoing support was needed. People knew how to complain if they were not happy with their service. The provider dealt with issues before they became formal complaints and kept a record of compliments. The provider worked in partnership with other agencies in response to people’s changing needs.

Staff spoke positively about the management team. The provider had a system of obtaining feedback from people in order to make improvements to the service. Staff had regular meetings which kept them updated on training and good care practices. The provider used quality assurance systems to improve the quality of the service provided. The service was currently participating in several pilot schemes to improve the outcomes of people who used the service. The provider worked jointly with other agencies to ensure they could meet people’s needs and people’s expectations could be managed.

The service was last inspected in July 2016 when breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations were identified. The service was rated inadequate overall. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Enablement service provides up to six weeks’ support to people in their own homes to support them to regain their independence or to learn new skills. At the time of our inspection they were providing support to approximately 20 people, due to the nature of the support provided the number of people receiving a service varied from week to week. The service was not yet operating at capacity having voluntarily suspended admissions following our last inspection in July 2016.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service had been re-structured since our last inspection which had resulted in significant changes to the experience of people using the service. The service was now clear to people about the purpose of the service which meant people knew what to expect from staff and how long support would be provided for. Staff completed through needs and risk assessments before people started to receive a service. People told us and records confirmed they were involved in the assessment process and understood and consented to the service they received. The thorough assessment led to care plans and risk assessments that were highly personalised with clear instructions for staff to follow in order to support people and manage risks. People and staff told us they felt safe as the standard of paperwork was high.

People’s lifestyles, religious beliefs, cultural backgrounds and sexuality were taken into account when packages of care were put together. The service scheduled visits in order to take into account people’s religious and cultural commitments. Where the service was unable to meet a linguistic or gender preference for care they did not take on the referral.

Staff were knowledgeable about safeguarding adults processes and knew how to respond to concerns about abuse. Records showed that staff escalated concerns about people’s welfare, as well as progress made towards enablement goals. Where concerns were raised or feedback provided this was acted upon by managers.

The service did not support people to take their medicines, as the policy framework required to do this safely was not yet in place. Where people had identified needs with regard to medicines they were not suitable for the service and the referral was refused. Care plans contained details about people’s health conditions as well as their nutrition and hydration needs and staff were provided with training and information on various health conditions to ensure that concerns were escalated appropriately.

People told us the staff were kind and treated them with respect. Staff told us the culture of the service was focussed on people using the service and this was reflected in the changes to care plans that had been implemented.

The management of the service completed a wide range of audits in order to monitor and improve the quality of the service. These included benchmarking against recognised quality standards and seeking information from established organisations delivering a similar service. The service was working on an improvement plan which had support from senior leadership in the council. The registered manager and other staff told us they felt the service was being supported to develop. Although significant changes and improvements had been made to the service, these had not yet fully embedded and the service was not yet operating at a similar level of capacity as it had been in July 2016.

Enablement service provides up to six weeks’ support to people in their own homes to support them to regain their independence or to learn new skills. At the time of our inspection they were providing support to approximately 50 people, due to the nature of the support the number of people receiving a service varied from week to week.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were knowledgeable about how to keep people safe from harm and reported concerns to their managers. However, the processes in place to respond to concerns did not always escalate issues appropriately. We have made a recommendation about safeguarding adults.

People were at risk of harm and poor support because needs and risk assessments were not completed before people started receiving a service. Care plans and risk assessments in place lacked detail and were not personalised. The service relied on the knowledge and experience of staff to provide safe support that met people’s needs. The service monitored people’s progress closely and made referrals to other services appropriately.

Where the service supported people to meet their nutrition and hydration needs their needs and preferences were not clearly recorded. We have made a recommendation about meeting nutrition and hydration needs.

Staff told us, and feedback surveys confirmed, the service was not always able to meet the cultural and linguistic needs of people receiving a service. We have made a recommendation about meeting the needs of a culturally diverse population.

