Elite Support Providers Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 50 (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 systems to share learning, including staff meetings, handovers, supervision and incident reviews. However, we were not fully assured that learning was consistently embedded and effectively disseminated across the whole workforce, particularly given the recurring concerns identified during the assessment period.

We found concerns from the previous assessment were still not addressed. For example, there were identified concerns regarding the provider’s transparency, safe care and treatment, and poor medicines records. The provider did not demonstrate sustained improvements from previous identified concerns.

Staff were supported with regular supervisions to support their learning and wellbeing. The provider maintained an incident log with identified learning outcomes and actions to mitigate the risk of reoccurrence
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager told us how they worked with families and the local authority to assess people’s needs and requirements to ensure their service was able to meet people’s needs. Relatives told us the provider worked well with them and their family member to support a transition into the service. One person said, “The move to the home went smoothly and I visit every day.” Another person said, “[Relative] went for a trial period of a month before [they] moved in full time to see how things went. The manager was very good with providing booklets and information. There were inductions for the carers to look after my [family member]. It was a good transition.”
 

The provider did not always promote people's rights, wellbeing and safety.

We found several examples of restrictive practice. For example, people were subjected to constant supervision and monitoring, and we found doors were locked by staff. We shared these concerns with the provider. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

At the time of this assessment, we found processes were in place for MCA, Best Interests and Community DoLS in relation to some people using the service. However, the provider did not demonstrate they ensured these processes were in place for all people using the system and for each restrictive practice identified. The provider also failed to demonstrate they had reviewed these decisions to ensure people were subjected to the least restrictive option for the least amount of time.

The provider maintained a safeguarding log and referred information of concern to the local authority where required.
 

The provider did not always assess, monitor and mitigate risks to people's safety. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care records contained discrepancies relating to people’s conditions and assessed needs. For example, although 1 person had guidance in place from speech and language therapy (SaLT), we found concerns regarding the record consistency across several of their documents to ensure the correct level of thickener was used.

We also found 1 person was at risk of developing pressure ulcers and required repositioning, as well as staff to check their pressure relieving equipment. We found there was no guidance in the person’s care plan to inform staff on how and when to complete these tasks. The person’s daily notes also demonstrated repositioning was not taking place regularly. This lack of systems and processes for the repositioning to be monitored effectively meant the person’s risk of developing pressure ulcers was not sufficiently mitigated and the person was at risk of avoidable harm.

Another person was currently using an emollient. These are moisturising treatments applied to the skin. They cover the skin with a protective film to trap in moisture. However, when emollients dry onto fabric, they can increase the speed of ignition and intensity of a fire. This accelerant effect significantly reduces the time available to act to put out a clothing or bedding fire before serious and fatal burns are sustained. The provider did not demonstrate there was a clear, person centred risk assessment in place for this person at the time of the assessment to mitigate risk of avoidable harm.
 

The provider had identified a range of environmental and fire safety risks.

A building Fire Risk Assessment identified disabled or non-ambulant people as potentially at risk, considered evacuation arrangements and recorded that PEEPs were in place.However, during our visit, staff had locked the front door. The provider did not demonstrate that the specific staff-controlled locking arrangement, including how it would be released promptly during an evacuation, had been assessed in the building Fire Risk Assessment or relevant individual evacuation plans. This meant there was insufficient assurance that the locking arrangement would not delay evacuation.

One person’s care records instructed staff to check that their wheelchair was safe, accessible and in good working order and to report defects. The provider advised such checks were supported by a family member. However, records did not reflect this and assure these checks had been carried out.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

At the time of the assessment 1 person using the service required staff to administer an emergency rescue medicine for epilepsy. The provider was unable to demonstrate staff had received appropriate training to administer this medicine at the time the person began using the service. This meant the person was at potential risk of harm from being supported by untrained and unqualified staff. Furthermore, staff assessing the competencies of other staff administering medicines did not have evidence of appropriate qualifications and experience at the time of the assessment. The provider did not demonstrate how they assured assessors were competent to complete these tasks.

Staff told us they were not always supported with training for some high-risk conditions people using the service had. For example, one staff told us they were not trained on ‘PICA’ and had to research what this condition was by themselves. The provider told us further PICA training sessions were planned. PICA is a medical term for eating non-edible items. We also found staff were not trained in dysphagia, despite people using the service currently presenting as a high risk with this condition. Dysphagia is a condition where you have problems swallowing.The provider could not assure us they had good oversight of all the staff and their competencies to be able to support and respond to people and to ensure they understood their different needs. This placed people at risk of receiving care that did not meet their needs safely.

We received mixed feedback from relatives about the consistency of staff. One relative said, “There is consistency of staff which is good as my [family member] [has] got to know them well.” Another relative said, “There have been some changes in staff, and I hope they keep them as changes upset [family member].

The provider had safe systems and processes in place to recruit staff appropriately. Staff were supported with supervisions to ensure their learning and development needs were discussed with senior managers.
 

We observed that staff did not always follow good practice in relation to personal protective equipment (PPE). For example, one member of staff was observed using the same pair of disposable gloves to complete several tasks, including supporting a person to eat and using shared TV remote controls. This was not in line with the provider's infection prevention and control policy and was discussed with the registered manager during the assessment.

The provider had systems in place to assess, monitor and review infection prevention and control arrangements, including audits, risk assessments, supervision and action planning. These systems had identified areas for improvement, including reinforcing PPE use and hand hygiene. However, the observation made during the assessment demonstrated that infection prevention and control procedures were not consistently followed in practice by all staff.
 

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not always involved in planning.

Staff were found administering medicines with variable dosing. Where staff administered the higher dose, there was no documented rationale for this decision.’ to ‘Where staff administered the higher dose, there was not always a documented rationale for this decision. This meant there was a potential risk of people receiving too much or too little medicine.

The provider had detailed ‘as needed’ (PRN) medicines protocols in place. However, the reason and outcome of administration was not recorded at the time it was administered to people. This meant the provider could not demonstrate how medicines were always monitored and managed at the time of administration to ensure it was appropriate and effective.We found 1 person was administered ‘as needed’ a medicine every day without clear rationale. This medicine had side effects including drowsiness. After we shared these concerns, the provider later shared documentation with us which stated the person experienced hives every night at 8pm. Hives are itchy, raised bumps or welts on your skin. We checked this against the person’s daily notes and found the person did not present with any concerns which justified the reason for administration. The provider also failed to demonstrate they followed up these concerns with appropriate healthcare professionals where required.