We visited Kent Enablement at Home on 11 January 2017. Kent Enablement at Home is a domiciliary care agency offering a range of services for people in their own home including personal care for adults. This agency is part of the local authority Social Care, Health and Wellbeing Directorate. The service focuses on providing short term care to adults and older people, including those discharged from hospital. At the time of our visit, the service was providing support for 102 people, and 68 staff were employed. This included support workers, administrative staff and management roles known as locality organisers and supervisors. Kent Enablement at Home was split into two areas and each area had its own team providing the service, led by a locality organiser.

The service required 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. There was a registered manager in post.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults.

We found that recruitment practices were in place, however we found that the service’s own policies were not always followed surrounding completion of pre-employment checks prior to a new member of staff working at the service. Staff received regular training to enable them to work safely and effectively

All of the responses from people who spoke with us was that the service was either very good or excellent. People told us they were very happy with the staff and felt that the staff understood their care needs. People confirmed that staff arrived on time and stayed for the length of time allocated and that an on-call system was always available.

Each person we spoke with knew their care plans and said that they were involved in the assessments, each person also told us that all care was provided with their consent.

The staff employed by Kent Enablement at Home knew the people they were supporting and the care they needed. People who used the domiciliary service and staff told us that Kent Enablement at Home was well led and staff told us that they felt well supported in their roles. We saw that the manager and the senior staff were a visible presence and it was obvious that they knew the people and staff who they supported really well.

Suitable processes were in place to deal with complaints and people knew how to access the information, however each person we spoke to had no complaints about the service.

We carried out an inspection to help us answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection, discussions with two of the people using the service, four care staff and two supervising managers. We looked at five people's care records. If you wish to see the evidence supporting our summary please read the full report.

The service was safe. People who used the service told us that they felt safe. One person told us, "I feel 100% safe with the support staff, they are all so lovely". Safeguarding procedures were in place and staff spoken with showed they understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

People's independence, rights and choices were protected because the provider had procedures in place to gain people's consent to the care and support they received.

Staff knew about risk management plans and we saw that they supported people in line with those plans. This meant that people were supported with their care needs in a way that was intended to ensure their safety.

The manager ensured that staff rotas were planned in advance to maintain the staffing levels required. Extra support could be made available if necessary. Systems were in place to make sure that accidents, incidents and complaints were recorded and acted on as soon as possible and checks were made on aspects of the service. This enabled the management to make changes when required to improve the service provided.

The service was effective because people’s care needs were assessed with them. All of the people we spoke with told us they were involved in their care planning. We saw that care plans were updated as required should changes to needs occur. People had been assessed for capacity where required and staff were aware of the need of a best interest meeting if the need arose.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the staff. This meant the provider worked with other services to ensure people's health care needs were met.

The service was caring because people were supported by care staff that were kind and caring. We saw that care staff gave people encouragement and respected their privacy and dignity. One person told us, "I am always treated with respect by all the staff".

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

The service was responsive. People were asked their views about the service and the provider acted on comments and suggestions that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. This was because staff discussed people's care needs with them on a regular basis. People told us staff would always do their best to make sure they were happy. The staff spoken with told us that their times on visits were very flexible and if a person needed more than the allocated time, they were supported to stay and complete what was felt necessary. Other visits were then offered to other carers to ensure all care needs were met.

The service was well led. The provider had quality assurance and risk management systems in place.

The provider sought the views of people who used the service after the completion of each package. Records seen by us showed that people had been very happy with the service provided.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the service was well organised and they felt supported by their manager.

We spoke with five people who used the service, and they were all happy with the service they received from the agency. People told us "I think the agency staff are super; they did everything I wanted”. Another person said "The agency has been absolutely excellent; the carers are brilliant".

People told us that staff provided them with enough information to make choices about their care, and kept them informed about any changes to their care. We saw that care records included an agreement detailing the care to be provided, signed by the agency and the person receiving care.

We reviewed eight care records out of a total of 80, and found that all of them contained care plans which had been written and regularly reviewed based on assessments of each person's needs. We spoke with staff members who said that they referred to the care plan and risk assessments regularly to ensure they were able to meet the person's needs.

People told us that they felt safe with the carers from the agency, and staff told us that they had received suitable training in protection of vulnerable persons.

Staff members told us that they felt well supported by the management team and their colleagues. We noted that a range of training programmes was available to staff at the agency, and all new staff completed an induction programme which followed national guidance.

We found that the provider had implemented ways to gather feedback on the service from people, as well as monitoring the quality of the service provided through spot checks and staff appraisals.

People said they were involved in decisions and the agency supported them with their needs, provided the service they wished to receive and treated them with respect and dignity.

People who use the service felt supported to make decisions for themselves and were encouraged to be independent. One person who uses the agency said “They give me support, help I need to get me back on my feet”. Another said when referring to the staff that supported them said “They are lovely people. I am happy with them”.

People told us they received care from a small team of staff and were happy with the care received and had no concerns relating to the staff.

We spoke to a member of staff working in the community. They told us that they try to empower people with knowledge and make them aware of the potential outcomes of all options. They went on to say that where people were no longer able to make decisions for themselves they spoke to others who know the person well including their family and GP about what they think the person may want and any previous preferences.

People told us that they were happy with the care and support they received and that their needs were being met and that the support requested was provided. Goals were set to enable people to get back to independence. These goals were set by people receiving the service and supported by staff to achieve the desired outcome. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed.