Enterprise Homecare

Enterprise Homecare is a domiciliary care agency. It provides personal care to people living in their own homes in the community. At the time of the inspection the service was providing personal care to 163 people living in the Manchester and Stockport areas.

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

The service provided a range of care packages. Most people who used the service were happy with the care and support provided by Enterprise Homecare. People and relatives told us they felt safe and staff were caring. Call times were generally reliable. The provider used an electronic call monitoring system to help monitor scheduled calls and to ensure the quality of the service.

Risk assessments identified risks to people. People felt safe and protected from the risk of harm. People told us they received their medicines as prescribed. Staff completed medication training and their competency was checked.

Staff described signs they would look for to identify abuse and records showed appropriate action was taken to safeguard people.

There were sufficient numbers of staff who were safely recruited. They received a programme of support through training, supervision and appraisal.

Care plans were person-centred and contained information about people’s life history and their preferences. Staff demonstrated their knowledge of people’s care needs and action needed to reduce risks to people.

The Accessible Information Standard was being met. People were supported by staff who met their equality, diversity and human rights. People’s communication needs were recorded in care plans.

People were supported by staff to access healthcare services and records. Staff provided good examples of occasions when they recognised a deterioration in people’s health.

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.

Recent management changes meant there was no registered manager at the time of the inspection. The provider had promoted the previous deputy manager and they were awaiting registration. The manager completed a range of audits and checks but aspects of good governance were not evident in all areas.

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 13 September 2018).

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.

Enterprise Homecare is a domiciliary care service providing personal care and support to people living in their own homes. The length of visits for care and support vary depending on the assessed needs of people, with calls ranging from 15 minutes or more. At the time of this inspection, 158 people were using the service. However, not everyone using Enterprise Homecare received regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We last inspected Enterprise Homecare in November and December 2017. The service was rated ‘inadequate’ overall. At the last inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment; dignity and respect; person-centred care; complaints; staffing; fit and proper persons and good governance. We served a notice of proposal to cancel the provider’s registration in response to our findings at that inspection.

There was a new registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC 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 looked at people’s care records to ensure the care and support which people needed was being delivered safely and that risks to people's health and wellbeing were appropriately managed. At our last inspection we identified that people were not safe due to the lack of appropriate risk assessments in place. The new registered manager had instigated a complete review of all packages of care to address any outstanding risks. Audits of these reassessments identified if any additional risks were posed to people and these were then completed by supervisory staff.

Electronic visit schedules were sent to all care workers via their mobile phone handsets and important information, for example about risks posed to people receiving a service, was included. Care workers were now provided with the information they needed to keep people safe.

At our last inspection we saw the use of mobile telephones by staff for call monitoring had improved but was still inconsistent. We looked at a number of records in relation to call monitoring and saw this had improved further. Staff were spending more time with people. We will check that the improvements to call logging are sustained and that people are being cared for and supported by staff for the whole of the commissioned time on our next inspection.

We reviewed how the service sought to ensure the people’s medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found measures had been introduced to assist staff to manage medicines more safely. A pilot was in place in two geographical areas and the registered manager planned to roll this out across all areas once staff were familiar with the new processes.

Enterprise Homecare provided a service to people who lacked capacity. For example, people living with a diagnosis of dementia. The registered manager was the Mental Capacity Act champion and had attended a workshop to gain knowledge and insight into this legislation and how it affected care and support. They intended on cascading this information down to team leaders and in turn to care workers so that staff gave people the opportunity to have maximum choice and control of their lives when being supported.

We checked to ensure staff were receiving regular supervision sessions. Staff supervision provides a framework for managers and staff to share key information, promote good practice and challenge poor practice. We saw and staff told us that supervisions were regular and appraisals of performance were in place. Staff felt fully supported by the new management structure.

