Elite Support Providers Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment were effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s care plans did not demonstrate their needs were regularly reviewed and updated. Care reviews had not been consistently completed when people’s needs changed. For example, on discharge from hospital or following an incident.

We found 1 person’s care plan contained some information about their communication and well-being. However, this was not person centred. For example, this explained the person who did not communicate verbally could understand staff when they speak slowly and calmly. The care plan stated, “I make my wishes known through gestures and body cues.” However, the care plan did not detail what these gestures and cues looked like and how to effectively respond to each one. This meant there was a potential risk that people’s needs may not be identified and understood.
Staff told us they understood the person’s communication needs. One staff said, “[Person] uses body language communication and short words, light and clear, so can understand.”
 

People’s care, treatment and support was not always delivered in line with good practice.

The provider did not consistently ensure care and support was delivered in line with best practice for medicines management, risk management, and person-centred care. For example, some people required fluid monitoring to ensure their health needs were not impacted. We found some evidence that hydration risk assessment, monitoring guidance and recorded hydration support was in place. However, the provider did not demonstrate how they maintained oversight of this. The provider told us people’s families were responsible for this, however they did not demonstrate how they ensured staff-maintained oversight when people received longer periods of care and support away from their families.These issues indicated that the provider was not consistently using evidence-based tools to assess, monitor, and respond to people’s needs, which may result in risks not being appropriately identified or managed
 

The provider worked well across teams and services to support people.

Staff told us they worked well as a team. One staff said, “We have meetings every week and as I say if we have anything we call straight away, we have a lot of support.” Another staff said, “Other staff cover when I am not there, they are skilful as well. They will cover when I am off.”Staff told us they communicated with the office when any changes happened with people, and they updated the person’s care plan. The provider had an admissions and discharge policy in place.

The registered manager told us how they supported staff to work with other services. They said, “Its working together with all the services, for example safeguarding is everyone’s business. We have a list of the contacts people have, for example if they are attending a club every week, we look at if they understand the risks. It’s about giving staff contacts in key areas, for example if they are attending college then make regular contact. Get to know the key person and what the plan is. We make contact with the local GP. Key thing is communicating with people, understanding their role and what they can and can’t do.”
 

Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Care plans contained guidance for staff regarding healthier food options and healthy eating. One person required support and encouragement to make healthy dietary choices due to diagnosed medical conditions. Records showed staff supported the person to visit a fast-food restaurant on two consecutive respite days. The person's care plan identified these visits as a preferred respite activity and instructed staff to offer choices and respect their decisions. However, records did not demonstrate that healthier alternatives had been explored or discussed on these occasions, meaning the provider could not demonstrate how staff consistently balanced health promotion with supporting informed choice.

Staff told us they worked with families to ensure people could get to their appointments.
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Monitoring arrangements existed but were not consistently evidenced as effective. For example, one person’s care plan stated staff should always check they have drunk their fluids because they are at risk of developing a urine infection. Although hydration support was documented on some occasions, this was not consistent. The provider also did not demonstrate how they monitored this to ensure the person always achieved positive clinical outcomes. We raised this with the provider, and they told us the person’s family were responsible for food and fluids. This did not demonstrate how the provider worked with the family and ensured fluids were monitored when they supported the person for longer periods of time.

People’s care records did not accurately reflect their high-risk conditions to ensure they could be monitored safely. For example, 1 person’s care plan stated they have epilepsy. In one part of the care plan it stated they had not experienced a seizure for 6 years, yet in another section it stated the person had not experienced a seizure since they were 8 years old. This meant there was a risk that people’s conditions may not be monitored accurately and effectively. These inconsistencies were also not identified in the provider’s quality assurance systems.

The registered manager told us how they monitored people’s care and treatment. They told us, “We work according to SMART goals. [People] need to be registered with a GP within 7 days. If there are any care planning or mental health meetings, we join those and make sure we are all working from the same plan so we are effective in what we do and the person is at the centre of what we are doing."
 

The provider did not always tell people about their rights around consent and respect these when delivering person-centred care and treatment.

We reviewed people’s mental capacity assessments and best-interests decisions. These did not always demonstrate that all principles of the Mental Capacity Act 2005 were followed. For example, records did not consistently demonstrate all practicable steps taken to support people to understand, participate in and make the specific decision. We also found inconsistencies in the chronology and recording of mental capacity assessments and best-interests decisions.

Although care and support arrangements had been reviewed, the records available did not consistently demonstrate how capacity had been assessed for each specific decision at the relevant time, including consideration that capacity may change or fluctuate. The provider’s governance systems had not identified or resolved these recording shortfalls.

Staff told us they had received training for MCA. Staff we spoke with were able to describe the capacity of people they supported at the time of this assessment and how they understood their non-verbal cues for consent