5 January 2019
The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team: This inspection was carried out by two inspectors, one specialist advisor and two Experts 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: EnViva Paediatric Care Limited - London is a domiciliary care agency. It provides nursing and personal care to people living in their own houses and flats in the community.
There was a registered manager in place at the time of the inspection. 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.
Notice of inspection: This inspection was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
What we did when preparing for and carrying out this inspection:
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the completed PIR and previous inspection reports before the inspection. We reviewed other information we had about the provider, including notifications of any safeguarding concerns or other incidents affecting the safety and wellbeing of people. Because the majority of people receiving the service were children we called and spoke with 11 of their relatives.
What we did during the inspection: An inspection site visit activity started on 24 and ended on 25 October 2018. It included speaking to the registered manager, HR and compliance manager, the operations manager, a care manager and three nurse managers. During the inspection we reviewed 18 people's care records, which included care plans, risk assessments and Medicines Administration Records (MRS). We also looked at 11 staff files, complaints and quality monitoring and audit information.
Prior and during our visit, we emailed and called care staff employed by the agency. We received feedback from 42 of them.
What we did after the inspection:
Following our visit, we contacted a number of health and social care professionals who worked regularly with the agency. We received feedback from two of them.
5 January 2019
What life is like for people using this service:
During this inspection we identified a small number of shortcomings with the service provision. These were related to the recording of medicines administration, the provision of supervision and staff competencies checks, communication with staff and people about rotas and calls allocation and the auditing of people’s care records. We noted that these shortcomings had been known to the agency’s management team. We saw that a process had begun to ensure the shortcomings were addressed. This included thematic audits and additional training for the management and nursing staff at the agency.
People told us that they received their medicines as required. Some improvement was required to how staff recorded medicines administration. The agency was in the process of carrying out the medicines management audits. The registered manager assured us appropriate action would be taken to address this matter.
Staff received appropriate training and induction to help them to support people effectively. Some improvements were required to ensure that staff knowledge and skills had been consolidated following the training. This had been addressed by the provider via introduction of additional training on the purpose of their supervision and competencies checks of the staff who provided direct care to people.
People using the service, the relatives, staff and external professionals gave us generally positive feedback about how the agency was managed. The vast majority of people and their relatives were happy with care and support provided by the agency.
The agency helped to protect people from harm from others. There were sufficient recruitment practices in place to ensure people were safe from unsuitable staff. Appropriate risk management and accidents and incident procedures as well as infection control measures helped staff to provide care that was safe and effective.
The agency had assessed people’s needs and preferences before they provided care and support to people. The information gathered during the assessment process was then used to formulate care plans for people. Care plans included information on people’s dietary needs and preferences, specific care needs and requirements, for example, equipment being used as well as what people liked and what was important to them. Care plans were detailed and person centred and provided staff with sufficient level of information on how people would like their support to be provided.
People’s human rights had been respected. People were encouraged to make decisions about their care and support they received. Staff asked for people’s consent before providing care to them.
Staff were kind and relatives thought that staff had genuinely cared for people. Staff spoke kindly about people they supported. Staff told us they want to provide care that was safe and effective but also comfortable and non-intrusive to people.
People were encouraged to voice their opinions about the care and support provided by the agency. This was done through an effective complaints system, service user surveys, care reviews as well as by ongoing communication between the agency and people or their representatives.
Staff said they were encouraged to give their feedback about how the agency was managed. They felt they could give their suggestions and ideas and they felt these were heard by the management team.
The agency worked closely with external health and social care professionals to ensure people received all-round care that was responsive to people’s changing health and care needs.
Transparent communication and proactive approach from the management team drove positive changes and needed improvements. Therefore, people could receive person centred care that met their needs the way they wanted it.
More information is in Detailed Findings below.
Rating at last inspection: Good. The report was published on 15 April 2016.
About the service: EnViva Paediatric Care - London 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. The agency has a satellite office in Bristol called EnViva Complex Care which was covered in this inspection.
Why we inspected: This was a scheduled/planned inspection based on previous rating.
Follow up: We will continue to monitor the agency and we will revisit it in the future to check if they continue to provide good quality of care to people who use it.