Archived: Care Elite

Care Elite is a supported living service. Supported living services are where people live in their own home and receive care and/or support in order to promote their independence. The service provides support to five young adults males with mental health issues, some of whom also had autism. There were four people using the service at the time of our inspection. At our inspection in September 2017 we found a continued breach of the regulation relating to staff support. We served a warning notice and told the provider to be compliant by 31 January 2018. We also found a breach in relation to the way the provider governed the service.

There was no registered manager in post at the time of 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. The manager registered with us had recently left the service and the director told us a new manager had been recruited who would register with us as soon as possible. This meant leadership was not always visible across the service, although staff told us the director was accessible to them at any time.

The service had improved since our last inspection and the provider was now compliant with regulations. The service met the requirements of our warning notice and staff were provided with suitable support with a training and supervision programme. The way the provider governed the service had also improved and there was no longer a breach in relation to this. The provider had followed their action plan to improve the service and the director had a good understanding of their role and responsibilities, as did staff.

Systems were in place to protect people from abuse and staff received training in their responsibilities to safeguard people.

Risks relating to people’s care were reduced as the provider assessed and managed risks. However, the provider did not always encourage positive risk taking to provide people with more choice and control in their lives. Although the way risks were recorded could be improved for clarity, assessments contained sufficiently detailed information about risks to guide staff.

People’s medicines were managed safely by staff although we identified some improvements could be made such as checking medicines were stored at safe temperatures.

People were supported by staff who the provider checked were suitable to work with them. In addition there were enough staff to care for people.

People were encouraged to live healthy lives and received food of their choice. People received support with their day to day healthcare needs.

People received care in line with the Mental Capacity Act 2005 and staff received training on the Act to help them understand their responsibilities in relation to it.

Staff understood people’s needs and preferences and people were encouraged to maintain their independence. Staff maintained people’s dignity and treated them with respect. People were encouraged to maintain relationships with those who were important to them.

People’s needs and preferences were assessed by the provider. People’s care plans were sufficiently detailed to inform staff about people’s needs and to guide staff in caring for them. People’s care was planned and delivered in response to their needs.

People were informed how to complain and the provider responded to complaints appropriately. The provider communicated openly with people and staff. Although the provider worked closely with professionals a social worker told us they sometimes experienced delays in communication and information provided was not always comprehensive which hindered co-working.

At our previous inspection in March 2017, we found a breach of legal requirements as the service was not supporting staff well in relation to training and supervision and we rated the service ‘requires improvement’ overall. After the inspection the provider wrote to us to tell us what they would do to meet legal requirements in relation to staff support.

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. In addition, before our inspection we received information indicating the provider was not meeting the mental health needs of a person using the service. We looked at these concerns as part of our inspection. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care Elite on our website at www.cqc.org.uk

This unannounced, focused inspection took place on 28 September and 10 October 2017.

The service had a registered manager in post. 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 this inspection we found the provider had not followed their action plan to become compliant in relation to staff support. We identified the provider did not provide staff with the training they required to understand their role and the needs of the people using the service well. We are taking further action against the provider in relation to this repeat breach and we will report on this when our processes are complete.

At this inspection we found the governance in place had not identified a continued breach in relation to staff training. The action plan the provider put in place to improve the service after our inspection was ineffective as the service had not improved the training provided to staff. In addition, the governance in place had not identified the service was not meeting the mental health needs of a person. We identified a breach relating to good governance of the service, and you can see the action we asked the provider to take at the back of the full version of this report.

The provider had improved the support staff received in relation to supervision. Records showed, and staff and the registered manager confirmed, staff received supervision every month.

At this inspection we identified the provider was not responsive to the mental health needs of one person using the service. The person and their social worker agreed the provider could improve the way they supported the person to manage their mental health to reduce their anxiety. In addition the provider had not put in place effective strategies to support the person to manage their anxiety and the person’s care plan provided staff with little guidance on how best to support the person in relation to this. Staff had not received training in relation to the person’s mental health needs so may not have understood the person’s needs well. However, the provider told us they would arrange training as soon as possible. We identified there was also conflicting information in the person's care plans about their mental health diagnosis and some staff were unaware the person had received a specific diagnosis.

After the inspection the director gathered detailed information about the person’s mental health history. The person’s keyworker confirmed they were updating their care plan to ensure it contained accurate information for staff to be aware of. The provider confirmed they were liaising closely with the person’s social worker and other professionals to put in place more appropriate support for the person to help them manage their mental health.

This inspection took place on 27 and 30 March 2017 and our first visit was unannounced. At our previous inspection in October 2016, we found the service did not have a registered manager in post and required notifications were not being submitted to the Care Quality Commission. .

The service now had a registered manager in post. 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.

There were systems and processes to protect people from the risk of harm. Staff had attended safeguarding training and were aware of safeguarding procedures. Assessments were completed for any identified risks to help keep people and staff safe.

New care documentation had been introduced and staff told us the service had improved since our last inspection.

People were supported to have their health needs met. People’s medicines were managed safely and regular audits took place to make sure that people were having their medicines as prescribed.

Required statutory notifications were now being submitted to CQC about certain incidents and events. Notifications are information about important events which the service is required to tell us about by law.

Records kept by the service did not show that there was a system in place to make sure staff training was kept up to date. Additionally the registered manager and staff were not receiving regular supervision with their line manager.

There was a system in place for dealing with people’s concerns and complaints. The registered manager understood their role and responsibilities and there were systems in place to help ensure the safety and quality of the service provided.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care Elite on our website at www.cqc.org.uk.

We found improvements had been made to make sure that staff were recruited safely. Appropriate recruitment checks took place including those required for criminal records, references and identity checks.

A registered manager was not in post at the time of this inspection. The provider stated that the previous registered manager had left the service after our last inspection in November 2015. An acting manager was in post and they stated that they were intending to apply for registration with CQC.

It was additionally found that required statutory notifications were not being submitted to CQC about certain incidents and events. Notifications are information about important events which the service is required to tell us about by law.

During this inspection we found that people using the service care files had been updated and included up to date care and support plans and risk assessments. We also found that staff were receiving training relevant to the needs of the people using the service.

All told us they had been provided with information about the service when they moved in. They told us they had care plans and risk assessments and had been involved in planning their care.

We found that information relating to people using the service's care and support needs was not readily available or accessible to staff.

The lack of training for staff in important areas meant that staff were not fully aware of people’s needs and could place people using the service at risk of inappropriate care.

The registered manager had employed the services of an external consultant to make improvements at the service.