Elyon Healthcare

Elyon Healthcare is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to younger and older adults. At the time of our inspection 15 people were using the service, 3 of which received personal care.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We gathered feedback from relatives of people using the service, this was positive. One relative told us, “They [staff] are great, they always listen to us and want to find out as much as they can about [person]” and “We have regular contact, we are involved in all reviews of [my relative’s] care.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice.

The service carried out regular audits to monitor the quality of the service. The provider had identified they did not have evidence of lasting power of attorneys. Although initially they had contacted relatives to obtain the records, the provider had failed to follow this up. This meant that decisions were being made without evidence of the legal authority required to do so.

People were protected from abuse. There were systems and processes in place to protect people from avoidable harm. Staff understood their responsibilities on how to identify and report concerns and felt confident that the management team would action these appropriately.

Medicines were managed safely. Staff received training in the administration of medicines during their induction and undertook annual refresher training.

Staff were recruited safely. The service organised staff allocation so that a small group of familiar staff supported each person.

People's needs were assessed before they started using the service to ensure these could be met. Relatives told us they had been fully involved in the assessment and care plan process.

Staff had completed induction training prior to delivering services to people and they had regular refresher courses to maintain their skills and knowledge. Staff received training and support in relation to infection prevention and control

People were supported to maintain or improve their health. They had access to external health care professionals when needed.

The management team gathered feedback about the quality of the service through telephone calls, surveys and visits to people using the service and their relatives.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People received person-centred support to achieve positive outcomes. Staff had received training about people’s right and choices, and this was promoted in their practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 May 2019) with breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We received concerns in relation to the safety and wellbeing of people using the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

We found no evidence during this inspection that people were at risk of harm from this concern.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the effective and well-led sections of this full report.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elyon Healthcare on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ Safe recruitment procedures had not been consistently followed; at the time of the inspection this was being investigated by the police. Action had been taken by the provider following the concerns being raised to ensure that people’s support was provided in a safe appropriate way. However, the provider's own quality assurance systems had failed to identify the concerns.

¿ Governance systems and audits were not always effective in identifying where improvements were needed.

¿ Risk assessments required reviewing to ensure they were reflective of people’s current needs.

¿ The induction process for staff who had not worked in health and social care previously required strengthening.

¿ The staff were friendly, passionate about their work and caring; they treated people with respect, kindness, dignity and compassion.

¿ Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The provider was aware of how to make referrals if people lacked capacity to consent to aspects of their care and support and were being deprived of their liberty.

¿ People were supported to maintain good health and nutrition.

¿ Information was provided to people in an accessible format to enable them to make decisions about their care and support.

¿ People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

Rating at last inspection: Requires Improvement (Report Published April 2018). The overall rating has remained the same. The service has been rated requires improvement at the last two inspections.

Why we inspected: This inspection was brought forward due to concerns raised by the police about recruitment practices at the service.

Enforcement: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed.

Follow up: We will continue to monitor this service. We will check improvements have been made by completing a further inspection in line with our re-inspection schedule for those services rated requires improvement.

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

Personal care is a regulated activity; CQC only inspects the service being received by people provided with 'personal care' living in their own homes or in specialist housing; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager. 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 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 9 and 11 January 2018. Five breaches of legal requirements were found. After the comprehensive inspection, the provider was asked to provide an action plan to tell us what they would do to meet legal requirements in relation to breaches in Safe care and treatment, Safeguarding service users from abuse and improper treatment, Receiving and acting on complaints, Staffing and Good governance. We received the action plan which showed how Elyon Healthcare planned to be compliant with these regulations.

We issued two warning notices to the provider in relation to Staffing and Good governance. We undertook this unannounced focused inspection to check that the provider was compliant with the warning notices by the date we had asked them to be. 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 Elyon Healthcare on our website at www.cqc.org.uk

At this inspection we found the provider had made most of the required improvements and was compliant with the warning notices.

People received their care as planned from staff that had the skills and competencies to provide their care. The provider had a clear plan of action to improve and embed the rotas and ensure people received their care.

The provider had a clear oversight of the service. They had systems in place to monitor the quality of the service; however, these systems required further improvement to embed audits and evaluate their findings.

We could not improve the rating for Safe or Well Led above requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Elyon Healthcare is a domiciliary care agency providing personal care and treatment for disease or injury to adults and children. At the time of inspection they provided care for 18 people; five older persons, nine children, four of which had complex health needs and four younger adults.

Personal care is a regulated activity; CQC only inspects the service being received by people provided with 'personal care' living in their own homes or in specialist housing; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service had a registered manager. 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 and associated Regulations about how the service is run.

The provider Elyon Healthcare Ltd has one director, who is also the registered manager. The provider had a vision to build a service to meet the needs of three types of service users; children, young adults and older adults. In building the three areas of the service the provider had not ensured they had the systems and processes in place to assess, monitor and improve all areas of the quality and safety of the service. This service required improvements to ensure people received safe care.

The provider did not have oversight of the deployment of staff to meet older people’s needs; as a result people did not always receive their allocated time for care. People were not given the time or opportunity to have all of their meals, prescribed medicines or personal care. The provider did not identify that older people were at risk of neglect due to the inadequate deployment of staff.

People could not be assured that they would always be protected from the risk of harm or poor practice. The provider did not have systems in place to identify issues that may indicate potential abuse; or then report any issues to all of the relevant authorities immediately.

Staff did not always ensure that older people received their medicines in a safe way. Although the provider had identified that people’s medicines were not being safely managed they had not taken sufficient action to change staff practice to make people safe. We have made a recommendation about the use of emergency medicines.

People were at risk of not having their complaints responded to as not all information reached the right person to be recorded. Written information was not analysed for the potential for concerns or complaints. Where complaints had been recorded the provider had followed their procedures to manage people’s complaints.

Staff did not always understand their responsibilities under the Mental Capacity Act. The service needed to improve their existing culture to embrace the changes required to ensure people are treated with respect and working practices were carried out in line with the protected characteristics under the Equality Act. We have made a recommendation about advocacy for people who may need support to make decisions.

People were cared for by staff that had been employed using safe recruitment practices. Staff received training and supervision to support them in their roles.

People had risk assessments that were reviewed regularly; people received their care as planned to mitigate their assessed risks.

People’s (adult) care was provided by staff that had received training and support to carry out their roles.

Children received care from staff that had the skills and competencies to provide their care; they were closely supervised by a paediatric nurse who supported staff in their roles.

Where people chose to stay at home as they approached the end of their life. Staff referred people to healthcare professionals for assessment and symptom control.

People were protected from the risk of infection by staff that complied with their infection prevention policy.

We made a recommendation about exploring people’s future wishes and priorities for care including care at end of life.

We made a recommendation about compliance with the Accessible Information Standard.

At this inspection we found that Elyon Healthcare were in breach of five regulations relating to the staffing, medicines, safeguarding, complaints and governance as the provider did not have sufficient systems and processes in place to ensure the quality and safety of the service.

This is the first time the service has been rated Requires Improvement.

You can see what action we told the provider to take at the back of the full version of the report.