Elite Homecare

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not safe and were at risk of avoidable harm.

The provider was in of breach of legal regulation in relation to safe medicines management, individual risk management, staffing and safe recruitment.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

We found there were no processes in place at the service to learn from mistakes, such as missed calls and medication errors. Action had not been taken to mitigate future risks to people. We were not assured potential safeguardings or other incidents had been identified and managed to improve the service and ensure people were kept safe.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We found no evidence care and support was planned and organised with people, together with partners and communities in ways that ensured continuity. People did not always have care plans in place at the time of commencement of their care calls. This meant staff did not always know about people’s health and care needs, wants and wishes to enable them to provide safe and effective care.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People told us they felt safe with staff during their care calls and did not have concerns around their safety. However, not all staff were able to describe to us how they would identify when someone was at risk of abuse and some staff told us they had not had safeguarding training. The management team told us there had not been any safeguarding’s, incidents, accidents or complaints and therefore, were not able to demonstrate how these were managed and mitigated safely. However, we found incidents had occurred where people had been placed at the risk of harm. People told us they had experienced missed care calls, and we found evidence medication errors had occurred. Actions had not been taken to future mitigate these incidents.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found no evidence people had been involved in the assessment and management of their individual risks. It was evident people had specific risks, such as a high risk of falls or skin integrity risks; however, no risk management plan was in place to guide staff on how to keep people safe. The management team told us there was no-one at the service who required moving and handling support due to their mobility needs and staff had not undergone practical moving and handling training. However, we found several people required this type of support, including the use of a hoist.

We also found staff were supporting people with their catheter care without the relevant training on how to safely care for people who used this medical equipment. One staff member told us they did not know how to provide catheter care and had previously raised this concern with the management team but did not receive assistance. They told us, “I had to figure it out on my own”. During a review of care documentation, we found two people were supported by staff to use a shower chair; however, neither person used a safety belt and there was no risk assessment in place to manage this risk. We raised a safeguarding with the local authority as we found staff were supporting people with equipment, medical devices and moving and handling without the necessary training in place.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We found care plans included environmental risk assessments of the person’s home and property. We reviewed 3 of these documents and found 2 were only partially completed and any potential risks were mostly marked as “none identified” throughout the document. The other risk assessment had not been revisited since 2022. Therefore, we were not assured a robust and up-to-date assessment had been carried out for each person’s living environment.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

We found significant concerns in relation to the provision of suitably qualified, competent, skilled and experienced staff to ensure they could meet people’s care and treatment needs. We were not assured staff had received sufficient and appropriate training and competency checks to ensure the delivery of safe care and treatment, nor that staff had received effective support, supervision and appraisal. The training listed on the training matrix did not align with information provided to service users in their handbook about the training staff would receive, it also did not align with what staff told us about what training they had completed. Staff had not received appropriate moving and handling training or skin pressure care training, despite people being provided with this support. Staff had not received regular infection prevention and control (IPC) training, and staff had not received mandatory Learning Disability and Autism training in line with CQC regulations. Staff told us they had to complete the training and shadowing in their own time and did not get paid for this. We found no evidence to show staff had undergone robust and regular checks of their competency, so the management team could assure themselves people were receiving safe and good quality care.

Robust and safe recruitment practices were not in place to make sure all staff were suitably experienced, competent and able to carry out their role. During a review of recruitment files, we found concerns with a lack of suitable and appropriate employment references, lack of employment histories and one staff member did not have a suitable police check in place. We also discovered another staff member had been working for the service for over a year, and their name was not on the staff list provided to us. We requested recruitment details for this person along with the other outstanding recruitment information to be sent to us. Despite several requests for this information, it was never provided to us. This meant we could not be assured only suitable staff had been employed to care for people in their own home, some of whom may be vulnerable. We shared our concerns with the local authority.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

Staff told us they had not had training in relation to infection prevention and control, and this training was not included within the training list for staff. However, people told us staff usually wore personal, protective equipment (PPE) during care calls.

The provider did not make sure medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

We were not assured staff had received up-to-date training nor that competency checks in relation to medicines administration had been carried out. We reviewed a sample of people’s medicine administration records (MARs) and found concerns regarding the accuracy of recordings. We found evidence of medication errors, including large gaps in the records which indicated people had not had their medicines as prescribed. The medicine administration procedure was not robust and did not follow best practice guidance, for example, medicines had been handwritten on MARs without any checks or balances completed to ensure these entries were accurate. We found no evidence of immediate actions being taken where people had missed their medicines, or action taken to mitigate future risks when MARs had not been completed or contained errors. Our concerns around unsafe medicine administration were such that we raised a safeguarding alert with the local authority.