ENA Homecare Service

ENA Homecare Service is a domiciliary care service providing personal care to younger adults and older people in and around Swadlincote. The service currently provides a service for 44 people.

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

People felt safe and felt improvements had been made within the service. People generally had a small team of staff who provided their support, and they felt staff knew them well. This enabled them to feel more confident and at ease with staff. People felt there was enough staff to provide their care and staff generally arrived when they were expected.

Staff understood how to recognise where people may be at risk of harm or abuse and knew what action to take. People received support to take medicines and staff knew how to act where they were concerned, or medicines had been missed.

People had been involved with developing their care plan and had a copy of their care records in their home. People felt the care records reflected the support they wanted, and this had been reviewed with them. People knew how to make a complaint, although felt they had not needed to raise any concern.

The registered manager had developed systems to enable them to monitor service provision remotely during the COVID-19 pandemic. They knew current guidelines to reduce the risk of transmission and ensured staff had necessary equipment to keep safe and arrangements were made for staff to participate in weekly tests for COVID-19.

The registered manager undertook a range of checks as part of their quality audit to identify shortfalls. The registered manager was committed to developing the service and providing good care and support.

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 Requires Improvement (published 8 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an announced comprehensive inspection of this service on 18 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and safeguarding service users from abuse and improper treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

ENA Homecare Service is a domiciliary care service providing personal care to younger adults and older people in and around Swadlincote. The service currently provides a service for 53 people. 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

People were not always protected from abuse and avoidable harm as staff had not always identified all potential safeguarding concerns and taken necessary action to ensure people’s safety. There was not always enough staff at weekends to ensure people had their support call at the agreed time and staff rosters did not allow for travelling time. Medicine management systems need to be reviewed to ensure this complies with best practice guidelines; information was not available for people who needed prompting to take their medicines. The provider had systems and processes in place to monitor quality and safety, however these were not always effective as they had not identified these concerns.

Risks associated with people’s care needs and the environment had been assessed and planned for. Staff had guidance that was up to date in how to provide safe care and mitigate any known risks. The provider had a system to record and analyse accidents and incidents to help to reduce further reoccurrence. Safe staff recruitment checks were completed before staff commenced their employment. Staff wore personal protective equipment when providing care for people.

People were supported by staff who had received an induction and ongoing training. Competency checks were carried out to ensure staff were carrying out their role effectively. Where people needed support to eat and drink, staff prepared this to people’s satisfaction. People’s healthcare needs had been assessed and staff monitored this and sought guidance and professional support if people were unwell.

People chose how to receive their care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff that were kind, caring and who knew them well. People were involved in their care and support which was reviewed to ensure it continued to meet people’s needs. People knew how to raise a concern if they were unhappy.

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

Rating at last inspection (and update) The last rating for this service was Good (published March 2017)

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ENA Homecare Service on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our previous inspection in March 2016 we rated the service as Requires Improvement as systems were not in place to ensure people received all their medicines at the right time. Safeguarding incidents were reported to the local authority but agreed safeguarding procedures were not always followed. People generally received the support visit on time but some people did not receive their support for the agreed length of time. Travelling time was not included in the staff roster which impacted on the support people received. On this inspection we saw improvements had been made.

The service had a registered manager in place at the time of our 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.

People received their medicines when they were needed. The staff knew when to give these and what to do if they were concerned or medicines were missed. People were protected from the risks of abuse. Staff knew how to recognise the signs of abuse and knew what actions to take if they felt people were at risk of harm. People were protected from risks associated with their health and care provision and measures to reduce or prevent potential risks to individuals were taken.

People had developed good relationships with staff, who recognised where care needed to be reviewed to reflect changes with their support. The provider had identified that more staff needed to be recruited to ensure people received greater consistency in care from the staff team.

People received care and support from staff who were well trained and knew how people liked things done. Staff received effective supervision and their work was reviewed through regular checks on their performance and their work was appraised.

People's were able to make decisions about how they wanted to be supported. Where they needed supported, they were helped to make decisions that were in their best interests.

People received support that was individualised to their personal preferences and treated with care and kindness and supported to be as independent as possible. They were supported to express their views and be involved in decisions related to the planning of their care and the running of the service.

People were provided with information about raising concerns or complaints and were happy to speak with staff about any worries. Staff felt supported by the registered manager who was committed to improving care services.

The service provides care and domiciliary support for older people and people with a learning disability who live in their own home in and around Swadlincote. At the time of the inspection 44 people were receiving a service.

There was a registered manager in the service. 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.

People received their medicine and were supported to apply any creams or ointments they needed to maintain their health. Where medicines were not administered in blister packs, systems were not in place to ensure people received all their medicines at the right time.

