EnhanceAble Living

EnhanceAble Living is a domiciliary care agency. It provides a personal care support service to people in their own homes. At the time of inspection, four people were receiving support with personal care from this service.

The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

At the last inspection monitoring and audit systems did not always identify issues in relation to the quality of care provided through keeping up to date records, including recruitment, medicines administration and spot checks.

This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection monitoring and audit systems identified issues in relation to the quality of care provided by keeping up to date records, including recruitment, medicines administration and spot checks and action taken was clear.

The agency management and leadership were transparent and there was an open culture that was honest and positive. The statement of purpose clearly defined the agency vision and values, that staff understood and followed. Areas of responsibility and accountability were made clear to staff and they were willing to take responsibility and report any concerns they may have, when needed. The agency reviewed service quality and made changes to improve the care and support people received. This was in a way that best suited people. The agency had well-established working partnerships that promoted people’s participation and reduced social isolation. Registration requirements were met.

The service provided was safe for people to use and staff to work in. People were supported to live in a safe way and enjoy their lives, by staff who were appropriately recruited and trained. Risks to people using the service and staff were assessed and monitored. The agency reported, investigated and recorded accidents, incidents and safeguarding concerns. Medicines were safely administered, by staff trained to do so. The agency met shielding and social distancing rules, used PPE effectively and safely and the infection prevention and control policy was up to date.

Rating at last inspection

The last rating for this service was Requires Improvement (published 17 July 2019).

Why we inspected

This inspection was prompted in part due to ongoing concerns about audits and monitoring systems not always identify issues in relation to people’s care and safety. A decision was made for us to inspect and examine the risks associated with these issues.

Care Quality Commission (CQC) has introduced focused/targeted inspections to follow up on previous breaches and to check specific concerns.

We undertook a focused inspection approach to review the key questions of Safe and Well-led where we had specific concerns about staffing numbers and audit management.

As no concerns were identified in relation to the key questions is the service Effective, Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

Whilst the inspection was to cover support in the people's own home, the organisation also offered people day centre and respite services.

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

Quality assurance processes were not always in place to ensure effective care delivery. There were no audits carried out by the management team to monitor people’s medication administration record (MAR)sheets, review criminal record checks, staff’s performance and training needs. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s care plans were detailed and person-centred but required additional information in relation to their personal histories and end of life care choices. The provider told us they would address this immediately.

Staff were aware of the actions they had to take should they notice abuse or incidents and accidents taking place. Pre-employment checks took place to ensure staff’s suitability for the role. People had support to take their medicines as prescribed. Staff understood their responsibility to provide hygienic care for people. Risk assessments were robust and person-centred.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood and complied with the requirements of the Mental Capacity Act (MCA) 2005.

Guidance and support from healthcare professionals was implemented into the care delivery to people. Staff supported people to access sufficient amounts of food and drink to meet their dietary requirements.

People told us they were well treated, and that staff kindly attended to their care needs. People had their cultural and religious needs embraced which helped them to feel valued. Staff supported people to enhance their independence and express their choices where possible.

People addressed their concerns with the management team if they wanted to make changes to the services they received. Contacts details were provided should people want to raise their concerns outside the organisation.

The management team worked together and shared responsibilities to provide leadership at the service. Staff had the necessary support in their job and were encouraged to develop in their role which motivated their involvement in providing good support for people. The staff team worked in conjunction with the healthcare professionals to support people’s well-being.

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

Rating at last inspection- The last rating for this service was good (published 5 January 2017).

Why we inspected- This was a planned inspection based on the previous rating.

Follow up- We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

EnhanceAble Living provides a domiciliary care service to over 50 people living in Kingston and the surrounding area. People who used the service had needs associated with a physical and/or learning disability, an acquired brain injury, autism or dementia. The support people received was to help enhance their social skills and prevent isolation because of their disability. Some people were not able to fully express their opinion of the service verbally but could communicate through Makaton signing and showing us pictures of the activities they took part in. Most people required some type of personal care during their support time. A few people only needed help with day-to-day tasks such as housework, shopping, meal preparation and household duties. We only looked at the service for people receiving personal care during this inspection as this is the service that is regulated by the Care Quality Commission.

The service had a registered manager. 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 told us they felt safe with the support they received from staff. There were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place to inform people who used the service and staff how to report potential or suspected abuse. Staff we spoke with understood what constituted abuse and were aware of the steps to take to protect people.

People had risk assessments and risk management plans to reduce the likelihood of harm. Staff knew how to use the information to keep people safe. The provider ensured there were safe recruitment procedures in place to help protect people from the risks of being cared for by staff assessed to be unfit or unsuitable for the role.

Appropriate arrangements were in place in relation to administering and the recording of medicines which helped to ensure they were given to people safely.

Staff received training in areas of their work identified as essential by the provider. We saw documented evidence of this. This training enabled staff to support people effectively.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Records showed people were involved in making decisions about their care and support and their consent was sought and documented.

People were involved in planning the support they received and their views were sought when decisions needed to be made about how they were supported. The service involved them in discussions about any changes that needed to be made to keep them safe and promote their wellbeing.

The type of activities people engaged in were chosen by the person and tailored to meet their individual needs.

Staff respected people’s privacy and treated them with respect and dignity. Staff supported people according to their personalised care plans.

The provider encouraged people to raise any concerns they had and responded to them in a timely manner.

Staff gave positive feedback about the management of the service. The registered manager was approachable and fully engaged with providing good quality care for people who used the service. They encouraged a positive and open culture by being supportive to staff and by making themselves approachable.

The provider had systems in place to continually monitor the quality of the service and people were asked for their opinions about the service and action plans were developed where required to address areas for improvements.

On the day of our inspection 50 people were using the services of EnhanceAble Living. All people using the service had some form of learning or physical disability. We looked at the care records of seven people, spoke with 11 people and four members of staff. We also emailed a questionnaire to 14 other members of staff.

Below is a summary of what we found.

Is the service safe?

Care plans were individually written and included comprehensive information about the person using the service. This helped staff to understand a person's needs. Risk assessments relating to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely. The provider had a safeguarding vulnerable adults and children's policy in place and staff had also received recent training.

Is the service effective?

People using the service had agreed and signed a contract detailing the hours and days that staff would work with them. Including a choice of the gender of staff that would help them and the type of help required. Care plans were reviewed annually with the person using the service

Staff were trained and supported by the manager. Staff received a range of training and regular one to one supervision and yearly appraisals.

Is the service caring?

The service was caring. People told us how they were helped by staff to achieve their goals of independent living and what that meant to them. People said 'This service has transformed my life, staff are marvellous. I am now able to go out and about.'

Families that we spoke with said 'This is an excellent service, because the staff are friends.' People commented that staff were always on time and 'never let them down.'

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs.

There was a one page monthly round up of a person's activities. These notes were especially helpful when more than one member of staff supported a person. They gave a clear picture of the activities a person had or hadn't enjoyed and their progress towards independence.

Is the service well-led?

The service employed a manager who knew their staff and people well. Records showed that staff received a six week induction programme that included at least four weeks of shadowing more experienced staff.

There were effective recruitment and selection processes in place which included employment reference and Disclosure and Barring Service (DBS) checks (formerly known as Criminal Record Bureau (CRB) checks). We saw that staff received mandatory safeguarding training that was updated bi-annually as part of a rolling training programme.

The provider carried out a variety of quality assurance to assess and monitor the quality of care provided to people who used the service. People who used the service were aware of the complaints process and how to use it.