People we spoke with as part of the inspection process were complimentary about the care and service received, particularly if they had a number of regular care workers who attended to their needs. People were less positive however, if or when they did not have regular carers and deemed that other care workers did not have the same level of knowledge or skill as regular care workers. The registered manager told us that providing continuity of care for people was a priority and we will check on progress with this at our next inspection.

Enterprise Homecare provides care and support to diverse and multi-cultural communities, in and around central and south Manchester and Stockport. At our last inspection equality, diversity and human rights had not been embedded into everyday practice. We saw this had improved. Staff had received training in this aspect. The service now recognised equality and diversity and was exploring ways of how this could be incorporated into practice. We saw the service was trying to allocate staff who were able to communicate with individuals in their own language, when English was not their first language.

People were now involved in decisions about how their care package should be organised. Reassessments of all packages of care had been carried out by supervisors on a face to face basis. These reassessments of need were then audited by the registered manager for accuracy. People had signed their care plan where this was possible and we saw examples of signed consent for care within support plans.

The service was able to demonstrate care and support was delivered to people in a person-centred way. Care plans contained appropriate language, had a person-centred focus and included information about a person’s past histories and needs.

People were aware of how the service now dealt with complaints. A revised protocol included in the updated statement of purpose outlined how complaints would be handled, by whom and within specified timescales. The revised statement of purpose had been distributed to everybody receiving a service. Complaints were often resolved by meeting with people, their relatives and staff on a face to face basis, with discussion and agreement about how and what the service could do better for the individual and to resolve the complaint.

At this inspection we found the new registered manager had made progress with regards to improving audits of the service, quality assurance and the development of staff practice. There were more robust quality assurance systems in place and the registered manager was able to evidence how new practices that had been introduced met the regulations. The quality assurance records we saw demonstrated how the registered manager maintained oversight of the service and we saw examples of processes they planned to implement to further improve the service.

The overall rating for this service is ‘requires improvement’ and the service is no longer in ‘special measures’. We will check that the improvements found on this inspection are maintained and sustained by the provider, including for any new packages of care commissioned in the future. We will check that people are in receipt of a quality service and continue to be cared for and supported by staff for the whole of the commissioned time on our next inspection.

Enterprise Homecare is a domiciliary care service providing personal care and support to people living in their own homes. The length of visits for care and support vary depending on the assessed needs of people, with calls ranging from 15 minutes or more. At the time of this inspection, 202 people were in receipt of service. However, not everyone using Enterprise Homecare receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

We last inspected Enterprise Homecare in March 2017. The service was rated ‘requires improvement’ overall and ‘inadequate’ in the key question of well-led. At the last inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safeguarding people from abuse; receiving and acting on complaints; and good governance.

Following the last inspection, we met with the provider and sought assurance that sufficient improvements would be made and sustained, to ensure the quality of the service improved to attain a rating of at least ‘Good’ at this inspection. However, this has not been the case. During this inspection we found continued systemic failures and multiple breaches of regulations. We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment; dignity and respect; person-centred care; complaints; staffing; fit and proper persons; and good governance. We have also made a recommendation with regards to consent and mental capacity.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC 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. However, the continued and multiple breaches of regulations identified during this inspection, demonstrated that systems and process were not operated effectively to ensure compliance.

We looked at people’s care records to ensure the care and support which people needed was being delivered safely and that risks to people's health and wellbeing were appropriately managed. At the last inspection we acknowledged some improvements had been made in this area but during this inspection, we found these improvements had not been sustained.

We found where a person who used the service was deemed to be a ‘high risk’ for a particular care related activity, such as risks associated with moving and handling, eating and drinking or pressure area care, there was little or no information about how the service sought to mitigate such risks. Risk assessments were too subjective and generic and not based on a formalised assessment or scoring tool. We also found that reviews of risk were not completed in a timely manner.

We reviewed how the service sought to ensure the people’s medicines were managed safely. At the last inspection this had been an area of concern. During this inspection we found improvements had not been sustained and medicines were not always managed safely. Issues identified included the timeliness of administering ‘time critical’ medicines, the availability of a medicines support plan in a person’s own home, procedures for when medicines were seen to not be taken and the competency and training of staff.

