Elite Care and Support Services

People’s experience of using this service:

We found improvements had been made in some of the key questions we rated as requires improvement following our previous comprehensive inspection. We also found the breaches of regulations that were issued at that inspection had been met. However, we found some improvements were needed to ensure quality assurance systems were embedded and care records contained the information staff needed to refer to in relation to meeting people’s health care needs and the risk management of some people’s needs.

Improvements had been made to how people were supported by staff, there was greater consistency provided by a core team of staff.

Staff knew people’s needs and had received training which provided them with the skills to support people safely and effectively. Staff felt supported in their role and were kept up to date with changes in people’s care needs. Staff were recruited safely.

Staff were aware of people’s healthcare needs and how to support them to maintain good health. People received their medicines as needed. People’s nutritional needs were met.

People had access to some leisure opportunities and activities and people’s independence was promoted.

People told us they felt safe. Staff understood how to recognise signs of abuse and how to report concerns within the organisation and externally. People were protected from the risk of infection.

Staff felt the registered manager was approachable and provided good leadership and direction. There were systems in place to respond to complaints and concerns about the service and people were asked for their views about what could be improved.

Rating at last inspection: We inspected the service in February 2018 and rated the service ‘Requires Improvement’ overall with an ‘Inadequate’ rating for well led. We found breaches of regulation 12 and 17 and imposed conditions on the providers registration. We carried out a focused inspection on 24 August 2018 and looked at the safe and well led key questions. There was evidence of some improvement and both key questions were rated as ‘Requires Improvement’. However, the breaches remained unmet and the conditions we imposed on the provider remained in place.

Why we inspected: This was a planned inspection which took place on 20 and 21 February 2019. At the last inspection the service was not meeting the regulations and we imposed conditions on the provider’s registration.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out this inspection because we received further concerns in relation to;

• Poor care

• Safeguarding concerns

• Staffing levels

As a result, we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to the two key questions of safe and well led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 278 Moseley Road on our website at www.cqc.org.uk

278 Moseley Road provides care and support to people living with learning disabilities and/or mental health conditions, in three separate 'supported living' settings 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. At the time of our inspection, the provider was supporting 15 people with their personal care needs.

The provider had appointed a manager who had formally applied to be registered with us and this process was completed shortly after our inspection. 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.

A common theme throughout our previous inspection, which was found to have impacted upon the safety and the quality of the service provided to people was poor record keeping and ineffective quality monitoring systems and processes. Information we requested to support our inspection was not always provided and information providers are required to send to us by law, by way of statutory notifications, had not always been sent. Inconsistencies within the provider's quality monitoring practices had failed to identify or remedy the shortfalls we found within the service, which collectively formulated a breach of Regulation 17 of the Health and Social Care Act. At this inspection we found some improvements to promote the safety and governance of the service. However, the shortfalls that we identified within this inspection showed that further improvements were still required. The provider had failed to make sufficient improvements to the efficiency of their quality assurance systems. This meant that this was the second consecutive inspection whereby the provider had failed to achieve a ‘good’ rating in the well led area of our inspection, it was also the second inspection whereby they had failed to meet the requirements of 12 and 17 of the Health and Social Care Act 2008 ( regulated Activities) 2014. Therefore the conditions we imposed on the provider following our previous inspection remain in place. You can see what further action we have taken at the end of this report.

It is a legal requirement for providers to display their rating, to show whether a service was rated as outstanding, good, requires improvement or inadequate following an inspection. The ratings are designed to improve transparency by providing people who use services, and the public, with a clear statement about the quality and safety of the care provided. The provider has a regulatory duty to ensure that ratings are displayed legibly and conspicuously at both the office location and on their website within 21 calendar days of the date at which the inspection report was published. We found at our last inspection in February 2018 that the provider had not displayed their rating on their website or at their office location. This is a breach of regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the time of writing this report we were in the process of issuing a Fixed Penalty Notice to the provider.

The service was not always safe because staff were not always aware of some of the risks associated with people's support needs and records concerning risks to people's safety and well-being were sometimes inconsistent and/or incomplete. People received support to take their

medicines as prescribed but some improvements were required to the risk management and recording of medicine administration within the service.

Staff knew the signs and symptoms of abuse and the reporting procedures. However, people were

still placed at risk of harm because of compatibility issues in one of the supported living house’s.

People were supported by adequate numbers of staff. However, there had been a period of instability in staffing with a number of staff changes which is unsettling for people.

Improvements had been made to the provider's recruitment checks for new staff employed at the service. However, some improvements were still needed for the recruitment records for some existing staff.

278 Moseley Road provides care and support to people living with learning disabilities and/or mental health conditions, in three separate ‘supported living’ settings 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. At the time of our inspection, the provider was supporting 16 people with their personal care needs.

The provider was required to deploy a registered manager to manage the service as part of the conditions of their registration. There had not been a registered manager in post since June 2017. This is an offence under section 33 of the Health and Social Care Act 2008 for failing to comply with the conditions of registration. The provider had appointed a manager who had been managing the day to day running of the service since the departure of the registered manager, information we hold showed they had submitted an application to register with us in January 2018. However, this manager left the service during the inspection process. We were told that a new manager had been appointed, but was yet to start their employment with the provider. 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.

