Ensure Care Ltd

Ensure Care Ltd is a domiciliary care service providing personal care to 45 people. The service provides support to older and younger adults with physical disabilities, people living with dementia, and people with learning disabilities. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People gave us mixed feedback on their experiences of care and their feelings of safety. Risks to people’s health and safety were not always identified or assessed. Medicine administration records (MARs) were not always clear and did not follow best practice guidance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the systems and processes in the service did not consistently support this practice. Improvements were needed to ensure mental capacity act assessments were accurate.

Recruitment checks included reference requests and Disclosure and Barring Survey (DBS) checks. Staff could describe signs of concern related to catheters and people’s skin, and that they would report these to the manager. Staff recognised the importance of keeping people safe from the risk of abuse and avoidable harm. Staff were trained in infection prevention and control and provided with Personal Protective Equipment (PPE). We have made a recommendation about processes for obtaining references, to provide greater assurances that these were verified.

Right Care: We received mixed feedback about people’s experiences of call times. Some people told us their call times were suitable, other people said they were too early or late. We received mixed feedback from people about staff competency and skills. People’s needs were assessed before they started using the service. When people needed help with their eating and drinking, or assistance to prepare meals, this information was recorded in their care plan. The provider worked in partnership with other healthcare professionals to meet people’s needs and in response to changes or concerns about people’s health. Staff spoke positively about their training.

Right Culture: Audits and governance processes to maintain oversight of the safety and quality of care were not operating effectively. We received mixed feedback from people and their relatives about their experiences of the care provided. Feedback from staff was consistently positive. Staff demonstrated pride in their roles as care workers and the support they provided to people. Feedback about people’s experiences of care was gathered through questionnaires, telephone calls and spot checks. Spot checks of staff were carried out to monitor care standards and identify where improvements were needed. The provider worked in partnership with external agencies and professionals, to access staff training and healthcare for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 June 2019).

Why we inspected

We received concerns in relation to staff training and competency. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ensure Care Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ensure Care Ltd is a domiciliary care agency. It provides personal care and support to older and younger people living in their own homes. At the time of inspection, 36 people were receiving personal care from Ensure Care ltd

People's experience of using this service:

Care plans did not always contain person centred information, however, staff understood people’s needs and preferences and cared for them in a person centred manner. Care plans were being updated to fully reflect people’s personal interests and preferences.

People received safe care and were protected against avoidable harm, abuse, neglect and discrimination.

Risks to people’s safety were assessed and strategies were put in place to reduce the risks.

The recruitment practices ensured only suitable staff worked at the service.

Staff were employed in sufficient numbers to meet people’s needs.

Where the provider took on the responsibility, people’s medicines were safely managed.

Staff received training that enabled them to have the skills and knowledge to provide effective care.

Staff received ongoing support from the registered manager.

Where the provider took on the responsibility, people were supported to maintain good nutrition and hydration.

People were treated with kindness, compassion and respect.

Staff encouraged people to maintain their independence.

People and their relatives were involved in the care planning and reviews of their care.

People's needs were assessed, and the care provided met their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Systems were in place to continuously monitor the quality of the service.

The service worked in partnership with outside agencies.

Rating at last inspection: Good, July 2016.

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service was last inspected in April 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Ensure Care is a domiciliary care agency providing care for people in their own homes. Most people who used the service received support through several visits each day. The agency specialised in supporting people whose first language was not English. On the day of our inspection visit the agency was providing support to 25 people with 17 members of care staff.

The service had a registered manager who was also the provider. 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. We refer to the registered manager and provider as the manager in the body of this report.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Care staff understood how to protect people from abuse and keep people safe. The character and suitability of care staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

There were enough care staff to deliver the care and support people required. People told us care staff arrived around the time expected and stayed long enough to complete the care people required. People told us care staff were caring, kind and knew how people liked to receive their care.

Care staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us care staff had the right skills to provide the care and support they required. Support plans and risk assessments contained relevant information for staff to help them provide the care people needed in a way they preferred.

Staff were supported by managers through regular meetings. There was an out of hours’ on call system in operation which ensured management support and advice was always available for staff during their working hours. The manager understood the principles of the Mental Capacity Act (MCA), and care staff respected people’s decisions and gained people’s consent before they provided personal care.

Staff, people and their relatives felt the manager was approachable. Communication was encouraged and identified concerns were acted upon by the manager. People knew how to complain and information about making a complaint was available for people in the service user guide each person had in their home. Care staff said they could raise any concerns or issues with the manager, knowing they would be listened to and action would be taken. People knew how to make a complaint and provide feedback to the manager, which was acted on.

There were systems to monitor and review the quality of service people received and to understand the experiences of people who used the service. This was through regular communication with people and staff, surveys, spot checks on care staff and a programme of other checks and audits. Where issues had been identified, the manager acted to make improvements.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We inspected this service previously on 26 November 2013 and identified improvements were required in the quality of the service's records. There were concerns that some people's care records were not accurate. We found the provider had made changes since our previous inspection and improvements had been made in this area.

We saw people's care records accurately reflected their care needs. We saw people had risk assessments in place that made sure most risks were managed. However we found some people who were at risk of developing pressure areas had not been assessed. We found staff understood how to check people's skin integrity and people who used the service told us staff made appropriate checks.

We found staff followed the provider's infection control policy. People told us staff maintained good standards of hygiene when they were supporting people in their homes.

We found evidence learning took place from incidents and that following investigations, appropriate changes were implemented to improve the service.

Is the service effective?

People told us the care they received met their needs.

Staff we spoke with had a clear understanding of the needs of the people they supported and what they told us was reflected in people's support plans.

We spoke with staff and found they felt supported by their manager. They told us they felt their manager was approachable and they could contact her at any time.

Is the service caring?

We spoke with three people who used the service and they were all positive about the staff who supported them. For example people told us; 'They (staff) are friendly and polite' and 'I'm totally happy with what I'm getting.'

Staff we spoke with were positive about their role as carer and enjoyed their job.

Is the service responsive?

We found people were asked for their views about their care and these were acted on. We saw the provider's latest customer quality survey results from March 2014.The results of the survey were good.

People told us they felt comfortable to raise any issues they had about the service. We found issues were responded to by the manager in a timely way.

People told us the service was flexible and they could contact the care office at short notice and request changes to their care.

People told us care staff noticed when their needs changed and took action.

Is the service well led?

We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service people received.

We found evidence that improvements had been made to the service following investigation of any concerns.

People we spoke with were positive about the care they received. One person told us the staff were, 'Very thoughtful.' They told us, 'I have the same staff, a couple come pretty regularly and I can't speak highly enough of them.' A relative told us the staff were, 'Really attentive.'

Staff demonstrated they understood people's personal needs and the individual ways they communicated their needs.

We found that care staff were aware of safeguarding procedures and knew how to keep people safe. People who used the service and their relatives told us they felt safe.

We found that the provider made appropriate checks on staff before they began work.

We found that there was a system for monitoring the quality of the service, which included customer satisfaction surveys.

We found that some records kept by the provider were not accurate.