We carried out a review of the data available to us about EL Marsh Supported Living on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about EL Marsh Supported Living, you can give feedback on this service.
About the service
EL Marsh Supported Living is registered to provide personal care to adults in their own homes. People had differing support needs including learning disabilities, mental health conditions and physical disabilities. At the time of inspection nine people were receiving the regulated activity.
Not everyone who used the service 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. At the time of the inspection six people were receiving support with personal care.
People’s experience of using this service and what we found
Right Support
The staff supported people to have the maximum possible choice, control and independence over their own lives. People were supported by staff to pursue their interests. The provider worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced. Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people to play an active role in maintaining their own health and wellbeing.
Right Care
Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right culture
People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. People and those important to them, including advocates, were involved in planning their care. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.
For more details, please see the full report which is on the CQC website at www.cqc.og.uk.
Rating at last inspection and update
The last rating for this service was inadequate (published 23 November 2021) and there were 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.
This service has been in Special Measures since 23 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for El Marsh Supported Living on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
EL Marsh Supported Living is registered to provide personal care to adults in their own homes. People had differing support needs including learning disabilities, mental health conditions and physical disabilities.
Not everyone who used the service 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. At the time of the inspection six people were receiving support with personal care.
People’s experience of using this service and what we found
Staff were not always wearing personal protective equipment (PPE) correctly and some staff were not being tested regularly for COVID-19. Some people were supported by staff who hadn’t had the training to meet their specific needs. People and most relatives told us they felt safe.
Governance systems had not identified the shortfalls we found on the inspection and some concerns identified at our last inspection had not been addressed. The provider had not always ensured that staff practices were in line with their own policies. Some relatives felt communication with management was improving but not all.
People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not always support this practice. Mental capacity assessments did not clearly indicate how the individual had been included and there were inconsistencies in the recording of best interest decisions.
Improvement was required to ensure staff had training in all relevant areas. People were supported to make choices about food and the service worked with relevant health professionals to ensure people’s health care needs were met.
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.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Some staff were not trained in restrictive interventions techniques. The provider was not consistently evidencing how people were included in mental capacity assessments and best interest decisions and were not adhering to their own policy.
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 04 October 2019) and there was a breach in regulations.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to how people who displayed distressed behaviours were supported, staff not wearing PPE in line with guidance and the oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for El Marsh Supported Living on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to regulation 12, safe care and treatment and regulation 17, governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
EL Marsh Supported Living is a supported living service providing personal care to adults in their own homes. People had a range of needs including learning disabilities, mental health conditions and sensory impairments. On the day of the inspection, 17 people were receiving support.
Not everyone who used the service 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.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes.
The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
The manager was not yet registered with The Care Quality Commission (CQC) but was in the process of doing this. Systems were not effective for monitoring the quality and safety of the services provided. Documentation relating to behaviour that challenged did not contain enough detail and were not consistently completed. Staff knew how to raise concerns.
Medicines were not always recorded correctly. Care plan and risk assessments did not always contain enough detail. People felt safe and staff had good knowledge of safeguarding processes. There were enough staff to support people safely.
People’s assessed needs were not always accurately reflected in their care plans. 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; the policies and systems in the service did support this practice although evidence of capacity assessments were lacking.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
People were encouraged and supported to take part in activities. People’s personal preferences were identified in their care plans. People were supported to build and maintain relationships.
People were supported by staff who knew them well. People’s privacy and dignity was maintained. Staff promoted people’s independence.
As part of thematic review, we carried out a survey with the manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.
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)
This service was registered with us on 15 August 2018 and this is the first inspection.
Why we inspected
This was a planned inspection.
Enforcement
We have identified breaches in relation to good governance during this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.