This inspection was conducted over three days on 27 and 28 September and 2 October 2018.

Enterprise Care Support Limited is a home care agency. It provides personal care to people living in their own homes in the community. At the time of our inspection this agency was providing a home care service to approximately 90 older people living in the London Boroughs of Camden, Merton, Wandsworth and Lambeth, as well as the home county of Surrey. People receiving a home care service from this agency had a range of personal and health care needs. The agency also specialised in providing a home care service, although not exclusively, to people who spoke a range of Asian languages.

The service continued to have a registered manager in post who was also the owner. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the service’s last two CQC inspections, which we carried out in November 2016 and 2017, we found staff had failed to follow best practice guidelines for the recording of the administration of medicines. This meant it was unclear if people had received their medicines and if they had, who had administered them. This repeated failure to identify and address these on-going medicines recording issues also indicated the provider’s management oversight and scrutiny arrangements were not being operated effectively. Consequently, we rated the service ‘Requires Improvement’ overall and for the key questions, Is the service safe and well-led?

At this inspection we found the provider had made improvements and now met the regulations and fundamental standards. We have therefore rated them 'Good' overall and for all five key questions, Is the service safe, effective, caring, responsive and well-led? This was because the provider had improved its governance systems. Quality assurance records showed field supervisors now routinely assessed staff’s medicines recording practice as part of their bi-monthly spot checks on staff during their scheduled visits. Consequently, we found no gaps or omissions on medicine's administration records (MAR) sheets we looked at. This meant we could also be assured people received their medicines as prescribed.

Staff continued to receive appropriate training and support to ensure they had the right knowledge and skills to effectively meet most people's needs. However, records showed staff who regularly supported people with a learning disability or mental ill health needs had not received any additional training in understanding how to meet these individual’s specific needs. This meant some staff might not have the right mix of competencies to effectively perform their roles and responsibilities. We have made a recommendation for staff training about people living with a learning disability or autism and mental ill health.

Furthermore, although people had been given essential information about the service, we found the service users’ guide, the provider’s complaints procedure and people’s care plans were not always available in easy to understand pictorial formats for people with learning disabilities or sensory impairments. This meant some people might not be able to understand all the information they were given about the agency, which could limit their opportunities to be actively involved in making decisions about the home care and support they received. We discussed this issue with the registered manager/owner who agreed where appropriate easy to understand pictorial, large print and audio versions of these documents should be available for people with specific communication needs. Progress made by the provider to achieve this stated aim will be assessed at their next inspection.

The comments above notw

This service is a domiciliary care agency. It provides personal care and support to people living in their own homes in the community. At the time of our inspection 60 mainly older people who were living in the London Boroughs of Camden, Merton, Wandsworth and Lambeth, as well as the County of Surrey, received a home care service from this agency. People had a wide range of health care needs and conditions such as dementia, mental ill health, learning disabilities, physical disabilities and sensory impairments. The agency also specialised in providing a home care service, although not exclusively, to people who spoke a range of Asian languages.

The service had a registered manager in post who was also the owner. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

When we completed our previous comprehensive inspection of the service on 1 November 2016 we found concerns relating to the provider not appropriately maintaining medicines administration record (MAR) charts and not displaying their most recent Care Quality Commission (CQC) performance assessment (known as performance rating). At this time these topic areas were included under the key questions of safe and well-led. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas remain included under the key questions of safe and well-led.

We carried out a follow-up focused inspection on 27 April 2017 to check the provider had improved their arrangements for displaying their previous CQC report and rating in order to comply with their legal requirements. At the time of our focused inspection we found the provider had resolved the aforementioned issue and now met the regulations and fundamental standards. This meant people now had a much fuller picture of the service prior to requesting care from them. However, we continued to rate them 'requires improvement' overall because we needed to see the service could consistently maintain this improvement over time.

At this comprehensive inspection we found the provider continued to conspicuously display their most recent CQC report and rating both at their offices and on their website. However, we have continued to rate the service 'requires improvement’ overall and for the two key questions is the service ‘safe’ and ‘well-led?’ This is because we found two new issues in relation to medicines record keeping and management oversight. This will be the third consecutive time the service has been rated ‘requires improvement’.

