Eniola Care Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection the provider had not put in place systems, processes, and training for staff about safeguarding and safeguarding issues had not been recorded or investigated. This was a breach of regulation. The provider remained in breach of regulation. At the last inspection the provider had not put in place systems to make sure that safe care and treatment were consistently provided. There were no risk assessments in place for staff to follow when supporting people. This was a breach of regulation. The provider remained in breach of regulation. At the last inspection the provider had not ensured that staff had the appropriate training and skills to support people safely. Ongoing support for staff was inconsistent relating to supervision meetings. This was a breach of regulation. The provider remained in breach of regulation. At the last inspection the provider had not put in place systems to make sure that medicines were managed safely. There were no PRN protocols or guidance for staff. No risk assessments were in place. Medicine administration records (MAR) had not always been fully completed and there was no guidance for staff supporting people who often forgot to take their medicines. This was a breach of regulation. The provider was still in breach of regulation.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their loved ones told us that concerns or issues they raised were usually resolved by staff and managers. They told us they had been made aware of the changes in management. Comments included, “No not currently because of changes with management, not much communication except a quick call, there was previous issues with communication, staffing, call times changing. Not yet experienced new management so it is a grey area,” “Previous management listened to concerns and dealt with. There was an urgent care review, thought we might have to change agency but didn’t so stuck with” and “Don’t have any concerns if I do would speak to carers, they are very good.”

Staff told us that training and support from managers was in place however that there were no processes in place for learning when things went wrong. Staff told us that sometimes they had conversations with managers but it was not consistent. A member of staff said about an incident, “I called an ambulance and spoke to managers.” This was evident in the inconsistent records kept relating to accident and incidents. The provider told us new forms were being put in place for reporting incidents.

A professional told us, “There is no improvement plan and little evidence of lessons learned.” Some accident and incident forms had been completed. These included details of what had happened, for example a fall. However, the lessons learned section was not always completed or did not demonstrate what actions had been taken. For example, one person had a number of falls but not when staff were present. Lessons learned comments included ‘out of staffs control’. Whilst staff had not been present this did not demonstrate that the persons care had been reviewed to determine if referrals to other professionals had been considered. One person regularly declined their medicines. This was recorded and an incident form had been completed to show this had been discussed with the relevant people, including the GP. Whilst staff were aware of this and there was a regular staff team supporting the person, there was no care plan to guide staff on how they should encourage the person to take their medicines to ensure a consistent approach. Some accident and incident forms had been previously completed, although these did not always contain the relevant information. There was no evidence of any recent accident and information forms having been completed. Staff showed us on their hand held devices about how they would report and record any accidents or incidents.

People told us that they met with staff at the pre-assessment stage of their care journey. Comments from people included, “In the very beginning spoke to organisation, well my daughter did, the bosses came round.” Another said, “Someone came out, we had a meeting. All agreed with what they should do.” At the time of this assessment the provider was carrying out any new pre-assessment processes.

Staff described positive working relationships with other professionals one telling us, “Talk to them (community nurses) about meds and other issues. We have a good relationship with others.” Staff knew which professionals to call if needed and one told us of advice recently received from a community nurse relating to support for a person living with Parkinson’s disease. With the recent changes in management structure at the service, the provider has contacted everyone to offer reassurance.

We spoke to statutory partners about safe pathways and transitions and received positive feedback with no concerns being raised.

Processes were in place for pre-assessments of people’s care and support needs before they were taken on by the service. However, there had been few new admissions to the service since 2022 and the completed pre-assessment documents we were shown contained some gaps and omissions. We were reassured by the provider about moving forward with new admissions. More recent documents were in place to record all details including personal details, medical histories, specific needs and preferred routines. Care plans reflected the details captured at the pre-assessment stage.

People told us they felt safe and protected from harm. Comments from people included, “Yes I do feel safe most of the time,” “Feel safe, good gracious yes” and “I feel quite safe with them.” A relative added, “Yes absolutely fine, they look after him well.” And “Yes he knows he has a red lifeline and they call the family or district nurses if there is any issues with the catheter.”