People were protected from the risks of abuse as staff knew how to recognise the signs of abuse and would report their concerns. Safeguarding incidents were reported to the local authority but agreed safeguarding procedures were not always followed.

People generally received the support visit on time but some people did not receive their support for the agreed length of time. Travelling time was not included in the staff roster which impacted on the support people received. This information was shared with commissioners of the service.

There were processes to monitor the quality of the service provided although these systems had not identified concerns with medication and receiving the correct length of support time.

People received effective care and support from staff who were well trained and knew how people liked things done. Staff received supervision and had opportunities to develop their skills to meet people’s needs.

People were treated with care and kindness and they were supported to be as independent as possible. People received support that was individualised to their personal preferences and needs. Positive and caring relationships had been developed between staff and people who used the service.

People benefitted from receiving a service from staff who worked in an open and friendly culture and were happy in their work. People were supported to express their views and be involved in decisions related to the planning of their care and the running of the service.

People had capacity to make decisions about their own care and people were asked about how they wanted to receive support. People usually received support from the same staff team and they knew who was providing their support in advance. The provider was flexible and responsive to changes for support times. There were sufficient numbers of staff to ensure visits were made when they should be and to meet people’s care needs.

People knew how to make a complaint if they needed to. People and staff were confident they could raise any concerns or issues with staff in the office and the registered manager, knowing they would be listened to and acted on.

We found a breach of the regulations and you can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

People who used the service told us that they felt safe with the service's carers and knew who to speak with if they were worried about anything. They said that carers talked things over with them while carrying out their care and support.

Although people felt safe with the service's carers we found that recorded risk assessments did not always include procedures to safely manage risks. We have asked the provider to tell us what they will do to ensure risk control measures are identified and recorded on every person's support plan.

Most people told us they thought the service employed enough staff. One person said, 'They've never let us down.'

Carers had received training on keeping vulnerable people safe.

Is the service effective?

People told us that carers encouraged them to be as independent as possible. One person said, 'I [am encouraged to] make a cup of tea.' Carers also confirmed this and one told us, 'I offer a flannel to people to wash their face.'

People were fully involved in planning the support provided by the service. Support plans detailed people's needs and guided carers in how these needs should be met.

Is the service caring?

People's privacy and dignity were respected. One family member told us that carers were, 'very good'they leave the room while [my relative] showers.'

Most of the people we contacted thought that their care and support was personalised for them. One person told us, '[My carers] treat me as I would like to be treated.'

Is the service responsive?

People we spoke with thought that their needs were understood by their carers and that the service employed enough staff. One person said, 'They've never let us down.'

Carers thought they were usually allocated enough time to provide the care outlined in people's support plans. Carers told us they felt listened to by the manager.

The manager acted on the views of people who used the service. For example, weekly staff schedules were sent to those people who asked for them, following requests for improved communication.

Is the service well-led?

The service had a quality assurance system to regularly assess and monitor the quality of service that people receive.

Carers had positive views on the service. These views included treating people who used the service with respect and being caring, honest and reliable.

One relative told us 'the care workers are polite and very patient. We ask staff during the day to give medicines to our parent and we give the medicines at night. This arrangement works well. This allows all of us to be independent and helps to meet our relative's needs. We have found the agency staff to have been very helpful'.

People using the service told us they had no concerns about the care workers who provided care to them and relatives also confirmed this.

We saw the agency liaised with other agencies to help provide care to people in the community. This included sharing a care package with another care agency and working with the different nursing teams.

Care plans included different assessments including medications to show how care workers would provide care.

One family representative told us 'We are able to give feedback on any matter about care at regular intervals and we do so'. The family representative told us they were able to judge how care was being provided during the six weeks review where they were invited to attend and take part in the review about their parent. They were aware they could speak to the manager at any time during the care package if they needed to do so.

We spoke with three people who told us they were more than satisfied by the care provided. One person offered, 'I have regular care staff that visit me and they know what to do and how to care for me. I think they are excellent'.

We spoke with another person and they confirmed staff knew what to do and used their care plan to meet their needs.

People we spoke with told us they felt safe with the staff provided by the company who visited them at home.

One person added 'I feel pretty safe with the staff who visit my home'.

'I have regular care workers who attend to me. When my regular care worker is on holiday I am sent another care worker. I tend to get the same care worker during this time'.

A person using the service told us, 'I think care workers are well trained, take their time and there is no rushing. I see staff adding to the care records about me. I think my care worker listens to me'.

A relative told us 'I think the service is better than expected. We are very satisfied with the service provided'.