This inspection took place over five days on 9, 13, 14, 16 and 17 August 2018. We gave the service appropriate notice so that people using the service and staff working at Enterprise Homecare could be contacted prior to our inspection of the service.

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 con

This inspection took place over three days on 29, 30 November 2017 and 01 December 2017. We gave the service 24 hours’ notice.

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

We carried out an inspection of Enterprise Homecare on 21 and 24 March 2017. The first day of inspection was unannounced.

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 r

We carried out an inspection of Enterprise Homecare over two days on 9 and 11 August 2016. The first day of inspection was unannounced.

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 r

As part of this inspection we spoke with three people receiving support from the agency. We also spoke with four staff and the manager. We looked at staff records, training and supervision. We also looked at the provider's arrangements to safeguard people from abuse and to monitor the quality of the services provided.

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.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still a registered manager on our register at the time.

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.