Ensure Care Ltd

Updated 12 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats, and specialist housing.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 11 May 2023 and ended on 24 May 2023. We visited the location’s office/service on 11 May 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 8 members of staff including the registered manager, managing director and care staff. We also spoke with 6 relatives and 7 people for feedback on their experiences of the care provided and 1 health professional. We looked at 6 people's care records and a number of medicine administration records. We also reviewed a variety of documents relating to the management of the service including quality assurance checks, staff recruitment records, policies and procedures, compliments received, and training records.

Updated 12 July 2023

About the service

Ensure Care Ltd is a domiciliary care service providing personal care to 45 people. The service provides support to older and younger adults with physical disabilities, people living with dementia, and people with learning disabilities. 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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People gave us mixed feedback on their experiences of care and their feelings of safety. Risks to people’s health and safety were not always identified or assessed. Medicine administration records (MARs) were not always clear and did not follow best practice guidance. 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; however, the systems and processes in the service did not consistently support this practice. Improvements were needed to ensure mental capacity act assessments were accurate.

Recruitment checks included reference requests and Disclosure and Barring Survey (DBS) checks. Staff could describe signs of concern related to catheters and people’s skin, and that they would report these to the manager. Staff recognised the importance of keeping people safe from the risk of abuse and avoidable harm. Staff were trained in infection prevention and control and provided with Personal Protective Equipment (PPE). We have made a recommendation about processes for obtaining references, to provide greater assurances that these were verified.

Right Care: We received mixed feedback about people’s experiences of call times. Some people told us their call times were suitable, other people said they were too early or late. We received mixed feedback from people about staff competency and skills. People’s needs were assessed before they started using the service. When people needed help with their eating and drinking, or assistance to prepare meals, this information was recorded in their care plan. The provider worked in partnership with other healthcare professionals to meet people’s needs and in response to changes or concerns about people’s health. Staff spoke positively about their training.

Right Culture: Audits and governance processes to maintain oversight of the safety and quality of care were not operating effectively. We received mixed feedback from people and their relatives about their experiences of the care provided. Feedback from staff was consistently positive. Staff demonstrated pride in their roles as care workers and the support they provided to people. Feedback about people’s experiences of care was gathered through questionnaires, telephone calls and spot checks. Spot checks of staff were carried out to monitor care standards and identify where improvements were needed. The provider worked in partnership with external agencies and professionals, to access staff training and healthcare for people.

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 11 June 2019).

Why we inspected

We received concerns in relation to staff training and competency. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.