18 May 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection of the service took place across two dates 15 and 16 February 2018. A follow up desktop review of evidence was completed 20 March 2018. This was completed following a meeting with the registered manager of the service. The delay was due to the registered manager and the inspector’s conflicting schedules.
The inspection was announced. This was done due to the complexity of the service. The service comprises of six separate aspects and social enterprises.
Inspection site visit activity started on 15 February 2018 and ended on 20th March 2018. It included site visits to the two offices, site visits to the older adults service, deaf service, women’s service, independent support service and peoples own homes. We visited the office locations on 15 and 16 February 2018 and 20 March 2018 to see the manager and office staff; and to review care records and policies and procedures.
The inspection team consisted of four inspectors, one of which was the lead inspector for the service, and a British sign language interpreter.
Before the inspection visit we contacted the commissioning department at Lancashire County Council. In addition we contacted Healthwatch Lancashire. Healthwatch Lancashire is an independent consumer champion for health and social care. This helped us to gain a balanced overview of what people experienced accessing the service.
We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We checked the provider’s website before the inspection visit to check if they were displaying their previous rating. Elizabeth House were displaying their previous rating of Requires Improvement.
During the time of inspection there were 136 people who used the service. We spoke with a range of people about Elizabeth House. They included ten people who used the service, the registered manager and 16 staff members.
We closely examined the care records of 12 people who used the service. This process is called pathway tracking and enables us to judge how well the service understands and plans to meet people's care needs and manage any risks to people's health and wellbeing.
We reviewed a variety of records, including policies and procedures, safety and quality audits, four staff personnel and training files, records of accidents, complaints records, various service certificates and medicine administration records.
18 May 2018
The inspection of the service took place across two dates 15 and 16 February 2018. A follow up desktop review of evidence was completed 20 March 2018. This was completed following a meeting with the registered manager of the service. The delay was due to the registered manager and the inspectors conflicting schedules.
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.