Kent Enablement at Home

Kent Enablement at Home (KEaH) is part of the Social Care, Health and Wellbeing directorate of Kent County Council. It provides support at home for older people and adults with a physical disability. The service has been designed for people who need support to regain their independence after a medical or social crisis. The service provides time limited support to people in their own home, initially for a period of three weeks. The service supports people who have been discharged from hospital, or those referred who live in their own home. Support provided includes help with day to day tasks like cooking, shopping, washing and dressing and help to maintain their health and wellbeing. There were 60 people using the service at the time of our inspection, living in the areas of Swale, Sittingbourne, Sheerness, Canterbury, Herne Bay and Whitstable. People were funded through Kent County Council Social Services.

At our last inspection on the 15 and 18 April 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

There was a registered manager employed at the service. The registered manager also the operations manager of the service and covers other registered locations, providing a similar service in other areas of Kent. 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’s needs were assessed and care and support was planned to maintain people’s safety, health and well-being. Risks were assessed by staff to protect people. People told us that staff discussed their care with them so that they could decide how it would be delivered. Care plans were kept reviewed and updated.

Staffing levels had been maintained to ensure there were enough staff available to meet people’s physical, social and emotional needs. Staff were suitably trained, for example staff had the skills to protect people from abuse. Staff received regular supervisions so that they had the knowledge and skills to meet people's needs.

The service continued to have robust recruitment practices in place.

Staff continued to encourage people to undertake activities and supported them with their independence.

Safe medicines management processes were in place and followed by staff.

People continued to experience care that was kind, caring and personalised. People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. They thought that staff were caring and compassionate.

People had access to health care professionals to make sure they received appropriate care and treatment.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people.

The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

Audits continued to be effective and risks were monitored by the registered manager to keep people safe. There were systems in place to monitor incidents and accidents.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

Further information is in the detailed findings below.

Kent Enablement at Home (KEaH) is part of the Social Care, Health and Wellbeing Directorate of Kent County Council. It is the in-house provider for support at home for older people and adults with a physical disability. The service has been designed for people who need support to regain their independence after a medical or social crisis. The service provides time limited support to people in their own home, for a period of three weeks initially. The service supports people who have been discharged from hospital, or those referred who live in their own home. Support provided includes help with day to day tasks like cooking, shopping, washing and dressing and help to maintain their health and wellbeing. There were 80 people using the service at the time of our inspection, living in the areas of Swale, Sittingbourne, Sheerness, Canterbury, Herne Bay and Whitstable. People were funded through Kent County Council Social Services.

There was a registered manager employed at the service. He was also the operations manager of the service and covered the five registered locations, providing a similar service in other areas of Kent. 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 registered manager and staff had received training about the Mental Capacity Act 2005 and understood when and how to support people’s best interest if they lacked capacity to make certain decisions about their care.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

The service provided sufficient numbers of staff to meet people’s needs and provide a flexible service. The service had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. All staff received induction training which included essential subjects such as maintaining confidentiality, moving and handling, safeguarding adults and infection control. They worked alongside experienced staff and had their competency assessed before they were allowed to work on their own. Refresher training was provided at regular intervals. Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

People’s needs were assessed and care and support was planned to maintain people’s safety, health and well-being. Risks were assessed by staff to protect people. People told us that staff discussed their care with them so that they could decide how it would be delivered. Care plans were kept reviewed and updated.

People spoke about the staff in a positive light regarding their feelings of being safe and well cared for. They thought that staff were caring and compassionate.

There were policies in place which ensured people would be listened to and treated fairly if they complained. The registered manager ensured that people’s care met their most up to date needs and any issues raised were dealt with to people’s satisfaction.

People were happy with the leadership and approachability of the service’s registered manager and locality organisers. Staff felt well supported by managers. Audits were effective and risks were monitored by the registered manager to keep people safe. There were systems in place to monitor incidents and accidents.

- Is the service safe?

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw that all staff were trained in the safeguarding of vulnerable adults, that the training included the principles of the Mental Capacity Act 2005 and that refresher courses were scheduled. All staff had been subject to Disclosure and Barring Services (DBS) checks before they started work. We found risk assessments with clear action plans were in place to ensure people remained safe. People's consent to care and treatment was sought appropriately and people's records were kept securely.

- Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. People who used the service commented, "We were all very impressed with the service" and "The service was excellent". We looked at some people's assessment of needs and support plans and we checked with people who used the service that the delivery of care was in line with their care plans and assessed needs. We found that care was appropriately delivered with an emphasis of enablement and recovery of independence. A member of staff told us, "The job is all about helping people get on their feet again and building their confidence". One person who used the service said, "The care workers have allowed me to recover in my home, without them I could not have managed". We found that the staff had received training to meet the needs of people who used the service.

- Is the service caring?

We found that people who used the service were supported by kind and attentive staff. A member of staff told us, "The job is all about helping people get on their feet again and building their confidence". One person who used the service said, "I was quite afraid after I had a fall but the care workers encouraged me to become more confident like I was before". Another person said, "The quality of care is excellent, the care workers are so kind, patient and respectful, they take time to have a chat with me before they go".

- Is the service responsive?

People's needs had been assessed before care and support began and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's care plans included their history, wishes and preferences. People and/or their representatives were involved with reviews of care plans and they were kept informed of any changes. People's views were sought about the quality of care that they received and their views were taken into account. A person who used the service told us, "We worked together on a plan that suited my needs for recovery".

- Is the service well-led?

We found that comprehensive policies and procedures were in place that addressed every aspect of the service. Policies were updated regularly and staff were made aware of the updates. The manager operated a system of quality assurance to identify how to improve the service. Every month people and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were sent, collected and analysed. Staff told us they were encouraged to express their views at team meetings or at any other time and that they were listened to. A member of staff told us, "There is an open door policy, we can pick up the phone and speak to the locality organiser and they make things happen". Staff's practice was regularly observed and monitored to identify whether additional training or refresher courses were needed.

People spoke very positively about the care and support they had received. We obtained comments which included 'I wanted to thank the Enablement support workers for the service. They are very wonderful, very kind, and very helpful'; and 'Thank you and all your fantastic team for all the help. I am most grateful.'

We saw that people's support plans were discussed and agreed with them prior to the commencement of the service. We found that people felt well cared for, and were assisted to regain their independence as far as possible.

The service liaised with other health and social care professionals to ensure that people received the on-going support they needed.

We found that the service had reliable staff recruitment, induction and training procedures in place.

People's comments, concerns and complaints were listened to, and were taken into account to bring about improvements to the service.

We saw that records were appropriately stored, were kept up to date, and were accurately maintained.