We looked at how the service sought to ensure newly recruited staff were suitable to work with vulnerable people. We looked at a sample of recruitment records and found a variety of issues including incomplete application forms with some sections completely blank, unaccounted employment gaps and missing employment references. This meant the service was not able to consistently demonstrate the suitability of candidates to work with vulnerable groups before an offer of employment was made.

At this inspection we saw that the provider had invested in mobile telephones for staff to improve call monitoring. We looked at a number of records in relation to call monitoring and saw that call logging had improved. Electronic call monitoring records we looked at reflected that staff were not always staying for the full commissioned time with people, however we were assured that visits had taken place.

Electronic visit schedules were sent to all care workers via their mobile phone handsets and important information, for example about risks posed to people receiving a service, was included. We evidenced that information was not always added to the system once identified and there was no electronic audit trail with regards to people’s changes in need. We were not always assured that staff were provided with the most current information in relation to the person’s health condition and risks.

Enterprise Homecare provided a service to people who lacked capacity. For example, people living with a diagnosis of dementia. However, we were not assured that people were always supported to have maximum choice and control of their lives and we were not assured that staff always supported people by the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We checked to ensure staff were receiving regular supervision sessions. Staff supervision provides a framework for managers and staff to share key information, promote good practice and challenge poor practice. We found the completion of supervision sessions to be sporadic and not in line with company policy. When performance issues were identified, these were not always addressed.

Enterprise Homecare served a diverse and multi-cultural community in and around central and south Manchester and the client base was reflective of this. However, we found equality, diversity and human rights had not been embedded into everyday practice. One person who used the service was living with a visual impairment but we found the service had failed to provide information in an accessible format.

People were not always involved in decisions about how their care package should be organised. Records were not sufficiently detailed to demonstrate how and when people may have been involved, or indeed, if they had chosen to not be involved.

The service was unable to demonstrate effectively that care and support was delivered to people in a person-centred way. We found an unacceptable variation in the quality of care plans and plans were too task orientated and lacked meaningful information about the person.

In order for any service to be considered ‘well-led’, good governance is fundamental. At this inspection we found continued systemic failures, with no tangible improvements. In particular, in respect of the overarching governance of this service.

We found no progress had been made with regards to improving audit, quality assurance and questioning of practice. We looked at records that were described as ‘quality assurance’ but these were not fit for purpose and did not demonstrate how the registered manager maintained oversight of the service. Furthermore, we found governance arrangements in respect of the registered provider to be non-existent and no evidence could be provided to demonstrate how they maintained oversight of the quality of services being delivered from this location.

The overall rating for this service is ‘Inadequate’ and the service continues to be in ‘special measures’. This is the third consecutive inspection where one or more of the five key questions has been rated as ‘Inadequate.’ We are therefore reviewing our enforcement options. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Enterprise Homecare is a domiciliary care service providing personal care and support to people living in their own homes. The length of visits for care and support vary depending on the assessed needs of people with calls ranging from 15 minutes or more. Some packages of care involved assistance with medicines.

At the time of the inspection the service was supporting 269 people within local communities of Manchester. We last inspected the service on 9 and 11 August 2016 and we judged the service to be inadequate overall.

There was a registered manager in post. 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.

The overall rating for this service is ‘requires improvement’ however the service remains in ‘special measures' as there is still a rating of inadequate for the well led key question. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the last inspection we saw that risk assessments were recorded on a basic, generic document completed for all in respect of moving and handling, environment, medicines and mobility. Some improvements were noted at this inspection in relation to risk assessments personal to individuals, for example those with high mobility needs detailed any equipment they might need to use to reduce the risks of falls. Identified risks were input onto the computer system. These then appeared as notes on care schedules which were distributed to staff electronically on a weekly basis so that staff were aware of risks posed to people.