More specifically, during this inspection we found the provider was still not following best practice guidelines for the recording of the administration of medicines. This meant it was unclear if people had received their medicines and if they had, who had administered them.

Furthermore, although we saw the provider had established some good governance systems to assess and monitor the quality and safety of the care and support people received; we found these measures were not always operated effectively. For example, as described above we identified large numbers of omissions on MAR charts where care workers had failed to sign for medicines they had administered. This meant the provider had either failed to pick this issue up as part of their quality monitoring audits and spot checks on care worker practices during scheduled visits, or if they had identified this trend, failed to take appropriate and timely action to resolve this on-going problem. This indicates the provider was not always sufficiently monitoring or improving all aspects of the service so that people experienced good quality, safe care.

These failings repre

We carried out an announced comprehensive inspection of this service on 1 November 2016 and we found a breach of regulations. This was because the provider was not displaying the Care Quality Commission performance assessment (known as performance rating) it received on 6 August 2015 which was Requires Improvement, either on its website or at the provider’s premises. This meant people who were considering options for using an agency that provides personal care in a domiciliary care setting, might not have been provided with all the information they needed to make an informed choice.

We also found at the November 2016 inspection, concerns that people’s medicines administration records were not being completed appropriately by care workers, to confirm people received their medicines as prescribed. Additionally, people told us care workers were often late for calls which meant there were risks their care needs were not fully met. We did not consider the provider had breached legislation but considered improvements could have been made. We therefore rated the service for the outcomes areas of ‘Is the service effective’ ‘Is the service responsive’ and Is the service well led?’ as Requires Improvement. We have not checked whether improvements have been made in these key questions and will do so at our next comprehensive inspection.

We undertook a focused inspection on 27 April 2017 to check the provider now met legal requirements. This inspection was announced and we gave the provider 24 hours’ notice as we needed to be sure of access to the providers’ offices.

This report only covers our findings in relation to the legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Enterprise Care Support on our website at www.cqc.org.uk

Enterprise Care Support Ltd provides personal care to people living in their own homes. At the time of the inspection they provided a service to 50 people who lived mainly in the London Boroughs of Camden, Merton and Lambeth and to people living in Middlesex and Surrey. The provider specialises in providing a service, although not exclusively, to people who speak a range of Asian languages.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our focused inspection we saw the provider had included a link on their website to include the CQC last inspection report completed on the 1 November 2016. They had also made a copy of the inspection report available in their office.

The provider had therefore taken adequate steps to meet the legal requirement to display their performance rating.

This has not changed the ratings for the outcomes areas of ‘Is the service effective’ ‘Is the service responsive’ and Is the service well led?’ These will remain as ‘Requires Improvement’ until the next full comprehensive inspection when the services’ rating will be reviewed.

This inspection took place on the 1 November 2016 and was announced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out on 6 August 2015 when we rated the service as ‘Requires Improvement’. We also imposed three requirement notices for breaches of regulations that we checked during a focused inspection on 1 December 2015. We found the provider was meeting the regulations we looked at, but we did not amend our rating of the service as we wanted to see consistent improvements at the service.

Enterprise Care Support Ltd provides personal care to people living in their own homes. They currently provide a service to 47 people who live mainly in the London Boroughs of Camden, Merton and Lambeth and to people in Middlesex and Surrey. The provider specialises in providing a service, although not exclusively, to people who speak a range of Asian languages.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

During the inspection we found the provider was not following best practice guidelines for the recording of the administration of medicines. This meant it was unclear if people had received their medicines and if they had, who had administered them.

A number of people we spoke with told us care workers were often late for their calls. We were told that as a consequence care workers were often rushed in completing tasks. People also told us they sometimes felt care workers did not understand their needs. People said if they raised the issue with office staff they were not confident they would be listened to.

Additionally the provider was not displaying their CQC rating from an inspection completed in August 2015 at their premises or on their website, according to legal requirements. This meant people may have not had a full picture of the service prior to requesting care.

We identified a breach of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. This was in relation to the provider was not displaying their previous rating. You can see what action we told the provider to take at the back of the full version of this report.