It is a legal requirement for providers to display their rating, to show whether a service was rated as outstanding, good, requires improvement or inadequate following an inspection. The ratings are designed to improve transparency by providing people who use services, and the public, with a clear statement about the quality and safety of the care provided. The provider has a regulatory duty to ensure that ratings are displayed legibly and conspicuously at both the office location and on their website within 21 calendar days of the date at which the inspection report was published. We found that the provider had not displayed their rating on their website or at their office location. This is a breach of regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A common theme throughout the inspection, which was found to have impacted upon the safety and the quality of the service provided to people was poor record keeping and ineffective quality monitoring systems and processes. Information we requested to support our inspection was not always provided and information providers are required to send to us by law, by way of statutory notifications, had not always been sent. Inconsistencies within the provider’s quality monitoring practices had failed to identify or remedy the shortfalls we found within the service, which collectively formulated a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 concerning the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

The service was not always safe because staff were not always aware of some of the risks associated with people’s support needs and records concerning risks to people’s safety and well-being were sometimes inconsistent and/or incomplete. The provider’s quality monitoring systems and processes had failed to ensure that safety checks within the supported living properties, including fire safety, had been consistently carried out and appropriate records maintained. On the whole, people received support to take their medicines as prescribed but some improvements were required to the risk management and recording of medicine administration within the service. The provider’s recruitment checks were not always robust and incidents were not always recognised as potential safeguarding concerns to ensure they were referred on to the appropriate agencies.

The service was not always effective because staff had not always received the training they required. Training records were not available for us to view at the time of our inspection. People were cared for in the least restrictive ways possible and staff understood their responsibilities associated with the Mental Capacity Act 2005. People were supported to choose foods and prepare meals that they enjoyed and were supported to access to health and social care professionals, as required. People were supported to maintain good health because the provider worked collaboratively with other agencies. People were encouraged to develop and maintain their independence as far as reasonably possible and were supported to sustain relationships with people that were important to them.

We received mixed reviews about the level of involvement people and those that were important to them, had had in the planning and review of their care. However, we found that care records contained information about people’s needs, likes, dislikes and preferences, which reflected our observations and the feedback we had received from people, staff and relatives we spoke with.

We gave the provider 48 hours ‘notice that we would be visiting the service. This was because we wanted to make sure staff would be available to answer any questions we had or provide information that we needed. We also wanted the registered manager to ask people who used the service if we could visit them in their own homes.

At the time of the inspection the service was providing support and personal care to three people who shared a home within a ‘supported living’ facility in the community. Supported living enables people who need personal or social support to live in their own home supported by care staff. The level of staff support provided by the service varied according to people’s assessed needs and people’s level of independence. The provider was also registered with us for treatment of disease, disorder or injury. However, they told us that they were not providing this regulated activity when we inspected.

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 provider monitoring systems had not identified that records in relation to medicines were robustly managed to ensure that they were effective at reducing the risks associated with peoples’ medicines.

People were supported by staff who had received training to recognise possible signs of abuse and how to report any concerns. Staff were aware of their responsibilities in this area and what actions they should take. All staff spoken with were confident that if they had to raise any concerns that they would be acted upon and dealt with appropriately.

Staff understood the potential risks to people’s safety and knew how to reduce the risk of harm to people. People were supported by sufficient numbers of staff who had been appropriately recruited, trained and supported for their roles. People received their medicines as prescribed by their GP.

People were supported by a staff team who were caring in their approach and understood people’s needs. People were enabled to make day to day choices about their care. People’s privacy, dignity and independence were promoted and they were treated with respect.

There were systems in place to respond to people’s concerns and complaints about the service.

At the time of the inspection the service was providing support and personal care to two people who shared a home within a ‘supported living’ facility in the community. Supported living enables people who need personal or social support to live in their own home supported by care staff. The level of staff support provided by the service varied according to people’s assessed needs and people’s level of independence. The provider was also registered with us for treatment of disease, disorder or injury. However, they told us that they were not providing this regulated activity when we inspected.

At the time of our inspection the provider had been providing a service to people for six weeks. We were therefore not able to award a rating as we could not answer all the Key Lines of Enquiry ( KLOE) against the regulated activity.

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 in the early stages of development. Some care records needed development so that staff had all the information they needed to meet people’s needs consistently.

People were supported by staff who had received training in how to recognise possible signs of abuse and how to report any concerns. Staff were aware of their responsibilities in this area and what actions they should take. All staff spoken with were confident that if they had to raise any concerns that they would be acted upon and dealt with appropriately.

Staff were recruited appropriately and there were sufficient numbers of staff to meet people’s needs. Staff had received induction training when they first started work.

People were supported with their nutrition and health care needs.

People told us that the staff who supported them were kind and caring.

Arrangements were in place to listen to concerns and complaints and take action if needed.

The provider had quality assurance systems in place . However, it was too soon to assess the effectiveness of these at this inspection.