Elite Support Providers Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People may be at risk of unsafe care because staff were not always well-equipped to provide suitable care to people. In addition, staff did not always follow guidance recorded in people’s care plans. One person in particular had a number of incidents and accidents and although staff told us they learnt from these, there was no process to demonstrate learning was shared amongst all staff. Although staff had undertaken safeguarding training concerns had not always been notified to CQC. People’s medicines records were not always accurate which meant staff could not assure themselves that people always received their medicines in line with their prescription. Staff followed good infection control processes. However, as one person did not have specialist wall and floor coverings in their bedroom, staff could not be certain that their cleaning had the desired effect of keeping this person’s room free from potential infection. The environment in which people lived was not always suitable for them or in line with their specific needs. Although staff were taking advice from external professionals and agencies, people had continued to live in an unsuitable service for several months. We found the lack of potential safe care, poor environment and poor medicines records was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff were not recruited through robust recruitment processes as we found the registered manager provider was not following legislation related to safe recruitment. This was a breach of Regulation 19 of the Care Quality Commission (Registration) Regulations 2009. People were cared for by a sufficient number of staff and staff received a wide range of training.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some people had accidents and incidents as staff did not have the necessary experience or background knowledge to know how to help prevent these. A relative told us in January there was water leaking into their family members room from broken pipes. They had been told this would be fixed, but this had not happened by the time of their call to us in February. At the time of our visit the issue with the leaking pipes had been fixed.

Staff told us they had learnt from incidents by discussing concerns with each other. They told us, “We have to think what we would do differently next time.” Staff knew how to respond to an incident. They said, “If someone had a fall, I would put a pillow under their head and call an ambulance. We have to write down incidents and fil in a separate falls form.” A professional said, "On the first day when he was moving in I asked [registered manager] if they would like my support. I’d written a PBS specification when he was at home with his previous carers. However, the provider said they didn’t want support. They could meet his needs. That has meant incidents have occurred which could have been avoided.”

External professionals told us they felt staff were unprepared for one person's move into the service. One said, "They haven't got the right experience." Another told us, "Incidents could have been avoided if they had had my input from the beginning."

An internal accident and incident reporting system was in place and staff filled in accident and incident forms. Staff said they felt they were becoming more skilled in relation to responding to one person’s accidents and incidents which they felt had helped reduce them. The registered manager told us following our assessment that they reviewed these records and completed a root cause analysis and a process was in place for staff to learn from accidents and incidents. However, despite this process being in place it did not wholly prevent similar incidents from reoccurring.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

There was mixed feedback from relatives in relation to how safe their family member was. One relative told us they felt their family member was not safe and they did not feel staff were able to provide appropriate care. However, another relative said, “I haven’t seen any marks or problems. I can’t compromise safety. If he was not safe, I would move him.”

Staff received safeguarding training and knew who to report any concerns to. They told us, “I will tell the manager and then the manager will deal with everything and I will write it down myself. If the manager was not doing anything, I am going to call social services” and, “I know what to do and who to call. We are here for the wellbeing of kids or adults.” Staff understood the different types of abuse that may occur. A staff member said, “We have to keep people safe from harm or neglect. There is physical, verbal and sexual abuse. If we see this, we inform management and call the local authority.”

We could not collect the evidence to score this evidence category as we did not observe any care between staff and people.

Processes were not in place to ensure people were safeguarded from abuse. Although staff were able to tell us how they would report a safeguarding concern, we found safeguarding alerts were not always shared with CQC. We had been told that staff had locked one person in their room whilst staff were participating in a training session. This is a form of restrictive practice. A professional told us they raised a safeguarding alert, but the provider failed to inform CQC of this. In addition, the local authority had raised a safeguarding concern about one persons living conditions. Again, the provider had failed to inform CQC of this and we found out this information for another external agency.

We received mixed views from relatives as to people's safety and how staff were mitigating risks. One relative had no concerns, however a second told us they felt their family member was at risk at the service. They told us the living conditions in which they lived were unsafe and unsuitable for them and as such they felt they were at risk of being harmed.

Although staff had a wish to keep people safe. They told us, “Our first priority is to keep [person’s name] safe. We do not use restraint. We hold his hand or his arm either side when crossing the road.” We found this was not the case as staff were not always following guidance available to them.

We could not collect the evidence to score this evidence category as we did not observe any care between staff and people.

Staff were not always following guidance that was available to them or aware of risks to people which left people at potential risk of harm. One person’s community safety protocol stated they should be taken out in a car and not on foot by staff. However, staff told us they walked with this person each day. It also stated staff should wear high-vis jackets and arm bands so members of the public did not approach the person when out. Yet, staff were not seen wearing these when they went out with this person. In addition, this person should wear a harness when in a car and staff should sit in front of them. But staff told us this person travelled in taxis using a normal seatbelt and their descriptions of where the person and staff sat in the car was not in line with guidance. A second person was recorded as being at risk of eating inappropriate items. Yet, despite this risk being clearly recorded in their care plan, two staff were unaware of this diagnosis. Each person had a care plan which recorded information about them as well as information relating to any associated risks. Other people did have good information in place. One person had a choking risk assessment which noted staff should supervise the person whilst they were eating and offer them small portions.

Relatives gave us mixed feedback about the environment people lived in. One relative was happy with their family member's home and yet another felt it was unsuitable. They told us that within a couple of weeks their family member had to be moved to another room because the room they were in became unsafe.

Staff and the registered manager told us they were working with professionals to improve the environment for one person. The registered manager said, “I had considered bars on the (outside of the) windows to protect [person’s name] from smashing the glass, but instead we have had safe glass installed.”

