EnViva Complex Care Limited - London

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.

EnViva Paediatric Care Limited - London provide nursing and personal care to children in their homes. The service provides care and support for children with learning disabilities, physical disabilities and sensory impairment. There were 26 children being supported by EnViva Paediatric Care Limited London at the time of our inspection.

The service did not have 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. The current manager had been in place since January 2016 and was in the process of registering with the Care Quality Commission to become the registered manager.

The manager, staff and health and social care professionals worked closely with children and their families to ensure the support offered was person centred and responsive to individual needs.

Staff had a good understanding of safeguarding children and adults and the types of abuse that may occur. There were suitable arrangements in place to safeguard people including procedures to follow and how to report and record information.

Assessments were undertaken to assess any risks to the children using the service and to the staff supporting them. Measures were put in in place to minimise any risks identified.

Arrangements were in place to ensure the safe administration of medicines, including appropriate training for staff.

There were appropriate procedures in place for the safe recruitment of staff and to ensure all relevant checks had been carried out.

There were sufficient numbers of staff to meet the needs of the children they supported.

All staff had received induction training and mandatory training. They also received specialist training in areas such as ventilation, tracheostomy, nasal gastric tubes and epilepsy.

Staff received regular supervision and appraisal from the management team. This included a discussion about any arising issues with the children they supported and any training needs they had to better care for those whom they supported.

Staff treated children and their families with dignity and respect and they had a good understanding of equality and diversity and received up to date training in this area.

Children and their families were supported to actively express their views and be actively involved in making decisions about their care and treatment.

Information on how to make complaints was given to children and their relatives individually and discussed at the start of a service. Relatives told us they knew how to make a formal complaint and staff were clear about how to support people to do so.

There were regular checks, including spot checks of staff practice via field supervision that looked at how staff were working practically with children and their families and monitored their performance.

A client quality assurance survey had been undertaken in December 2015 to gain feedback on the service and the overall satisfaction rate was deemed as good, although this had slipped slightly since 2014. An action plan had been devised to ensure improvements were on-going around the issues raised by relatives and this was being monitored by the manager to ensure a high quality service was being delivered.

This time when we inspected, we found that the provider had implemented the measures they had committed to in their action plan and that children 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.

When we last inspected the service on 2 September 2013 we found that the provider did not have effective quality assurance systems in place to make sure that monitoring checks and reviews of care plan records were carried out when required. We issued the provider with a compliance action and the provider sent us an action plan detailing how they were going to implement changes to meet requirements.

This time when we inspected, we found that the provider had implemented the measures they had committed to in their action plan and that the provider had an effective system to regularly assess and monitor the quality of service that children receive.

We looked at all six of the care plan records for the children being supported through homecare contracts. We spoke with parents of the children and also spoke with six of the staff (four care staff and two nurses) who provided care under these contracts.

Staff demonstrated that they had a good understanding of children's communication needs and their likes and dislikes.

Children were cared for by the same small number of staff to make sure they received continuity of care. When we spoke with staff they demonstrated that they knew the complexities of children's needs.

We found that the provider had not taken reasonable steps to make sure that children who the service provided care for were protected from the risk of abuse.

Children were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider did not have effective quality assurance systems in place to make sure that monitoring measures and reviews of care plan records were carried out when required.

We spoke with people involved in providing and receiving care under this one care package. The representatives of the person receiving the care said they were satisfied with the care provided and that they would continue to use the service.

We found that the provider had processes in place to make sure that people who used the service were protected from the risks of abuse. The provider had robust processes in place to make sure that people employed by the service were suitable to work with children and vulnerable adults. We spoke to a nurse who had provided the most recent care to the person using the service and they demonstrated that they had received appropriate training and guidance on safeguarding.

We found that the provider had effective systems and processes in place for monitoring and evaluating the quality of care being delivered.