Elite Support Providers Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. The service remained in breach of legal regulation in relation to good governance.
 

This service scored 57 (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 had a clear vision and values which were understood by staff and embedded within the culture of the service. Staff felt supported in their roles and were actively involved in reviewing and improving people's care through regular meetings and feedback opportunities.

Staff reported the provider was supportive. Staff were able to tell us about the values of the service. One staff said, “Care and sympathy and empathy for the [person], and to help them the best we can in a dignified way, respecting their privacy.”

The provider carried out surveys with the staff team and ensured there were monthly meetings to review people’s care. Staff contributed towards these meetings to ensure they were aware of any necessary changes.
 

Leaders did not always demonstrate the level of capability required to maintain effective oversight of the service. They did not consistently recognise risks or shortfalls in practice, which meant some concerns were only identified during assessment rather than through leadership monitoring.

During the assessment, we identified some concerns regarding the information and records available to demonstrate compliance with the provider's systems and processes. As a result, we could not be assured the provider had consistently embedded a culture of openness, transparency and continuous learning and improvement. For example, we identified inconsistencies within care records and supporting documentation, which made it difficult to verify that assessed care needs, professional recommendations and associated risk controls were consistently reflected across records. We also found the provider had not always identified when incidents required referrals to local authority safeguarding teams. This did not demonstrate effective oversight of the service and people's safety
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

There was a freedom to speak up policy in place at the time of the assessment. Staff told us they felt able to report concerns to management. Staff told us the provider was supportive, and they enjoyed working at the service. One staff said, “That’s why we do our team meetings and all the communication we write in our group chat with the supervisor and the manager. They know what is going on, they talk openly.”

The registered manager told us they supported staff to encourage a culture of openness. They said, “Supervisions are really helpful. We operate the open-door policy so [staff] can come to us” and “It’s about making sure those doors are open, people know they can approach you and which routes they can use.”
 

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Policies reflected equality and diversity principles. Leaders described how they promoted an inclusive culture and supported staff to understand and respect people's different backgrounds, cultures and beliefs.

The provider's governance systems and oversight arrangements were not always effective in identifying, assessing and mitigating risks. Governance systems were not used effectively to manage and deliver good quality, sustainable care, treatment and support. The provider did not consistently act on information about risk, performance and outcomes, or share this securely with others when appropriate.

We found some documents were not in place before this assessment. We were therefore not assured people had access to important documents such as hospital passports before this assessment. This did not demonstrate safe and effective oversight of the service and people’s needs.The provider did not ensure robust governance systems and processes were always in place to assess, monitor, and improve the quality and safety of the services provided. The quality assurance systems had failed to identify and address all of the concerns we found during this assessment.

We were not assured the registered manager always maintained up to date and accurate records. The registered manager did not ensure all staff followed the assessed needs and guidance for people’s risk management so the risk of avoidable harm would be reduced. The provider also did not demonstrate they maintained effective oversight of all staff learning and development and required training to ensure people’s needs could be safely met.Decisions made on behalf of people were not always recorded or evidenced as being in line with the Mental Capacity Act 2005 and associated Codes of Practice
 

The provider did not always work with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

We found 1 incident where someone sustained a fall and the provider recorded this as a sustained fracture. We raised this with the provider, and they later confirmed the person did not sustain a fracture. This demonstrated weaknesses in the provider’s recording, governance and maintenance of a clear, comprehensive audit trail of clinical involvement and changes in need.
We also found this person experienced chest pain, yet staff did not contact healthcare professionals immediately. This did not demonstrate people were always safeguarded from immediate risks of harm.

All staff received safeguarding training and staff were able to tell us when they would raise safeguarding concerns.
 

The provider did not always demonstrate a consistent focus on continuous learning, innovation and improvement across the organisation and local system.

Governance and learning arrangements were in place, including staff meetings, supervision, incident review, care-plan and risk reviews, documentation checks, and medication and infection prevention and control audits. The provider had taken action to share learning and strengthen expectations relating to medication risks, monitoring, escalation and record keeping. However, these arrangements were not consistently effective. Audits and quality-monitoring processes had not identified all the gaps and discrepancies found during the assessment in relation to people’s care planning, risk management and record keeping. The provider’s own review also identified that further work was required to strengthen audit sensitivity, record reconciliation, competency assurance and evidence that actions had been completed and sustained. This meant opportunities for learning and improvement were not always identified, acted upon or evidenced through to effective completion.

The provider remained in breach of Regulation 17, identified at the previous assessment. Although there was evidence of learning and improvement activity, the provider had not demonstrated that improvements were consistently embedded and sustained across the service