The provider tried to match people’s preferences for care workers with staff they had working for them to enable caring relationships to develop between them, but on some occasions this did not work very well. Once matched, the provider tried to ensure people had continuity with their care worker. Where the matching process worked people felt care workers understood their needs.

The provider completed recruitment checks to ensure only suitable people were employed. There were policies and procedures in place to safeguard adults at risk of abuse or harm. Staff were familiar with these and had received training and their knowledge was refreshed regularly to make sure they knew how to keep people safe.

Possible risks to people’s health were identified and there were guidelines to care workers outlining what action should be taken to minimise risks, this included infection control measures. People were encouraged to do as much as they could for themselves, in this way their skills were maintained.

People’s health was monitored. This included contacting healthcare professionals when it was necessary and making sure people had enough to eat and drink.

Care workers received support from the provider to ensure they had suitable skills to complete their work through training which was refreshed regularly. In addition, care workers were supported by their managers and peers to share information and discuss issues affecting their work practice.

Care plans were specific to the person which meant

We carried out an announced comprehensive inspection of this service on 6 August 2015 and breaches of legal requirements were found. This was because the provider did not did not ensure people’s consent was sought prior to care being provided; Nor was the registered manager aware of their legal requirements under the Mental Capacity Act 2005. We also saw care plans were not regularly reviewed. The provider did not have a complaints policy which was accessible to people who used the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We undertook a focused inspection on the 1 December 2015 to check that they had followed their action plan and to confirm that they now met legal requirements. This inspection was also announced. We told the registered manager a day before our visit that we would be coming to ensure they would be available.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Enterprise Care Support Ltd on our website at www.cqc.org.uk

Enterprise Care Support is a domiciliary care agency that provides people living in their own homes with personal care and support. At the time of our inspection, 21 mainly older people were using the service. The agency specialises in providing care for people from minority ethnic groups, although not exclusively. The agency covers the London Boroughs of Camden and Merton, and Staines.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

During our focused inspection we found the provider had followed their action plan and was meeting the legal requirements they were previously breaching. We saw that the registered manager had completed training, a policy had been rewritten and widely distributed and progress had been made towards new care plans which better reflected people’s needs.

This inspection took place on 6 August 2015 and was announced. We told the provider two days before our visit that we would be coming. At the last inspection on 21 July 2014 the service was meeting the regulations we checked.

Enterprise Care Support Ltd provides care for approximately 30 people who live mainly in Merton, Camden and Staines. The service provides support to some people from minority ethnic backgrounds although not exclusively.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

We found the provider could not demonstrate they were seeking consent from people prior to care being provided. Where people were not able to give consent the provider was unaware of their legal requirements in relation to the Mental Capacity Act (2005) and to show that decisions had been made in people’s best interests.

People’s needs had not been comprehensively assessed. Nor had there been an account of individual preferences. We found that on occasions peoples’ needs had changed but the care plans did not reflect this. People therefore may not have been receiving care that reflected their current and preferred needs.

The provider did not have an up to date written complaints policy which could result in complaints about the service being misdirected.

People told us the care they received from Enterprise Care Support was safe. Care workers knew what to do if they suspected people were at risk of harm and how to escalate any concerns. The provider completed all recruitment checks to make sure that only suitable people were employed by the agency.

There were arrangements in place to make sure people received their medicines safely. There were infection control measures in place to make sure any risks of cross infection were minimised.

The service had identified risks to people and how these risks could be minimised. Accidents and incidents were recorded and analysed in order to reduce re-occurrences. There were systems in place for care workers to contact senior staff out of hours if there was an emergency.

Care workers received training and support to undertake their roles in line with best practice.

The registered manager was aware of their responsibilities and had appropriately notified the CQC of significant issues that had arisen within the service. Care workers said they felt supported by their manager.

Care workers routinely monitored people’s health, which included ensuring people were getting enough to eat and drink. The provider had arrangements to ensure people’s cultural needs were being met.

Care workers respected people’s rights to privacy and dignity. People were encouraged wherever possible to do as much as they could for themselves. In this way people’s skills were maintained.

The service encouraged people to say what they thought of the service through regular questionnaires and reviews. The registered manager told us this information was acted on immediately.