The environment people lived in was not always safe. We saw, in one person's room, inappropriate protective wall covering. TIt was difficult to clean and therefore was a potential infection control risk. It was also not padded and as such the person could harm themselves.

There was a lack of processes in place to help ensure people consistently lived in a safe and appropriate environment. We saw on our first day of inspection that one person had caused a lot of damage to their bedroom and staff were repairing this when we arrived. We found that staff had installed a wall covering which they had painted. This was not a specialist wall covering specific for use in this type of environment which was undignified and not as effective as it could be. This covering had also been used on the person’s bed block. The provider’s autism policy stated staff should assess the environment in terms of personal space, décor, lighting and noise in relation to the impact of any service user. Despite this one person had moved in when the environment was not appropriate. A professional told us this person needed a large garden, space to run and a suitable internal environment to keep them safe. Yet, we found the supported living service had a small paved back ‘yard’ which was not in line with their needs. We also found that staff had not provided this person with an appropriate space indoors which had resulted in them having to move bedrooms twice in a short space of time. Staff were working with professionals in relation to one person’s environment. A professional told us, “The building is not suitable, but we now have a list of recommendations from the occupational therapist. I will be sharing it with staff.” Although a relative told us following our visit that not much change had been made.

People were cared for by a sufficient number of staff. Relatives felt there were sufficient staff and that staff were suitably trained. We received positive feedback from a relative and a professional. The relative said, “They do the right things and clean down the shower. They are trained.” A professional said, “During positive behavioural support training staff’s understanding was good.”

Staff told us they had learnt from incidents by discussing concerns with each other. They told us, “We have to think what we would do differently next time.” Staff knew how to respond to an incident. They said, “If someone had a fall, I would put a pillow under their head and call an ambulance. We have to write down incidents and fil in a separate falls form.” A professional said, "On the first day when he was moving in I asked [registered manager] if they would like my support. I’d written a PBS specification when he was at home with his previous carers. However, the provider said they didn’t want support. They could meet his needs. That has meant incidents have occurred which could have been avoided.”

We saw sufficient staff on duty on the day of our assessment. Staffing levels were in line with what we had been told by the manager.

Staff were recruited through a recruitment procedures. We were provided with evidence of a Disclosure and Barring Service check for potential new staff to help ensure they were suitable to work in this type of service. We read staff had shown evidence of their right to work in the UK and had provided references, although we noted some of these were not from their previous employer. Staff were also not consistently providing information in relation to their fitness for the role. Staff received a wide range of training. We were told by the registered manager, following our assessment, they carried out supervisions and mentoring to help ensure training was embedded. Although we did read that staff had reported in their supervisions in December 2023 they were struggling with people’s aggressive behaviour and did not feel equipped and we did not find any evidence of the registered manager supporting staff with this.

Staff followed infection control processes and people lived in an environment free from odour. Some relatives told us they were happy with the way staff managed cleanliness. A relative said staff wore suitable personal protective equipment (PPE) when needed. Yet another told us they had visited their family member and found a lack of cleanliness in their room.

Staff were aware of the specific cleaning regime in place for one person’s room. One staff member told us, “We use specific products for [person’s name] rather than the normal products. We wear gloves, aprons and masks. We always have plenty of personal protective equipment available.” A second said, “I was taught the different coloured buckets and mops and we use hand gloves and aprons. We have to check we have enough PPE before we run out.”

Although the service was clean and well presented, we found one person's room had a wall covering that may not be easy to clean which meant it could harbour bacteria.

There was an infection control procedure in place for staff for general areas of the supported living service as well as a specific cleaning regime for one person’s room. Staff were aware of where to find the guidance. Yet, due to the wall and floor materials used in one person’s room in the supported living house, the provider could not be assured that it could remain free from infection or it could be cleaned in line with safe standards. The wall covering used was textured with raised ‘bumps’ and this person’s bed block was covered in the same material. The registered manager had not considered specialist materials would be much more effective in reducing the risk of infection, although they had received recommendations from a professional which they were working towards. Although we found staff were knowledgeable in their responsibilities, we read there was no IPC supervision to help ensure staff were always following best practice.

We could not collect the evidence to score this evidence category as we did not see people being given their medicines. However, relatives did not have any concerns in terms of this aspect of their family members care.

Staff said they took an on-line course for medicines and had their competencies checked annually to help ensure they continued to follow good practice. A staff member said, “Yes, I do medicines. I follow the chart and give them the correct medication at the time.” Professionals shared information with staff to help them ensure they understood people’s medicines requirements. A professional told us, “The medicines team shared a plan with staff.” Despite this feedback from staff, we found medicines administration was not robust.

We could not collect the evidence to score this evidence category as we did not observe staff administering medicines.

Despite staff telling us they received medicines training and had competency assessments, they did not always follow robust medicines recording practices. Medicine Administration Records (MARs) were not consistently completed. In January there were numerous gaps on one person’s MAR, both during the morning and evening. A second person had 14 gaps in relation to the two medicines they received. We checked the count of some medicines to cross reference them with what staff had recorded. We found these did not tally and showed the number of tablets remaining were not always what was in the box. The recording and counting errors meant the provider would be unable to assure themselves that people were having their medicines consistently. We discussed the medicines records with staff who stated they did not feel the electronic system was working for them and they should go back to the paper system. This was confirmed by the registered manager.Only trained staff administered and dispensed people’s medicines. Staff were competency assessed each year to help ensure they continued to follow good practice. People’s medicines were reviewed by health care professionals and when appropriate either reduced or adjusted. Although due to the poor medicines recording, the registered manager could not be assured people were receiving their medicines in line with their prescriptions.