The service had completed a recruitment drive to ensure that it had enough staff to meet people’s needs as they recognised this was an area of need. Feedback from people and staff included that staffing shortages led to an inconsistent experience for people who were supported by a number of different staff. The recruitment processes in place ensured that suitable staff were recruited in a safe way.

The service was in the process of implementing a new medicines policy and procedure. The service did not provide people with support to take their medicines. Enablement staff occasionally checked that people had taken their medicines as prescribed. The service supported people to access healthcare services as required and had good links with community health services.

The service sought consent from people in line with legislation and guidance.

The service had a robust complaints policy and procedure. However, records showed complaints were not escalated to the complaints department. We have made a recommendation about complaints handling.

Staff told us, and records confirmed staff received the training they required to have the skills to complete their roles. Not all staff were receiving supervision in line with the provider’s policy. We have made a recommendation about staff supervision.

The quality assurance and audit processes in place were ineffective. They had not identified or addressed the risks faced by people and staff during the delivery of the service. Staff did not feel that their concerns had been listened to or addressed.

We found three breaches of the regulations. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

As part of this inspection we spoke with five people who use the service by telephone and visited another in their home. We spoke with the manager, the area manager, a senior enabler and three enablement staff. We also reviewed records which included four care plans, daily care records, staff training records and other records relating to the management of the service.

Below is a summary of what we found. The summary describes what people and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were protected from unsafe or unsuitable care because there were systems in place that ensured all care was appropriately assessed for and delivered. The care plans included actions required of staff to protect themselves, as well as risk reduction measures to protect people who used the service.

Staff we spoke with confirmed they were given enough time on each call to complete the care needed to a good standard. They felt they were provided with training that enabled them to do their job safely and efficiently.

Is the service effective?

The Care Quality Commission monitors the operation of the Mental Capacity Act 2005 which applies to all services providing care and support for people. We found before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

Relatives we spoke with told us staff always turned up when they should and stayed the correct length of time. All relatives said staff had never missed a call. On the rare occasions when staff were running late, relatives said staff always contacted them to let them know.

Is the service caring?

Relatives we spoke with felt the staff always respected their family member's privacy and dignity. One relative commented: "I cannot fault the carers." and another told us: "My relative is treated with great respect, the staff are excellent." People experienced care and support that was planned and delivered in a way that was intended to ensure people's safety and welfare. People were complimentary about the care workers and felt they had the skills needed when providing care and support. One person stated "I feel they care so much about their work."

Is the service responsive?

People we spoke with understood procedures such as how to complain or raise any matter which might be of concern. All felt their concerns would be listened to and acted upon.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people received. People who use the service, their representatives and staff were asked for their views about their care and support and they were acted on.

Comments received from relatives about the service included: "I am very happy with the service. I would recommend them."

People's views and experiences were taken into account in the way the service was provided in relation to their care. One person told us: "All the enablers are good and kind to me, my plan was discussed with me '.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. They contained detailed information setting out exactly how each person should be supported to ensure that their needs were met.

The provider had systems in place to respond appropriately to allegations of abuse. Our conversation with staff showed that they understood what constituted abuse and the procedure that needed to be followed if they had concerns or suspicions that people were being abused.

Staff received appropriate professional development. All staff had completed training in a number of key areas to ensure they were competent to do their job. This included training in manual handling, infection control, health and safety, food hygiene and safeguarding.

The provider took account of complaints and comments to improve the service. Complaints were made verbally or in writing and complaints forms were completed for each complaint.

The provider had policies and systems in place to minimise the risk of people being harmed. People told us they felt safe. Staff had a good level of knowledge about safeguarding issues. However, the staff we spoke with had not had safeguarding training recently.

People were cared for by experienced staff who felt supported by their managers. Staff had regular supervision meetings and the provider had identified staff training needs. However, we found that the provider did not offer staff appropriate training or the opportunity for professional development.

The provider had systems in place to regularly assess and monitor the quality of service that people received and acted on feedback from people using the service. One person told us, "they are always ringing me to find out how I'm getting on, nothing is too much trouble."