We identified three breaches of regulation relating to consent, person centred care and complaints. You can see what action we told the provider to take at the back of the full version of the report.

During our last visit to this agency on the 4 June 2014, we identified that the provider did not have a rigorous selection process for new care workers to ensure that only suitable applicants were chosen to work at the agency. They also had not sent notifications to the Commission about allegations of abuse as they are required to do by law for the Commission's staff to monitor the outcomes of the safeguarding investigations.

Following the inspection the provider sent us an action plan on 7 July 2014 setting out the steps they would take to make the necessary improvements.

This visit was carried out by an inspector who helped to answer one of our five questions: Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our examination of three sets of information about people who use the service and with talking with the registered manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider operates an effective recruitment procedure to ensure care workers that they employ are of good character and have the qualifications and experience needed. This includes completing all the necessary checks with other agencies and taking up appropriate references.

The manager has an understanding of significant or untoward events that they must inform the Care Quality Commission of. This is outlined in the regulations of the Health and Social Care Act (2008). We require the agency to do this so that we can track incidents and monitor whether the service has made the correct decisions when dealing with events that could put people at risk of harm.

Below is a summary of what we found. The summary is based on speaking with three people who used the service or their relatives. We also spoke with two care workers and office staff. We looked at four sets of information about people who used the service and care workers records. There were 22 people using the service when we inspected and they were from three boroughs - Camden, Merton and Surrey.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

Staff had undertaken some training regarding safeguarding vulnerable adults and how to respond to signs of abuse. However, the provider had not informed us of untoward incidents which related to safeguarding adults and so could be putting people who use the service at possible risk. We have therefore asked the provider to make improvements in this made a compliance action which requires the provider to take action and we will make sure that this is done.

The provider's staff recruitment and selection processes were not robust. References taken up were not adequate for the provider to assure themselves of the suitability of the candidate. This could mean that people who use the service were not protected from unsuitable staff. We have made a compliance action which requires the provider to take action and we will make sure that this is done by completing a follow up inspection in the near future.

Is the service caring?

People we spoke with were positive about the care provided by care workers. Comments included, “I can go to work and don’t have to worry”. People who used the service told us they were supported by kind and compassionate staff. Staff treated the people who used the service with respect and dignity.

Is the service responsive?

We found the provider continually monitored the service people were receiving and on occasions sought advice from social care professionals so that people received care that was appropriate to their needs.

The service had a complaints policy and procedure. People we spoke with told us they knew how to make a complaint if there was something that they were unhappy with. However, the complaints policy was not in an accessible format that could be understood by the people who lived at the service.

Is the service effective?

Care plans had details of people’s needs and the action to take to meet these. These plans were regularly reviewed and updated so that they were meeting people’s current needs. Any risks were assessed and reviewed regularly to ensure people’s individual needs were being met safely.

People received effective assistance from staff who in turn were supported by their manager.

Is the service well-led?

The service had a registered manager. The manager had a range of quality assurance systems in place, which included spot checks of care workers. An annual survey was completed by people who used the service or their relatives. The results were used to identify any areas for improvement.

Regular audits of the care plans and risk assessments were carried out to help ensure that people received good quality care.

We found the service to be well organised with a comprehensive and consistent system of records both for those that used the service and for the staff that worked for the agency.

All relevant policies and procedures that would be expected of a domiciliary care agency were well documented and readily available, including information on safeguarding, whistle blowing, complaints and recruitment policy.

The people we spoke to told us that they were happy with the standard and continuity of care that was provided and considered that their individual needs and wishes were taken into account. They felt that the care provided was reliable, and that there was a good collaborative working relationship with staff.

People were aware of a complaints procedure and were confident that they could relay any concerns about the service if they needed to do so.

Staff felt well supported and suitably trained and there was a clear and rigorous selection process in operation.

People told us that they felt respected and involved in their care and that they had been provided with enough information to help them make choices about the care and support they received from Enterprise.

People told us that they felt safe with their care workers and that they enjoyed the continuity they got from having the same care workers visit them.

People said that they felt their care workers were suitably qualified to help them and they said they knew how to make a complaint about the service if they wanted to do so.