About the service:

Enviva Care Limited is a live-in care agency that was providing personal care to 36 people at the time of the inspection.

They provide a live-in care service to people living with a disability, people living with dementia and older people.

Since the last inspection in December 2016, ownership of the provider Enviva Care Limited changed; in June 2018.

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

People’s experience of using this service:

The service continued to be outstandingly caring and to demonstrate a strong, visible person-centred culture.

People received exceptionally caring, kind and empathic care from staff.

People living with dementia especially, received excellent care, due to the consistency they experienced in the provision of their live-in care staff.

The service continued to be outstandingly responsive. The service was highly person centred.

Staff went the extra mile and enabled people to continue to live the life they had previously lived wherever possible.

People were asked about their wishes, preferences and what was important to them in the delivery of their care.

Staff supported people to achieve their aspirations and goals and to pursue their interests.

People benefited from an organisational culture that was continually focused on identifying areas for further improvement in relation to their safety.

Since the last inspection in December 2016, processes, guidance and staff training in the areas of safeguarding, reporting, risk assessments and medicines had been reviewed and further improved.

People benefited from the continuity provided by the recruitment of the new registered manager from within the service. They had a wealth of knowledge and experience about people, staff and the service which they used to drive further improvements.

Staff were well trained, and the provider ensured staff updated their knowledge annually to ensure it remained current and they could provide effective care for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Rating at last inspection:

At the last inspection the service was rated outstanding (09 December 2016).

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated outstanding. We will continue to monitor the service through the information we receive.

The inspection took place on 7 and 8 November 2016 and was announced to ensure staff we needed to speak with were available. Enviva Care Limited provides a live-in care service to people in their own homes. It is registered to provide personal care to older people, people living with dementia, people with a physical disability or sensory impairment and younger adults. At the time of the inspection they were providing the regulated activity of personal care to 41 people.

The service had a registered manager. 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.

People and their relatives told us they felt safe. A social worker confirmed the registered manager took the correct actions and reported any safeguarding concerns about people to ensure their on-going safety. Staff had undertaken relevant training to enable them to understand their role and responsibilities in relation to safeguarding people. Processes were in place to safeguard people from the risk of abuse.

Processes were in place to identify and manage risks to people. Staff underwent relevant training and people’s care plans were detailed and applied professional guidance to ensure risks to people were managed safely. People’s care was provided in a way that recognised and managed risks to their safety but also respected and upheld their rights to make their own decisions.

Arrangements were in place to ensure staff were always available to provide people’s care at short notice. Staff had undergone the required pre-employment checks to ensure their suitability for their role. The provider had acted upon people’s feedback and taken appropriate measures to robustly assess staff’s written and verbal English skills as part of their recruitment process. This ensured staff were recruited who had the required level of English skills to enable them to communicate effectively with people.

Staff received training in medicines management and their competency to administer people’s medicines was assessed as part of their training. There was clear written guidance for staff in relation to obtaining, administering, disposing and recording peoples’ medicines. People received their medicines safely.

People were cared for by staff who received a thorough induction to their role. Records demonstrated that live-in carers received a high level of supervision in accordance with the provider’s supervision policy. Staff were supported to undertake professional qualifications to develop their skills and understanding. People were cared for by staff who were well supported in their role which enabled them to provide people’s care effectively

Staff had undertaken relevant training on the Mental Capacity Act 2005 and understood its application in their daily work with people. The registered manager took immediate action to ensure copies of people’s power of attorney documentation were obtained where relevant; to enable them to check legal requirements were being met for people.

People’s preference regarding the type of meals they enjoyed and their preferred level of involvement in meal preparation were clearly recorded. Processes were in place to record and monitor what people were eating, this ensured their dietary needs were being met.

People had regular contact with a range of health care professionals such as GP’s, district nurses, chiropodists, dentists, occupational therapists, speech and language therapists and physiotherapists. Staff supported people to access health care professionals as required.

At all levels of the service the staffs focus was on putting people first and ensuring they felt cared about and that they mattered. A nurse and a social care assistant both told us staff ‘Always wen

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of the inspection there were 20 people using the service. As part of the inspection we met with one person in their home, spoke with one person by telephone and spoke with two people’s relatives. We also spoke with the registered manager, the registered provider, four staff and two health professionals. We reviewed records relating to the management of the service which included four people’s care plans and daily care records. We reviewed the recruitment records for three members of staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service to be safe as people we spoke with told us that they felt safe in the care of the staff. One person’s relative told us “We had confidence X was safe and well cared for.” Staff had received relevant training in how to safeguard vulnerable adults at risk and had access to written guidance. They could ring the provider out of hours for advice and support as required.

The provider had a recruitment policy in place that had been followed. Relevant checks had been completed in relation to new staff before they started work to ensure their suitability for their role.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to domiciliary care providers. While no applications have needed to be submitted, proper policies and procedures were in place to ensure people’s rights were protected.

Is the service effective?

The service was effective. People told us that they had been involved in the assessment of their care needs and that they had been able to express their preferences about how they wanted their care to be provided. Staff told us that they promoted people’s right to make choices. People’s care plans demonstrated that consideration had been given to people’s choices and preferences. One person we spoke with told us that the carer had noted their preference about food and ensured that this was followed.

We found that risks to people had been identified and there were plans in place to manage them. People’s right to make lifestyle choices had been respected whilst the associated risks had been identified and managed.

Is the service caring?

We found the service to be caring in the manner in which people’ care was provided. We spoke with people and their relatives who told us that staff treated them with dignity and respect when they provided their care. One person told us “Yes, I am treated with dignity and respect.” Another told us “Staff use my preferred name to address me.” When we met with a person in their home we observed that staff respected the fact that they were working in the person’s home whilst they provided the service.

We spoke with one person who told us staff were “Very good at meeting my care needs.” Another person’s relative told us. “They have supported me in coming to terms with X’s diagnosis.” People and their relatives told us that staff had a genuine interest in them. The impact of this was that people felt that staff cared about their welfare and wellbeing.

Is the service responsive?

We spoke with a person’s relative who told us that the service had been responsive to their relative’s needs. They told us that a care package had been set up within hours of them making contact with the service in a crisis.

When people had required medical care this need had been identified and the relevant professionals contacted.

We saw evidence that learning from incidents had taken place. Following a recent incident the provider had reflected upon their practice to see if there were any areas that could be improved further. We noted that following any accidents or incidents a form had been completed. These were then reviewed by the provider to ensure that they had oversight of incidents and to enable them to identify any learning points.

Is the service well-led?

We found the service to be well-led as the provider had ensured that they sought people’s views through regular visits to people’s homes and an annual survey. In addition the provider had regular telephone contact with people. One person told us “Staff ring up and check on progress.” Another person’s relative said “Our views have been sought.”

The provider had ensured that learning took place from incidents in order to identify if areas of the service could be improved.