We carried out a review of the data available to us about Enable Health Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Enable Health Ltd, you can give feedback on this service.
Enable Health provides personal care services to people in their own homes. Enable Health is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults, and children. At the time of our inspection 27 people were receiving a personal care service.
We had previously carried out an announced comprehensive inspection of this service on 7 September 2017 where we identified a number of areas where improvements were needed, to ensure that people were receiving care that was safe, effective, caring, responsive and well-led. We followed up with an inspection on 5 April 2018 and found significant improvements had been made. We could not rate the service good at that time because we needed to ensure the improvements were sustainable over a period of time. Therefore, the service was rated as Requires Improvement.
At this inspection we found that the improvements made at the April 2018 inspection had been sustained and, in some areas improved on. The service is rated as Good.
There was not 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 manager running the service was applying to register with the Care Quality Commission.
We were greeted warmly by staff at the service. The atmosphere was open and friendly.
People were safe. Staff understood their responsibilities in relation to protecting people from the risk of harm. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.
Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. Sufficient staff were deployed to meet people’s needs. People received their medicine as prescribed.
Staff had a good understanding of the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected.
People were treated as individuals by staff committed to respecting people’s individual preferences. The service’s diversity policy supported this culture. Care plans were person centred and people had been actively involved in developing their support plans. People had good access to healthcare services.
People told us they were confident they would be listened to and action would be taken if they raised a concern. We saw a complaints policy and procedure was in place. The service had systems to assess the quality of the service provided. Learning was identified and action taken to make improvements which improved people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.
Staff spoke positively about the support they received from the manager. Staff supervision and meetings were scheduled as were annual appraisals. Staff told us the manager was approachable and there was a good level of communication within the service.
People told us the service was friendly, responsive and well managed. People knew the manager and both people and staff spoke positively about them. The service sought people’s views and opinions and acted upon them.
Enable Health provides personal care services to people in their own homes. Enable Health is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to older adults, younger disabled adults, and children. At the time of our inspection 21 people were receiving a personal care service.
We had previously carried out an announced comprehensive inspection of this service on 7 September 2017 where we identified a number of areas where improvements were needed to ensure that people were receiving care that was safe, effective, caring, responsive and well-led.
We found the service to be in continuing breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 following on from an inspection conducted on 20 February 2017 where the service was placed in special measures.
People were not supported in line with the principles of the Mental Capacity Act 2005 (MCA). The provider did not provide care and treatment in a safe way. Risks to people were not assessed and regularly reviewed and medicines were not safely managed. The provider did not have effective systems in place to monitor and improve the service and staff did not always receive effective support. People were not always supported to receive support from healthcare professionals. Following the inspection on 7 September 2017 we imposed a condition on the provider's registration to restrict new care packages. The condition on the provider's registration to require them to provide monthly reports of action they were taking, through their quality assurance systems, to address the concerns following the inspection on 20 February 2017 remained in place.
We undertook this inspection to check the service had made the required improvements from the inspection in September 2017.
We found the service had made significant improvements. Staff demonstrated an understanding of the MCA and how they applied its principles in their work. However, there was still room for further development. We discussed the Mental Capacity Act (MCA) 2005 with the provider who demonstrated a knowledge of the Act but was also unclear on some aspects of the Act. We found people’s rights in relation to the act were protected.
Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe.
People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.
The provider monitored the quality of the service and strived for continuous improvement. There was a clear vision to deliver high quality care and support and promote a positive culture that was person-centred, open and inclusive. This achieved positive outcomes for people and contributed to their quality of life. The provider was supported by an external consultant.
Staff received effective support through supervision, spot checks and training. Staff training plans were monitored and up to date.
There was not 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 head of HR (human resources) was applying to become registered manager.
People’s nutritional needs were met and where people required support with nutrition care plans provided staff with guidance on people’s support needs. People received their medicine as prescribed.
People told us they benefitted from caring relationships with the staff. There were sufficient staff to meet people’s needs and people received their care when they expected. Staffing levels and visit schedules were consistently maintained. The service had safe, robust recruitment processes.
People were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.
People were treated as individuals by staff committed to respecting people’s individual preferences. The service’s diversity policy supported this culture. Care plans were person centred and people had been actively involved in developing their support plans.
