Enabling Care For You Limited Head Office received a second consecutive 'Requires Improvement' rating following a focused inspection of Safe and Well-led domains, with continued regulatory breaches under Regulations 12, 17 and 18 relating to unsafe medicine management, inadequate risk assessment in care plans, and poorly planned overlapping care calls. While staff recruitment, infection control and safeguarding processes were effective, governance systems failed to identify these recurring issues and the provider remains in breach of the same regulations identified at the previous inspection in 2021.
Concerns (10)
criticalCare planning: “Care plans continued to lack important information and guidance for staff to refer to when supporting people with specific health needs such as diabetes, epilepsy, and catheter care.”
criticalMedication management
: “Important information about when and how medicine required as and when (PRN) should be administered was missing from people's care plans.”
criticalMedication management: “There were gaps in people's medicine administration records (MAR). Although we could see there were reasons for the gaps by cross referring to other documentation this was not a safe way.”
criticalStaffing levels: “Calls to people were planned in a way that did not account for travel time and overlapped. Staff said, 'I was running from one to another, driving like a maniac to get there.'”
criticalGovernance: “Audits did not maintain a good oversight of all aspects of the service delivered to people. People's care records and risk assessments were not always accurate or up to date.”
moderateMissed or late visits: “Staff don't turn up on time if other people ill. My early morning call is later, it should be earlier.”
moderateGovernance: “Systems to monitor care calls were ineffective, the provider had not identified where calls overlapped. The provider had no system in place to identify when calls were cut short.”
moderateRecord keeping: “Information was missing from care plans about people's holistic needs which could impact their mental health and wellbeing. Some of the information in care plans was inaccurate and contradictory.”
minorStaff training: “Others said training needed to improve as it was mostly eLearning (computer-based learning) and they would prefer more practical training.”
minorCommunication with families: “I do feel like communication with managers not the greatest. They could touch base more. Personally, I don't feel well communicated with and involved.”
Strengths
· Staff had been recruited safely with checks on employment history, references and DBS maintained.
· Effective infection prevention and control measures in place with sufficient PPE for staff.
· People felt safe and confident that concerns would be listened to; safeguarding responsibilities understood.
· Strong multi-disciplinary working with GPs, District Nurses, Occupational Therapy and Speech and Language Therapy.
· Positive feedback from health professionals about responsiveness and flexibility of the service.
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
Enabling Care for You Limited was rated Requires Improvement overall, with breaches of Regulation 12 (safe care) and Regulation 17 (good governance) due to inadequate risk assessments, medicine recording errors and absent quality assurance systems. Effective, caring and responsive domains remained Good, with notable strengths in end of life care, partnership working and a person-centred, open culture.
Concerns (7)
criticalCare planning: “There was not enough guidance or information available in care plans and risk assessments about how to safely support some people who required support with complex health needs”
criticalMedication management: “People's medicine administration records were not always completed accurately. It was not always possible to confirm if people had received their medicines as intended”
criticalGovernance: “There were no formal quality assurance systems and processes in operation. There was no development or service improvement plan in operation”
moderateRecord keeping: “People's care records and risk assessments were not always accurate or up to date. This presented risks to the safety and quality of people's support.”
moderateLeadership: “Statutory notifications had not always been submitted as required, and the registered manager was not aware of their responsibilities to do so.”
moderateStaff training: “systems to identify when staff required additional or updated training were not operating effectively. Some staff required re-fresher training”
moderateIncident learning: “Quality and safety issues such as staff training needing renewal, risk assessments not being completed or monitored... had not been identified and had continued occurring over long periods.”
Strengths
· Effective systems in place to protect people from abuse and improper treatment
· Enough staff to meet people's needs safely; care calls met and only very rarely delayed
· Safe recruitment practices including DBS, references and induction
· Effective infection prevention and control measures during COVID-19
· Staff worked well with other agencies achieving good outcomes including health-related outcomes
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
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effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Supporting people to live healthier lives, access healthcare services and supportNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: End of life care and supportNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated