Elevation Care Services

On this page

• 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

We assessed the following quality statements: Learning culture, Safeguarding, Involving people to manage risks, Safe environments, Safe and effective staffing, Infection prevention and control and Medicines optimisation. Improvements were needed to ensure people received consistently safe support. Incidents when people showed behaviour which may indicate distress were not always recorded or followed up appropriately. Support plans and risk assessments did not always provide staff with enough information or guidance to ensure people were well supported if they showed behaviour which may indicate distress. Medicines were not always managed safely. Staff received training in safeguarding and were aware of how to report any concerns. There were enough staff to support people. The houses we visited were clean and well maintained.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Incidents of distressed behaviour were not appropriately recorded and followed up to enable reflection and learning. There were several incidents of distressed behaviour recorded in one person’s care notes, but no incident forms or behaviour forms had been completed for these. Care records and incident forms that had been completed required more detail to enable learning and reflection to take place. It was not always possible to understand how staff had supported people during an incident.

Staff knew how to report accidents and incidents and showed us some recently completed accident and incident forms in one house. There were no recent incidents in the other 2 houses we visited. Staff told us that any learning points were shared with the team at meetings and via electronic communication channels.

The majority of feedback confirmed people received safe care and support. When any issues arose, relatives told us these were addressed and improvements were made. One relative had some concerns about their family member’s safety due to some recent incidents. The registered manager was aware of the concerns and working with staff to ensure the person received appropriate support.

The local authority had identified some concerns. These included safety issues in some houses and how the provider ensured people received safe care and support. They were working with the provider to ensure improvements were made and embedded into practice. One health professional had limited information to share but did not have any concerns about the person they supported.

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.

People were observed to be relaxed and comfortable in the houses we visited. We saw positive interaction between people and staff.

Most people and relatives told us people received safe care and support. One person told us, “I love it here. I love staff.” One relative had some worries about their family member’s safety due to some recent incidents. The registered manager and staff were working with the person to ensure they recieved safe support.

Staff told us they received safeguarding training and knew where to find information and guidance should they need it. Staff knew how to report any concerns and told us these were taken seriously by the management team.

A safeguarding policy was in place and records showed that staff had received training in safeguarding. Care plans referenced people’s ability to make their own decisions. However, mental capacity assessments and best interest decisions had not always been recorded where it had been identified people may lack capacity to consent to their care. There was a risk people would not be supported in their best interest.

Staff usually knew how to support people in a way which kept them safe, however were not always sure how to support people when they showed distressed behaviours. Staff talked to us about supporting people in the least restrictive way. They confirmed no physical intervention was used.

Known risks to people’s care and support were usually managed well. For example, 1 person previously showed behaviour which may indicate distress. Their relative told us they had been settled and happy for a long time since receiving support from Elevation Care Service. One person was showing an escalating level of distress which their relative was worried about, the registered manager was working with staff to ensure the person's care was appropriate.

We observed people were relaxed and comfortable in the homes we visited. We did not observe any issues which posed a risk to people’s safety or which required staff support while we were present.

Risks to people were not always adequately assessed. Support plans and risk assessments did not always contain enough information about how staff should support people who were exhibiting distressed behaviour. People were at risk of receiving support from staff who did not understand how to meet their needs. Other areas of risk in people’s lives were adequately assessed. For example, risk assessments and care plans were in place where people were at risk of falls or pressure ulcers.

Environmental risk assessments were in place and up to date. Personalised evacuation plans were in place to support staff and people to evacuate their home safely in the case of an emergency.

People and their relatives provided positive feedback about checks undertaken to ensure the houses were safely maintained.

Staff showed us records of checks which were undertaken in the houses. For example, fire safety checks and maintenance logs. Staff told us when maintenance issues were identified they were rectified quickly.

The houses we visited were observed to be well maintained and clean. No safety hazards were seen.

Staff told us the training they received equipped them well for their roles, however the registered manager acknowledged staff had not always received the training they needed. They usually worked in the same houses unless they were required to cover elsewhere. This meant they got to know people well. One staff member told us, “We work well as a team. Most staff don’t wait to be asked to do something, they will just join in.”

During the visits we observed people receive support from staff who knew them well. There were enough staff available to support people safely.

There were enough staff to ensure people could receive safe care. The majority of relatives told us people received support from a consistent staff team who knew them well, but some relatives said this was not always the case.

Recruitment checks, including criminal records checks had been carried out to ensure only suitable staff were employed. Rotas showed the service had enough staff, including one-to-one support for people to take part in internal and external activities how and when they wanted. Staff training and supervision records showed that some staff did not have all required training and had not received supervision in line with the provider’s policy. Senior staff were taking action to support staff to complete allocated training and further training was planned.

We observed the houses we visited to be clean and hygienic. We did not visit anyone while personal care was being delivered so did not see any PPE being used for this purpose. Staff wore PPE when they prepared food in the kitchen.

Staff showed us cleaning charts they filled in as they completed cleaning tasks in the houses. This reduced the risk of infection spread. Staff told us there were always sufficient stocks of personal protective equipment (PPE) including gloves and aprons which they used when supporting people with personal care.

The provider had an up-to-date infection prevention and control policy in place to provide staff with the guidance they needed to help keep people safe.

People and relatives told us staff ensured the houses were kept clean and hygienic, with support from people when appropriate. One relative told us, “Friday is the cleaning day. [Family member] wipes around and brushes up.”

We did not observe any medicine being administered as no-one required any medicine during our visits to people’s homes. Medicines were stored safely.

Staff showed us the processes they followed when they supported people to receive their medicines. Staff knew the medicines people received and how people preferred to receive them. Staff told us they received training and their competency was checked, but there was no guidance available in when and how over the counter medicines should be managed. For example, pain relief and cold remedies.

Relatives told us people’s medicines were safely managed, but records showed this was not always the case. One relative said, “It’s all fine. They get the prescription when it’s due. They give the correct medicine. There are never any issues.”

Medicines records showed that medicines were not always managed safely. Staff had not followed the provider’s policy when supporting people with over-the-counter medicines. They had not always discussed the use of the medicines with people’s GP or recorded the administration of these medicines on a medicines administration chart. One person ran out of medicines for a prolonged period, although action was taken to prevent a reoccurrence of this, insufficient action was taken at the time to mitigate risks to the person through not having access to their prescribed medicines. Where a person refused their medicines for a prolonged period not enough action was taken to discuss this with their GP in a timely manner to mitigate the risk of the person not taking their medicine. People were at risk of ill health due to staff not following safe medicines management.