Elegant Care Services

Updated 15 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector and a senior specialist. Another inspector made phone calls to staff to gather their feedback. An Expert by Experience made phone calls to relatives of the people using the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency and is registered to provide personal care to people living in their own houses or flats. This service also provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. They supported us during the inspection.

Notice of inspection

We gave the service 48 hours’ notice of the inspection to be sure that the registered manager would be in the office to support the inspection. We visited the location’s office on 13 and 15 November 2023. We visited 3 supported living settings on 15 November 2023 to meet the people using the service.

What we did before the inspection

Prior to the inspection we looked at all the information we had collected about the service including previous reports and notifications the provider had sent us. A notification is information about important events which the service is required to tell us about by law. We sought feedback from the local authority and professionals who work with the service. We reviewed the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager, the clinical director, 2 assistant psychologists and 12 staff working at the service. We spoke with 5 people using the service. We spoke to the nominated individual as part of the feedback session at the end of the second day of inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records including people's care and support records and other associated records. We also looked at a variety of records relating to the management of the service, including recruitment information, quality assurance, medicine records, training and policies and procedures. After the inspection, we looked at further information such as training data, recruitment, incidents/accidents, further records of care and support, policies and other service management records sent to us after the inspection. We spoke to 6 relatives of people using the service. We sought feedback from the local authority and professionals who work with the service and received 4 responses.

Updated 15 February 2024

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Elegant Care Services is a domiciliary care agency. This service provides care and support to people living in a 'supported living' setting, so that they can live in their own home as independently as possible. The service provides support to people with dementia, learning disabilities or autistic spectrum disorder, mental health, physical disability, sensory impairment, as well as younger adults, older people and children aged 13-18 years.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of inspection, 8 people were receiving support with personal care.

People’s experience of using this service and what we found

Right Support:

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support good practice and needed improving.

The service did not always work with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Staff did not demonstrate they had the knowledge and understanding they did everything they could to avoid restraining people.

The service did not always manage incidents affecting people’s safety well because provider did not investigate incidents to ensure lessons were learned. The managers did not review or monitor the use of restrictions to look for ways to reduce them.

Staff supported people with their medicines to promote their independence. However, other aspects of medicine management such as record keeping, review of medication usage and checks needed improvement.

The provider needed to ensure safe recruitment procedures and better records for checks, so people were supported by safely recruited staff.

Staff communicated with people in ways that met their needs. Staff helped people focus on what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to take part in activities and pursue their interests in their local area.

Staff enabled people to access specialist health and social care support. Staff supported people to play an active role in maintaining their own health and well-being.

People had a choice about their living environment and were able to personalise their rooms.

Right Care:

The provider and the registered manager did not always ensure that actions were consistently taken to reduce assessed risks to people's personal safety. Not all staff had the right knowledge to encourage and enable people to take positive risks.

The provider needed to review how staff’s training needs and skills were managed in order to meet people’s specific needs.

The provider needed to make improvements to how they assessed and clearly recorded capacity assessments and any best interest decisions for people.

The provider needed to make improvements to ensure they followed current guidance and legal framework regarding people’s liberty deprivation, seeking consent and keeping associated records.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People could communicate with staff and understand information given to them because staff supported them and understood their individual communication needs. Staff spoke to people politely giving them time to respond and express their wishes.

Right Culture:

The provider did not always follow their quality assurance policy effectively to assess, monitor and mitigate any risks relating to the health, safety and welfare of people using services, the service and others.

The provider did not always maintain accurate and complete records relating to people’s care and service management.

The provider did not follow the current best practice guidance regarding support agreements to ensure their rights, choice and independence.

The service worked together with staff and stakeholders to them to help improve the service. However, people’s and relatives’ involvement and contributions to the service needed improvement. This would ensure people’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

Staff knew people and were supporting their aspirations to live a quality life of their choosing. People and those important to them were involved in planning their care.

Staff turnover was stable, which supported people to receive more consistent care from staff who knew them well. People were supported by staff who understood their different range of needs or sensitivities.

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

Rating at last inspection and update

The last rating for this service was outstanding (published 20 March 2019).

Why we inspected

We received concerns in relation to people’s safety from abuse, risk and incident management and support to people, staff recruitment, training and support, and closed cultures. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to risk and incident review and management; medicines; assessing, reviewing and recording mental capacity assessments, consent forms; quality assurance and record-keeping at this inspection. We have made recommendations about ongoing staff and senior staff training monitoring and to reflect the latest best practice guidelines; keeping accurate records for recruitment checks. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.