Elizabeth House Also known as Integrate (Preston & Chorley) Limited

The service was given 24 hours' notice prior to the inspection due to the complexity of the service.

The agency, Integrate Preston, is managed from well-equipped offices located in Ashton, in central Preston. Services are provided to support people to live independently in the community. During this inspection there were 136 people who used the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing.

Not everyone using Elizabeth House receives a regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There is a registered manager at the service. 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.

At the last inspection of the service we found breaches of the regulations these were in relation to Regulation 11 HSCA RA Regulations 2014 (Need for consent), Regulation 12 HSCA RA Regulations 2014 (Safe care and treatment), Regulation 13 HSCA RA Regulations 2014 (Safeguarding service users from abuse and improper treatment), Regulation 17 HSCA RA Regulations 2014 (Good Governance), and Regulation 18 HSCA RA Regulations 2014 (Staffing).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. During this inspection we checked to see if there had been improvements at the service. We found all the breaches of regulation had been improved and we found no breaches of the regulations at this inspection.

We found people were protected from the risk of abuse because staff understood how to identify and report it. We found people were protected from risks associated with their care because the registered provider had completed risk assessments. These provided updated guidance for staff in order to keep people safe. We found recruitment to be safe. We reviewed staffing at the service and did not find any concerns.

We looked at how the service was managing medicines at this inspection. Monthly audits were being completed and management had oversight of these. We found that protocols for ‘as and when’ medicines were in place, as per the medicines policy.

At this inspection, we found mental capacity had been considered and written consent to various aspects of care and treatment was observed on people's files. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We were able to see staff supervision was taking place. Staff we spoke with confirmed they felt supported in their role. Staff training was ongoing and evidence has been seen of staff completing training.

We found holistic assessments were carried out by the service before any person was accepted, to ensure people’s needs could be met. Peoples needs for nutrition and fluids had been considered. People were supported by staff to live healthier lives. Staff supported people to healthcare appointments and arranged these if necessary.

We received consistently positive feedback about the staff and about the care people received. Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights.

Staff were highly motivated and described their work with a clear sense of pride and enthusiasm. One staff member told us, “My job is really rewarding.” We found the culture at the service was very person centred.

We saw evidence people were supported by the staff to explore sources of additional support including leisure activities. We spoke to people who use the service about support with activities. One person told us, “I go shopping and to bingo with my care worker, we have even been on holiday and we are going again for my birthday.”

We looked at what arrangements the service had taken to identify record and meet communication and support needs of people with a disability, impairment or sensory loss. Care plans seen confirmed the services assessment procedures identified information about whether the person had communication needs.

Each person had a care plan which was tailored to meet their individual needs. We saw care records were written in a person centred way. People told us they were encouraged to raise any concerns or complaints. The service had a complaints procedure.

We found the management team carried out audits and reviews of the quality of care.

Staff we talked with demonstrated they had a good understanding of their roles and responsibilities. We found the service had clear lines of responsibility and accountability with a structured management team in place.

The provider and registered manager had clear visions around the registered activities and plans for improvement moving forward. The management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

The inspection of this service took place across three dates; 20 & 21 October and 1 November 2016. A follow up desk top review of further evidence was completed 23 November 2016. This was completed following a meeting with the two registered managers for the service, the inspector and an inspection manager. This was the first time the service had been inspected under the comprehensive methodology. The service was given 24 hours’ notice prior to the inspection so that we could be sure someone would be available to provide us with the information we required.

The service has two registered managers, and one of the registered managers of the service was present throughout 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.

We found a lack of consistency in the way people's risk had been assessed and managed. The risks to people were not always sufficiently managed to avoid harm. In addition, there was not always information on how to mitigate risks and there was missing information to help guide staff if the said risk occurred.

We found that the service had policies and procedures in place to protect people from bullying, harassment, avoidable harm and abuse. We spoke with staff who told us they were aware of the procedure. However, these were not always being followed.

A central register of accidents and incidents was held by the registered manager in order for these to be monitored. The file contained an extensive list of accidents and incidents with clear guidance for reporting. However, we found a lack of consistency in reporting across the service.

We looked at how the service managed people’s medicines and found that medicine administration was being completed outside of Integrate policies and procedures.

We found that the providers disciplinary procedures were not always correctly adhered to and robust. We did find that recruitment within the service was safe.

A range of checks were carried out on a regular basis to help ensure the safety of the properties and equipment was maintained.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). We found that the principles of the MCA were not consistently embedded in practice. The service provided care for people who may have an impairment of the mind or brain, such as learning disabilities. We found that people's capacity to consent to care and treatment had not always been assessed.

We found supervision for staff working within the service was not consistent. We saw the service had a detailed induction programme in place for all new staff and that staff were required to complete an induction prior to working unsupervised. We found that the service promoted staff development and had a rolling programme to ensure that staff received training appropriate to their role and responsibilities.

People’s care records told us about their likes and dislikes in relation to food and drink. We saw that people had a choice of what they wanted to eat and staff were aware of people’s needs in this area. During the inspection, we observed staff supporting people to make meals for themselves.

The staff approached people in a caring, kind and friendly manner. We observed positive interactions throughout the inspection. Staff appeared to understand the needs of people they supported and it was apparent that trusting relationships had been created.

People were supported by staff to access the community and minimise the risk of becoming socially isolated. Staff understood how to respect people's privacy, dignity and rights, and received training in this area.

There was a lack of consistency in care planning across the service. We viewed some really good in depth information that was clear concise and up to date. However, there were also care plans that were out of date, vague or that had not been considered at all.

We saw that people were supported to be independent and their views and wishes respected. People were supported and encouraged to take part in activities of their choice.

We found there was a clear assessment process in place, which helped to ensure staff had a good understanding of people's needs before they started to support them. We saw multiple examples across the care records we looked at of people being referred for external health and social care support and professional advice being followed.

The service had a complaints procedure and people and everyone we spoke with said they felt confident that any complaint would be taken seriously and fully investigated. A system for recording and managing complaints and informal concerns was in place.

Evidence we found showed there was a lack of management oversight. Although systems were established and in place to allow for oversight of accidents and incidents these were not always operated effectively.

We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

The service regularly, support people who use the service to be more involved in external meetings and consultations regarding the wider disability agenda. People who use the service are actively involved in recruitment. People are trained in interviewing techniques and sit as equal members on the interview panels.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment, consent, safeguarding, staffing and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.

Some people we visited did not use words to tell us about their experience of the care they received so we observed the care provided. People who spoke with us told us that they happy with the care and support received. We were told: 'I love New Focus'. And: 'I've just moved here. I'm very happy'.

We found people's care plans were person centred, comprehensive and contained sufficient information for staff to provide good care and support.

We saw a range of evidence which showed the provider regularly cooperated and worked with other providers.

Homes we visited were clean and records we viewed indicated that all staff had received training in the prevention and control of infection.

We found that the provider had systems in place to monitor the quality of care and support provided to people who used services and staff.

People we visited told us they have the usual support workers. One person said, 'I have had the same staff for over ten years'. is great we are like friends'. Another person said, 'I like my staff '. is a lovely girl and always has a nice smile'.

People told us they felt safe in and out of their homes. They had arrangements in place for staff to gain entry and to keep their home secure. A person said, 'I don't go out without the staff unless I am going to work. I do that to keep me safe and nothing wrong will happen to me'. Another person said, 'He's like a friend but he had a conversation with me about that. He emphasised about being a professional, so we can't go out for a pint or clubbing. He explained about boundaries and I understood that and it's okay with me'.