We identified delays in the formulation of risk assessments for a new support package. We saw that an individual’s particular condition was identified and documented in the care plan but there was not yet a risk assessment in place to assist staff with this.

We saw that people weren’t always protected from avoidable harm. During the inspection we checked to see how the service protected vulnerable people against abuse and if staff knew what to do if they suspected abuse. There was an up to date safeguarding vulnerable adult’s policy in place. However we witnessed delays in the office staff reporting a safeguarding concern raised by a care worker at the time of our inspection and the manager had not been made aware of a potential financial abuse concern raised with the agency prior to this inspection .

Staff received training in the administration of medicines during induction. Packages of care focused on staff prompting people with medicines, however we identified occasions when staff administered medicines. The registered manager recognised that the company policy needed to be updated to fully reflect this.

The service was working to the principles of the Mental Capacity Act, 2005 and staff received formal training on MCA during their induction and with refresher training. Staff understood the need to seek a person’s consent prior to carrying out care tasks.

The service had robust recruitment processes which included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were suitable and fit to do so. We saw evidence of the induction process and staff were complimentary of the training they received.

Information recorded in the care files provided minimal information about the person. They lacked details about the person. All the care files had the generic outcome noted as ‘to be clean, comfortable and safe’. There were no personal profiles on the files we looked at but we saw evidence of people’s interests and social activities recorded in care plans.

People told us they were given choices and were involved with planning their support. The service was able to offer gender-specific choices for personal care and support and we saw care plans with people’s preferences documented.

The registered manager told us there were plans to introduce life histories paperwork that would provide care staff with a brief history about the person’s life, including things that were important to them.

Feedback with regards to the consistency of staff was varied. People we visited who were on regular runs told us that the staff team was consistent, particularly during the week but less so at weekends.

The service had a complaints policy in place and we could see that most people we spoke with using the service were aware of how to make a complaint. People we contacted as part of the inspection process did not feel that their complaints were acknowledged properly or always dealt with effectively. One person provided feedback about a complaint made to the service that had not been acknowledged. This person was not included on either of the complaint logs we were sent following the inspection. The service had received compliments from people which had been raised direct with the service and in reviews undertaken by commissioners.

People were critical about how the office was run and told us that communication could be better. Staff were complimentary of the manager but less so about how the service was run. Staff working evening shifts considered there was little support provided out of hours.

The service distributed feedback questionnaires. Feedback from people using the service showed us that the service could demonstrate some improvements since the last inspection but there were still areas of service delivery that required improvement.

During this inspection we found three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Enterprise Homecare is a domiciliary care service providing personal care and support to people living in their own homes in the community. The hours of support vary depending on the assessed needs of people. At the time of our inspection the service was delivering care to 297 people.

There was a registered manager in post. 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.

The overall rating for this service is ‘inadequate’. The overall rating for this service is ‘inadequate’ and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.

We found improvements were needed to ensure that staff were accurately using the electronic call monitoring systems in place. Analysis of electronic call monitoring records highlighted that the leaving times were being incorrectly recorded by office staff after care workers had failed to log out.

The electronic call monitoring records data were not always factually accurate in respect of the length of time the care worker had spent providing care to people. The evidence we were presented with indicated that actual time spent undertaking personal care was less than that commissioned for some people.

People had an assessment prior to receiving a service and risks were identified before the commencement of care. Managing those identified risks was not always made clear for staff as risk assessments that were in place were basic and did not contain enough information.

Staff were trained and competent to administer medicines and new documentation meant this was recorded appropriately. Staff knew their roles and responsibilities and were knowledgeable about the risks of abuse and reporting procedures.

Some people who used the service lived alone and staff required the use of a key to access their house. Keys were appropriately stored in a ‘key safe’ outside houses and three people we spoke with receiving a service were satisfied with the way this was managed.

