The Elms

Updated 14 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 4 inspectors.

Service and service type

This service provides care and support to people living in ‘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. This service is also registered as a domiciliary care agency which can also provide personal care to people living in their own houses and flats and specialist housing.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave a short period of notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection and also to allow the registered manager to notify the people they support that we would be visiting.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service, 5 relatives and 1 person’s key worker from their placement in education about their experience of the care provided. We spoke with 9 members of staff including the registered manager, the deputy manager, a director, support workers, a team leader and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. During the inspection, we visited some people’s living quarters at The Elms and we reviewed a range of records. This included reviewing 4 people's care records in detail. During the inspection we also looked at 3 people's medicines records, storage of medicines and various medicines documentation. We looked at 3 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 14 January 2023

About the service

The Elms provides both supported living services and domiciliary care services to people who require personal care. The service provides support to younger adults and older people with a sensory impairment, learning disability or autistic spectrum disorder. At the time of our inspection there were 12 people using the service. The service supported people across various sites in their own homes.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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, though most staff did try to support them in the least restrictive way possible and in their best interests, and the policies and systems in the service supported this practice. Necessary consent forms were not always in place and independence was not always promoted. Peoples needs and choices were not always consistently recorded. Whilst people were supported to express their views, it was not always clear how or whether this information was acted upon. Risks were not always being assessed and managed and accidents and incidents were not always recorded appropriately. Staffing levels required reviewing and recruitment practices and processes required some improvement and we made recommendations about this. People were not always supported with taking part in activities which were relevant to them, though we did see evidence of one person being supported to access education. People told us they were sometimes bored and various documents and relative conversations echoed this. We made a recommendation about this. People could access advocacy services when needed and people were supported when needed with their eating and drinking needs.

Right Care

Although people’s privacy was respected, people’s right to dignity was not. We found the service respected and supported people’s equality and diversity. The service worked closely with some agencies, though improvement in this area was required. Medicines processes, paperwork and administration was not always managed safely. Infection control practices did not always reflect national guidance at the time of the inspection, though people were supported to have visitors. Care records were not always as person centred as they needed to be and not everyone’s communication needs were being met.

Right Culture

Processes were not always followed to ensure people were safeguarded from abuse and a number of incidents and concerns had not been safeguarded that should have been. The provider raised a number of these historic safeguarding’s during our inspection. Staff received appropriate support and most staff had completed appropriate training. There was a complaints policy in place but this was not always being followed. We made a recommendation about this. No one was receiving end of life treatment at the time of inspection. The registered manager had limited knowledge about reviews that were completed in relation to learning from the lives and deaths of people with a learning disability, though they have sought to get involved in this going forward. Quality assurance systems and audits were not robust, and some policies were not being followed. Some documents were not in place and some were lacking detail. The registered manager had failed to notify CQC of a number of incidents, after raising this concern these were later notified to CQC by the provider. The service did not always promote a positive, open culture as detailed throughout this report. Whilst staff sometimes worked in partnership with other agencies, this was not consistent and there was no evidence to demonstrate that lessons were being learned from incidents and concerns. Surveys had been sent out to staff, and staff and tenants meetings were taking place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 26 March 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to various concerns received about the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this on all supported living inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 person-centred-care, consent, medicines, risk, infection control, safeguarding, governance and failure to notify CQC at this inspection.

Please see the action we have told the provider to take at the end of this report. However, full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.