People told us they were confident they would be listened to and action would be taken if they raised a concern. We saw a complaints policy and procedure was in place. The service had systems to assess the quality of the service provided. Learning was identified and action taken to make improvements which enhanced people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.
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.
Enable Health provides personal care services to people in their own homes. At the time of our inspection 21 people were receiving a personal care service.
We had previously carried out an announced comprehensive inspection of this service on 20 February 2017 and identified a number of areas where improvements were needed to ensure that people were receiving care that was safe, effective, caring, responsive and well-led. At the inspection on 20 February 2017 we found the service to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not supported in line with the principles of the Mental Capacity Act 2005 (MCA). The provider did not provide care and treatment in a safe way. Risks to people were not assessed and regularly reviewed and medicines were not safely managed. People were not protected from abuse and improper treatment. Staff did not understand their responsibilities to report abuse. The provider did not have effective systems in place to monitor and improve the service and there were not sufficient suitably qualified, competent, skilled and experienced staff deployed to meet people's needs. Following the inspection on 20 February 2017 we imposed a condition on the provider’s registration to require them to provide monthly reports of action they were taking, through their quality assurance systems, to address the concerns.
We undertook this inspection to check the service had made the required improvements from the inspection in February 2017. We found not all the improvements had not been made.
There was a lack of leadership, governance and managerial oversight of the service. Systems in place to monitor and improve the quality of the service were not effective. Most staff did not have confidence in the management of the service.
Medicines were not managed safely. Medicine records were not always completed accurately and staff competency to administer medicine was not always appropriately checked before staff supported people with their medicines unsupervised.
Risks to people were not always identified and assessed. Where risks were identified action was not always taken to reduce the risks.
Staff did not feel supported through regular supervision and appraisal. Staff did not always have access to training and development. Scheduled spot checks to assess staff competency were not conducted to ensure they had the skills and knowledge to meet people's needs.
The registered manager, provider and staff did not have a clear understanding of the Mental Capacity Act 2005 (MCA). Staff had received training to understand their responsibilities to support people in line with the principles of MCA. However, this training was not effective. Care records were not completed in line with the principles of the Act.
People were not always supported to access support from healthcare professionals. Appropriate referrals to healthcare professionals were not always made. Where healthcare professionals provided advice and guidance this was not always followed.
People told us they felt safe. Staff understood their responsibilities in relation to safeguarding. Staff had received training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.
People told us they benefitted from caring relationships with the staff. There were sufficient staff to meet people’s needs and people received their care when they expected. Staffing levels were consistently maintained and planned visits were generally punctual. No missed visits were recorded. The service had safe, robust recruitment processes.
At this inspection we found the service to be in continuing breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and 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 remains in ‘special measures’.
The service 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.
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There was 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 did not have sufficient suitably qualified staff to meet the needs of the people using the service. People experienced missed and late visits that impacted on their wellbeing.
There was a lack of leadership, governance and managerial oversight of the service. Systems in place to monitor and improve the quality of the service were not effective. Although the provider was aware of the issues related to missed and late visits action had not been taken to minimise the risk to people.
Medicines were not managed safely. Medicine records were not completed accurately and did not contain sufficient information to ensure people received their medicines as prescribed. Staff did not always complete medicines training before supporting people with their medicines and staff competency was not assessed before staff supported people with their medicines unsupervised.
Risks to people were not always identified and assessed. Where risks were identified there were not always plans in place to manage the risks.
People were not protected from the risk of abuse as staff did not have a clear understanding of their responsibilities to identify and report suspected abuse. Staff had not received training in safeguarding adults.
Staff were caring and people were positive about staff kindness and compassion.
Staff did not feel valued and were not supported through regular supervision and appraisal. Staff did not have access to training and development. Staff competency was not assessed to ensure they had the skills and knowledge to meet people’s needs.
The registered manager did not have a clear understanding of the Mental Capacity Act 2005 (MCA). Staff had not received training to understand their responsibilities to support people in line with the principles of MCA. Care records were not completed in line with the principles of the Act.
Care plans were not always up to date and did not reflect the support people required to meet their needs. Where people’s needs had changed care plans were not always updated.
At this inspection we found the service to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering what action we will take.
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 service 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.