Recruitment processes included the completion of pre-employment checks prior to a new member of staff working at the service. This helped to ensure that staff members employed to support people were suitable and fit to do so. People who used the service could be confident that they were protected from staff that were known to be unsuitable to work with vulnerable people.

There was a thorough induction process in place with appropriate training provided for those with caring roles and responsibilities which included face to face training in a classroom setting followed by the “shadowing” of more experienced colleagues. Feedback from staff about the induction process was positive.

The service was adhering to the principles of the Mental Capacity Act, 2005 which meant that care staff supported people to make their own choices about their care. Before any care and support was provided and when appropriate, the service obtained consent from the person who used the service. This was not an element of mandatory training however, but the registered manager assured us that it would be introduced.

We saw care records lacked detail with regards to person centred care and focused on tasks that were required by the care worker. Despite this care staff displayed an awareness of person centred care and gained knowledge about likes, dislikes and preferences from talking and listening to people receiving the service.

The service had a complaints policy in place and we could see that people using the service were aware of how to make a complaint. Formal complaints were acknowledged although it wasn’t clear if this was within correct timescales or what feedback had been given to the complainant. People we spoke with did not always feel that complaints were handled or resolved effectively.

Staff told us they felt they were able to put their views across to senior staff and to management and we saw examples of this from minutes of meetings and supervision records.

The service undertook some audits to monitor the quality of service delivery. We saw a number of audits in place including medication audits and spot checks on care staff completing visits. Electronic call monitoring logs had not been audited and the errors relating to the timing of visits had not been identified. The provider had failed to ensure that people were adequately protected from risks inherent with the timing and coordination of calls. The submission of notifications to the Care Quality Commission had not always happened. These are required by law.

We found the service had up to date policies and procedures in place, which covered aspects of service delivery including safeguarding, medication, whistleblowing, recruitment, complaints, equality and diversity, moving and handling and infection control.

During our inspection we gathered evidence to help us answer our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well-led?

Is the service safe?

People who used the service all told us that they felt safe when staff visited their home. People told us that they felt their rights and dignity were respected and they felt in control of decisions about their care and support. One person told us: "I feel safe when they come. You're always introduced to new staff. That reduces my stress." Another person told us: "Previous agencies were really awful. I wasn't getting my medicines. Now they check that I have enough medicines and it works really well." There were systems in place to protect people from poor practices or abuse. In general safeguarding procedures were good and staff understood their role in safeguarding the people they supported. Recruitment records were well organised, it was therefore straightforward to establish if practices were consistent across the service.

Is the service effective?

People told us that the service met their needs. People's support files showed evidence of regular reviews,

Is the service caring?

People were very complimentary about the staff and said that they respected people's privacy and dignity. One person told us: "The staff are very caring and supportive. The client comes first.'

Is the service responsive?

People told us that the service was responsive to their needs and that staff would change their usual visit time if they had an appointment. They said that the management team would provide another support worker if they were not happy with them for any reason. Some concerns had been raised about individual members of staff. The records demonstrated that the manager had investigated and resolved the concerns.

Is the service well-led?

The management team had an effective quality assurance system in place to monitor and improve standards within the service. The manager had systems in place that catered for the assessment of people's needs and staff recruitment, supervision and training within the teams.

One person who received a service told us: “They [the office] always send the same carers, and this is good for my [relative].” One person who received a service told us: “My two regulars [care staff] are very good. They are more friends than carers.”

We found that people's needs were assessed prior to a service being provided and their care and treatment was planned and delivered in line with their individual care plan.

A relative of a person who received a service from Enterprise Homecare told us: “We do like Enterprise. Every carer that has been is brilliant.”

One person told us they liked that care staff involved them in their care, for example when they made meals and hot drinks for them. This meant that care staff when possible were mindful to consider and include people when undertaking caring tasks.

We found that staff were not provided the opportunity to update their mandatory training.

We found that there were limited systems in place to monitor the day to day operation of the service.