Elegant Care Services

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.

Not everyone using Elegant Care Services receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, four people were receiving the regulated activity.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The inspection took place on 24 January 2019 and was announced.

There was a registered manager in post. 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.

The service was last inspected in July 2016. At that inspection, the service was rated Good. At this inspection we found examples of outstanding care and support in both the effective and responsive domains which have been rated accordingly.

The provider kept staffing levels under review and took time to match appropriately trained staff who had similar interests with the people they supported. The staff team was well established and stable, they were deployed appropriately to provide safe support for people. Robust recruitment practices helped to ensure only suitable people were employed to work at the service.

People were protected from the risk of abuse by staff who were trained and had the knowledge and skills to identify safeguarding concerns and act on them. Risks to people's health and well-being were assessed and appropriate plans were in place to minimise risks. The management team worked closely with the housing provider, conducting regular checks on the safety of the premises, reporting any issues promptly. People were supported to manage their medicines safely.

People received extremely effective support from a staff team who were regularly supervised and had their personal performance evaluated at an annual appraisal. Staff were trained in the skills necessary to fulfil their role and had received further training in areas relating to the specific needs of the people they supported.

The service had a strong person-centred approach which focussed on the individuals supported. The consistent approach used by the staff team had enabled people to make changes in their lifestyle and develop independence in order to bring about positive outcomes in their lives. Staff worked with health and social care professionals to meet people’s complex health needs and adopted a positive and forward-thinking attitude to supporting them to live life to the full.

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 support this practice.

People were encouraged to eat a well-balanced diet and supported to make healthy-living choices. When necessary their nutrition was monitored and staff sought and acted on advice from appropriate health professionals.

The interactions between people and the staff were very positive. Staff showed a genuine interest in the well-being of those they supported. They demonstrated kindness and understanding toward people and involved them fully in choices around their daily living. There was a strong emphasis on developing people's independence and supporting people to attain personal goals.

People were relaxed and comfortable in the company of staff, they sought support and assistance when required and there were several instances when they shared jokes and light-hearted banter. People were spoken to and about in a respectful manner, their privacy and dignity were maintained and staff knew the importance and processes of maintaining confidentiality.

Staff recognised the importance of maintaining relationships with family and friends. They had worked hard with social care professionals and introduced the use of technology to help re-establish and maintain family connections, achieving positive outcomes for people.

People were involved in all aspects of the service. Staff had been trained and had established ways to help people communicate and understand information that was presented to them. They had developed documents in pictorial format, talking mats and social stories to engage people and present information.

People's support plans were very comprehensive. They reflected the extremely person-centred approach used by staff. Additionally, they provided detailed guidance on how people were supported to achieve goals and positive outcomes to enhance their lives. Support plans also included people's likes, dislikes, cultural and spiritual preferences. Staff were familiar with these and worked to enable people to follow their interests and observe their culture and beliefs. People had opportunities to take part in activities of their choice for both enjoyment and to develop further independence.

The provider made people and their relatives aware of how a complaint may be made. Staff knew how to support people to raise concerns and the provider had a policy in place to respond accordingly. There had been no complaints since the previous inspection. The registered manager had systems in place to monitor the quality of the service provided. People, their relatives and staff had opportunities to feedback their views on the quality of the service.

Further information is in the detailed findings below

The registered manager has been in post since January 2014. 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 and associated Regulations about how the service is run.

This is the first inspection of the service under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People said the staff were caring and kind and treated them with dignity and respect. For instance one person commented, “Friendly, kind and helpful staff.” During our visit we observed people were comfortable with the staff member who supported them and was engaged in positive conversation with them.

Staff established good working relationships with people and demonstrated a good understanding of people’s care needs. They spoke confidently about people’s support needs, their hobbies and interests and communication needs. We found this to be line with what was written in people’s care records.

People supported to be involved in decision making and were able to express their opinions on the care and support received. A review of one to one key working meeting notes confirmed this. Staff respected people’s privacy and ensured their dignity was protected. A staff member commented, “Personal care is carried out in a dignified way and I ensure people’s bodies are covered.”

People strongly felt they were supported by staff who had the skills and the knowledge to give them the support they need. The service sought people’s consent and involved them in decisions. We saw people’s nutritional needs were met and they were supported to maintain good health.

People said they felt safe in the service and staff who knew how to recognise and report any concerns or potential abuse. Risks of abuse to people were minimised because the servicer had a robust recruitment procedure. There were sufficient staff to provide care and support to people, a review of staff rosters confirmed this.

People received care that was specific to their individual needs. Care records captured what was important to people this included their preferences; hobbies and interests; spiritual and cultural needs. People were actively engaged in a wide variety of social activities and staff encouraged people to maintain their hobbies and interests. This ensured people’s social well-being was promoted.

People said they knew how to raise concerns. We noted the complaints booklet was available in an easy read format to enable people to understand what to do and who to talk to if they had concerns. Relatives felt staff responded well to concerns raised and staff felt supported by management when they raised concerns.

We received positive feedback in regards to how well led the service was. For instance, one person commented, “I am very happy where I live and I would recommend this place to any friend.” The service sought people’s views about the care they received and took appropriate action in response to the feedback received.

The service had established effective quality assurance systems to assess monitor and improve the quality and safety of the service it provided.