Staff demonstrated a basic understanding of safeguarding, what amounted to a safeguarding and were able to tell us some of the steps they would take if they suspected abuse. Comments included, “Report to manager, document, wait for instructions” and “Call office, record, call 111.” It was clarified that in the absence of a manager they would contact the provider. Staff understanding of what actions to take to protect people at the scene of a safeguarding were not consistent however. No one was able to explain what immediate action they would take to make people safe.

Safeguarding and whistleblowing policies were in place however neither had been reviewed since February 2023, the policy stating reviews should be every 6 months. Staff training in safeguarding was inconsistent with 3 staff members being overdue training and another showing a 3 year gap between training. The provider told us they knew how to report safeguarding issues however there were no records kept or any reports received by CQC.

In most cases, people and their loved ones told us that risks were managed well. A person told us, “I feel perfectly safe with them, they know me.” Another added, “They wash me and help me get dressed and anything else like make me a coffee.” Feedback however was mixed with one person saying, “Not sure. I asked a carer if something happened to me what she would do. She said she would call the office. I thought about calling an ambulance, which I told her she should do.”

Staff knew people well and knew the risks associated with their health and support needs. Staff told us about people they supported living with dementia and how people’s levels of understanding and ability to consent, varied each day. A staff member said, “I try and talk to them and persuade them with tasks but it is for them not us. Can’t force them, try our best to do other things.” Staff were aware that if people’s health needs changed or they appeared unwell that they needed to take immediate steps to make them comfortable and consult the provider and other professionals if needed. Staff told us they had enough time at and between calls and a system was in place if they were running late.

Improvements were needed to some aspects of managing risks associated with people’s care. Care plans included risk assessments. These related to mobility, medicines and skin integrity. These had not been regularly reviewed. Information from the risk assessment wasn’t used to inform the care plan. For example, where Waterlow scores identified a high risk of pressure damage there was no information in the care plan to inform staff of the risk, no guidance about what they should do to help prevent pressure damage. One care plan did inform staff to report if the person developed any sore areas. Daily notes did not include any information to demonstrate checks of people’s skin integrity or pressure areas had taken place. Mobility care plans and risk assessments were inconsistent. Whilst some contained information staff needed. For example, ensuring person was wearing appropriate footwear and placement of feet before using a standing hoist. However, others contained conflicting or limited information. A risk assessments was in place for a person living with anxiety. This described the risk but gave no instructions to staff about an emergency situation.

People told us that they felt safe when the carers were supporting them. This included when being supported to move, to wash, to dress and to eat and drink. A relative told us, “Yes they are pretty good, my mums position is not great, it is not always very clean, but they have limited time.” A person added, “I have a shower chair and a commode, the carer wheels me to the bathroom for a strip wash same as my daughter. They always make sure the area is safe,” Another said, “Oh yes, they are very respectful of our property. They lock the door when leaving.”

Similarly, staff told us that they looked out for any hazards in people’s homes during their care calls. A staff member said, “Can move things to make safer – wobbly chairs and furniture and worn carpets. We have a good understanding.” Environmental risk assessments were carried out at the pre-assessment visit by the provider.

Environmental risk assessments had been completed before staff started to support people. These were reviewed and updated when required although some of these reviews had not been completed recently. Some contained very basic information but the review process was designed to capture any changes.

We received mixed views from people. One person told us, “Yes the organisation is dreadful, sometimes staff are not paid on time, they have told me this, it is not managed well and is in a state of chaos. Carers not coming from Eniola they are using a sub agency and they are owed money. There is another agency and they have taken some of Eniola’s staff.” However, other comments from people included, “Most of the staff are excellent. There is one that is always very quick” and “‘On the whole, I have no complaints.” Due to changes in staff people told us they had changes in their carers in recent months. People were positive about care call times, telling us, “They are always on time with the calls.” Feedback from relatives was mixed with one saying, “Yes they have, they go overboard, if they need to they have waited with him until I turn up.” Another said, “Only issue I have is that it is hard sometimes to understand them or make myself understood.”

