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Enterprise Homecare Requires improvement

This service was previously registered at a different address - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 15 September 2018

This inspection took place over five days on 9, 13, 14, 16 and 17 August 2018. We gave the service appropriate notice so that people using the service and staff working at Enterprise Homecare could be contacted prior to our inspection of the service.

Enterprise Homecare is a domiciliary care service providing personal care and support to people living in their own homes. The length of visits for care and support vary depending on the assessed needs of people, with calls ranging from 15 minutes or more. At the time of this inspection, 158 people were using the service. However, not everyone using Enterprise Homecare received regulated activity; 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 take into account any wider social care provided.

We last inspected Enterprise Homecare in November and December 2017. The service was rated ‘inadequate’ overall. At the last inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment; dignity and respect; person-centred care; complaints; staffing; fit and proper persons and good governance. We served a notice of proposal to cancel the provider’s registration in response to our findings at that inspection.

There was a new registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC 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.

We looked at people’s care records to ensure the care and support which people needed was being delivered safely and that risks to people's health and wellbeing were appropriately managed. At our last inspection we identified that people were not safe due to the lack of appropriate risk assessments in place. The new registered manager had instigated a complete review of all packages of care to address any outstanding risks. Audits of these reassessments identified if any additional risks were posed to people and these were then completed by supervisory staff.

Electronic visit schedules were sent to all care workers via their mobile phone handsets and important information, for example about risks posed to people receiving a service, was included. Care workers were now provided with the information they needed to keep people safe.

At our last inspection we saw the use of mobile telephones by staff for call monitoring had improved but was still inconsistent. We looked at a number of records in relation to call monitoring and saw this had improved further. Staff were spending more time with people. We will check that the improvements to call logging are sustained and that people are being cared for and supported by staff for the whole of the commissioned time on our next inspection.

We reviewed how the service sought to ensure the people’s medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found measures had been introduced to assist staff to manage medicines more safely. A pilot was in place in two geographical areas and the registered manager planned to roll this out across all areas once staff were familiar with the new processes.

Enterprise Homecare provided a service to people who lacked capacity. For example, people living with a diagnosis of dementia. The registered manager was the Mental Capacity Act champion and had attended a workshop to gain knowledge and insight into this legislation and how it affected care and support. They intended on cascading this information down to team leaders and in turn to care workers so that staff gave people the opportunity to have maximum choice and control of their lives when being supported.

We checked to ensure staff were receiving regular supervision sessions. Staff supervision provides a framework for managers and staff to share key information, promote good practice and challenge poor practice. We saw and staff told us that supervisions were regular and appraisals of performance were in place. Staff felt fully supported by the new management structure.

People we spoke with as part of the inspection process were complimentary about the care and service received, particularly if they had a number of regular care workers who attended to their needs. People were less positive however, if or when they did not have regular carers and deemed that other care workers did not have the same level of knowledge or skill as regular care workers. The registered manager told us that providing continuity of care for people was a priority and we will check on progress with this at our next inspection.

Enterprise Homecare provides care and support to diverse and multi-cultural communities, in and around central and south Manchester and Stockport. At our last inspection equality, diversity and human rights had not been embedded into everyday practice. We saw this had improved. Staff had received training in this aspect. The service now recognised equality and diversity and was exploring ways of how this could be incorporated into practice. We saw the service was trying to allocate staff who were able to communicate with individuals in their own language, when English was not their first language.

People were now involved in decisions about how their care package should be organised. Reassessments of all packages of care had been carried out by supervisors on a face to face basis. These reassessments of need were then audited by the registered manager for accuracy. People had signed their care plan where this was possible and we saw examples of signed consent for care within support plans.

The service was able to demonstrate care and support was delivered to people in a person-centred way. Care plans contained appropriate language, had a person-centred focus and included information about a person’s past histories and needs.

People were aware of how the service now dealt with complaints. A revised protocol included in the updated statement of purpose outlined how complaints would be handled, by whom and within specified timescales. The revised statement of purpose had been distributed to everybody receiving a service. Complaints were often resolved by meeting with people, their relatives and staff on a face to face basis, with discussion and agreement about how and what the service could do better for the individual and to resolve the complaint.

At this inspection we found the new registered manager had made progress with regards to improving audits of the service, quality assurance and the development of staff practice. There were more robust quality assurance systems in place and the registered manager was able to evidence how new practices that had been introduced met the regulations. The quality assurance records we saw demonstrated how the registered manager maintained oversight of the service and we saw examples of processes they planned to implement to further improve the service.

The overall rating for this service is ‘requires improvement’ and the service is no longer in ‘special measures’. We will check that the improvements found on this inspection are maintained and sustained by the provider, including for any new packages of care commissioned in the future. We will check that people are in receipt of a quality service and continue to be cared for and supported by staff for the whole of the commissioned time on our next inspection.

Inspection areas

Safe

Requires improvement

Updated 15 September 2018

The service was not always safe

Care plans were more detailed and risk assessments were in place, with actions staff should take to reduce risks. Care workers were provided with the information they needed to keep people safe.

People felt safe with their regular carers although expressed concerns about the continuity of care at times.

The service had devised measures to assist staff to manage medicines more safely, although these had not been fully rolled out. A deputy manager was the nominated medicines champion.

Effective

Good

Updated 15 September 2018

The service was effective

The supervision and appraisal of staff performance had improved. Actions had been taken where necessary, including observations of practice and retraining of staff.

The service was undertaking mental capacity assessments and acted in people’s best interests with the involvement of others when necessary.

Links were being established with other organisations so that people received effective care, support and treatment. People experienced positive outcomes due to action taken by the service.

Caring

Requires improvement

Updated 15 September 2018

The service was not always caring

People were positive about regular care staff however were less positive about other staff.

The service recognised and acknowledged people’s diverse needs and also the diversity of the staff providing the care.

People were able to be independent, whilst receiving care and support and staff encouraged people to retain their independence.

Responsive

Good

Updated 15 September 2018

The service was responsive

Care plans contained appropriate language, had a person centred focus and included information about a person’s past histories and needs.

There was a new care plan review process in place.

There was a revised protocol about how complaints would be handled, by whom and within specified timescales. People had been made aware of this with a copy of an updated statement of purpose.

Well-led

Requires improvement

Updated 15 September 2018

The service was not always well led

The new registered manager had made improvements to the organisation and the culture of the service.

Audits and quality assurance systems were now in place, however not all improvements or new ways of working were fully embedded into staff practice.

The service engaged with people and was exploring ways of developing customer involvement, for example, during recruitment, training days or in workshop sessions.