Enham Trust - Care & Support at Home

Enham Trust - Care & Support at Home is a registered to provide and support to people living in their own home. At the time of the inspection 10 people were using the service.

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

People and relatives told us the service was understaffed. The provider acknowledged the need to employ additional support workers and were in the process of recruiting. The provider was using agency staff to fill vacancies and permanent staff were working overtime.

The registered manager and management team informed us a number of their policies and procedures were being reviewed and updated to reflect the needs of the service and to ensure they related to homecare provision.

People who used the service said they felt safe. Staff were recruited safely and there were enough staff to provide people's care. People confirmed PPE was always worn by staff when delivering their care.

Staff were aware of their responsibilities regarding safeguarding and knew how to report any concerns. Staff had received training in safeguarding and had confidence management would investigate any concerns appropriately.

Appropriate assessments were in place for managing risk and records showed these were reviewed with input from people and professionals.

People were supported to take their medicine where required and governance systems were effective in identifying any errors or concerns.

The provider had effective arrangements in place to obtain feedback from people and their family members. People were mostly satisfied the care and support they received.

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

Rating at last inspection

The service was previously inspected on 9 July 2019 and was rated good.

Why we inspected

The service was inspected because we identified concerns relating to another registered location under the provider. We needed assurances the service was safe.

Follow up

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

Enham Trust - Care and Support at Home is a domiciliary care service. Personal care was provided to 16 people in their own homes, accommodation let by the provider, in specially built or adapted accommodation or in supported living.

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.

Coopers Chase is a ten bedded supported living service. Enham Trust – Care at Home provided all support for people living in this service.

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

The service was safe. People were cared for by staff who had been trained to identify safeguarding concerns and who would not hesitate to report concerns.

Risks associated with people, their environment and needs were assessed and actions to mitigate risks taken to ensure that people lived safe and fulfilling lives.

There were safe recruitment procedures however there were some difficulties in providing us with evidence of this when we inspected. All relevant documents were supplied after we inspected.

Staffing shortages had been addressed through use of agency staff who had been provided with on-site accommodation to facilitate flexibility in their working time.

Medicines training and competence checks were completed by staff before supporting people with medicines. Medicines of people that self-medicated were checked regularly to ensure that the correct medicines were taken at the correct times.

A quality team reviewed accidents, incidents and dangerous occurrences. Trends were identified, and actions taken to reduce future risks.

People’s needs were assessed before they commenced a care package from the service to ensure their needs could be met. People were involved with their care plans and told us they were always involved with discussions about their care.

Staff completed an induction when they commenced in post followed by a period of shadowing colleagues. Staff were happy with the amount of training offered and could complete qualifications in social care to further their careers.

Staff received regular supervision and attended a regular staff meeting which they told us was useful.

People were supported as needed with their meals, some people were supported to develop independent. Living skills while others required full support.

People told us they were supported to make and attend healthcare appointments and that the provider would adjust their call times to facilitate this.

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; the policies and systems in the service supported this practice.

People told us that staff were caring and they felt treated with respect.

People were encouraged to maintain and develop their independent living skills and staff worked to ensure people retained their dignity at all times.

Most people were happy that they had been included in the development of their care plans.

People had person-centred and holistic care plans and, when they wanted to, had completely written their care plans.

The provider had produced some of their publications in different formats such as easy read and a staff member was an expert in producing easy read documents and Makaton.

The Accessible Information Standard had been met.

People could participate in a range of activities, training and work opportunities on the Enham Trust campus. People were also supported to access the community individually.

People could ‘bank’ hours and use them for longer sessions of support so they could have a full day out for example.

People knew how to make complaints and would contact the providers office in the event they had concerns.

People were given information about the complaints procedure when they commenced their care package with the provider.

Regular reviews of support plans gave people an informal opportunity to raise any worries without the need to make a complaint.

When we inspected no one was receiving end of life care.

People had been asked if they wished to consider their end of life care. Plans we saw were person-centred and reflected people’s preferences.

When we inspected, the manager had applied to be registered with the Care Quality Commission. There had been no registered manager in post since August 2018.

A new manager had developed a more open culture within the service, staff received regular supervisions and had improved communications.

A quality team reviewed accidents and incidents within the service and learning was shared throughout the organisation. Quality checks had been developed to ensure that the manager had oversight of the service.

Staff told us they were happy with the recent changes to the management team, it had been unsettling but they were happy with the resulting team.

The provider engaged people and relatives in surveys to find out people’s views of the service they received. More opportunities to gain feedback were planned for the future.

The provider worked in partnership with local health and social care professionals and organisations.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 10 February 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

People were safe because staff understood their role and responsibilities to keep them safe from harm.

Staff had a good knowledge of the provider's whistleblowing policy and procedures which meant they were able to raise concerns to protect people from unsafe care.

Recruitment processes were robust and ensured people were cared for by suitable staff. There were sufficient numbers of staff deployed to meet people's needs.

People were supported by staff who received regular training, support and supervision to help them provide effective care.

Staff understood the requirements of the Mental Capacity Act 2005 and their responsibilities to ensure that people who were unable to make their own decisions about their care and support were protected.

People had good relationships with the staff and were treated with dignity and respect.

There were systems in place to monitor the care provided and people's views and opinions were sought regularly.

There was an effective complaints system in place. People told us they were confident to raise any issues about their care and that they would be listened to and addressed.

Staff told us the service was well-led and managed by an effective and organised management team.

People had confidence in the provider and staff were clear about their roles and responsibilities.

Staff we spoke with demonstrated their knowledge of the care and support plans and people's individual needs. This included their social, emotional and health related needs. People told us that the service was flexible and able to provide support at times that met their needs. One person told us: '[the manager] sends me a list, but I change it'. This was in relation to the personal assistants due to make the calls and the times of their visits.

We saw that support plans were signed by people who used the service to show that they agreed with the support that was planned. However staff understood that people could withdraw their consent at any time.

There was a programme of training in place and this was monitored closely to ensure staff did not fall behind with their training updates. We saw from training records that staff were up to date with the training that the provider had identified as essential for their role.

Incident reports formed part of the analysis by the provider's director of quality and governance. They reviewed all risk assessments and incidents to decide if further action was needed and if trends could be identified.

At this inspection we looked at the care and support plans of seven people who received support from the service. All the support plans we looked at showed that a review of the person's care and support needs had taken place recently. The review of support and the reassessment of people's needs were clearly documented within their care and support plan. One person told us: 'I've had an OT (occupational therapy) assessment and I've been to the opticians everybody is trying to help me.'

Support staff (known to people who use this service as personal assistants) kept a record of how the person's support time was used. This reflected the support needs which had been identified in people's needs assessment and review. One person said: 'There is always somebody there to help me if I need them."

People we spoke with told us they were very involved in planning the support they needed. Everybody said the personal assistants were always polite and were easy to get on with. One person told us "the staff always knock on my flat door and ask what I need. It's great to have help to cook and suggest what shopping to get.'

Personal assistants demonstrated a good understanding of people's needs and how they should be met. Staff knew all the people they supported well. However we found that some people's support plans had not been reviewed. Risk assessments were not always in place to protect people who use the service.

Personal assistants all demonstrated a good knowledge of safeguarding vulnerable adults and were able to describe the steps they would take if they recognised any signs of abuse.

During our visit we looked at five staff files. These all showed that checks had taken place. Safeguards included photographic identification, references, Criminal Records Bureau (CRB) checks and employment history.

People told us that as they see the registered manager regularly they would be quite happy to raise any issues about the service directly with him.