Staff told us that they went through an induction process that gave them the knowledge and skills to provide the right support to people. They were unable to provide much detail however one saying, “2 weeks I think. Getting used to care, training and how the company works.” Another told us it was an opportunity to get to know the managers. There were no records kept of staff induction. The provider told us that they were extending the induction period from 5 to 7 days and were being supported by the local authority to introduce this. Staff told us they had completed training in all key areas but there was inconsistency in the recording of this training and any details of refresher training. Ongoing support was provided by ‘spot’ checks from the managers, unannounced on-site supervision of their work and supervision meetings. A new process had been put in place to monitor and record supervision meetings. There had previously been long periods of several months between some staff supervisions. We were told in March that this would improve and again during this current assessment. The new process needed time to fully embed to be able to assess its effectiveness. Current staff numbers were sufficient, with some dependence on agency staff, to meet people’s needs.

Staff had been recruited safely. We looked at 4 staff files and each contained the necessary documents and safety checks that had been carried out. For example, each contained references, interview notes, photographic identification and Disclosure and Barring Service forms (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff were given rotas for a two week period and were given enough time between calls. There were few reports of care calls being late or staff not staying for the allotted time. Contingency plans were in place to cover periods of unexpected sickness. An on-call system operated so that care staff always had a manger to contact for advice if needed. However most of this responsibility, at the time of this assessment, fell to the provider.

People and their relatives told us that staff always wore aprons and masks when providing personal care. They told us staff washed their hands between tasks and disposed of used personal protective equipment (PPE) appropriately. A person said, “They always wear gloves, aprons and masks.”

Staff told us that they had sufficient supplies of PPE and this has never been a concern. Additional supplies of PPE were available when needed. A staff member said, “We have everything we need.” Another added, Plenty, no problem.”

Policies, procedures and contingency plans were all in place for the safe management of infection control. These had been reviewed in July 2024.

Some people received support with their medicines. Some people needed reminders and prompts from staff and others needed full support. People told us that staff provided the support they needed. Comments included, “They do his medicines and mine. I know what medicines I am taking as I used to do them myself,” “Yes, they remind me to take my tablets”.

Staff were inconsistent in their understanding of ‘as and when required,’ (PRN) medicines. One staff member told us, “If family ask I can’t but when I’ve gone they can give them.” Another said, “PRN comes with instructions – it’s all on the app and record on MAR.” Staff told us they had received training in relation to medicines. Staff were able to tell us about providing medicines for people. This included encouraging people who were reluctant to take their medicines and steps they would take if a person refused their medicines. Staff explained to us how their hand-held devices reminded them of all the care that each person required. This included which medicine was required at what time. A member of staff said, “Follow instructions on phone.”

The management of medicines was not supported well with processes and guidance for staff. Some people had been prescribed PRN (as required) medicines. However, there were no PRN protocols, for example, to show the maximum doses and times between doses. There was no guidance to inform staff how and when they should be given and actions following administration for example, whether the medication had been effective or needed to be reviewed. When PRN medicines were given the specific times of administration were not recorded. There were no medicine care plans and no information about what each medicine had been prescribed for or any potential side effects. One person’s care plan included names of medicines the person has been prescribed. Again, no information about what these are for or what time these should be given. Care plan states and daily notes show the person enjoyed a glass of red wine. There was no information about whether this was compatible with medicines. One person regularly declined their medicines. This was recorded and an incident form had been completed to show this had been discussed with the relevant people, including the GP. Whilst staff were aware of this and there was a regular staff team supporting the person, there was no care plan to guide staff on how they should encourage the person to take their medicines to ensure a consistent approach. MARs were completed. There was information about which medicines people were taking at what time. If medicines were not given they were completed with a code which identified the reason. For example, declined or medicines not available. However, there was no information about why the medicines had been declined or not available. For one person a blood thinning medication had not been recorded for 5 days despite this being given by family.