St Elizabeth's Domiciliary Care Agency

About the service

St Elizabeth's Domiciliary Care is a supported living service for people with learning disability and autism. The service was provided to adults in shared accommodation on their college site and in individual flats.

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 26 people were supported with the regulated activity.

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

Right Support

Staff did not always support people with their medicines to achieve the best possible health outcome. The provider did not ensure they had robust systems in place to manage medicines, however this was actioned immediately during the inspection.

People were supported to have choice and control of their lives and staff attempted to support people in the least restrictive way possible and in their best interests. However, there needed to be further development with documenting where decisions were made in people’s best interest and where people may lack capacity.

Staff adhered to safe practices when wearing personal protective equipment (PPE).

Right Care

People had care plans and risk assessments; however, these were not always clear and coordinated. The management team were updating these during the inspection.

People had enough appropriately skilled staff to meet people's needs and to keep them safe. Further development was needed where staff needed to use different methods of communication to support people.

Staff were starting to understand, and responded to, people's individual needs. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to to help promote people’s safety and wellbeing. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

People's quality of support was not always enhanced by the quality assurance system the provider had in place. Actions were not always documented, and it was unclear if actions were completed to improve the service

The management team had put systems and development plans in place to drive improvement and share lessons learnt from the previous inspections.

People did not always have risk assessments in place, to identify risks people faced and how staff should manage these.

People were supported by staff who understood best practice in relation to supporting people with a learning disability and autism.

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 inadequate (published 05 August 2022). At this inspection we found improvements had been made, however the provider remained in breach of regulations.

This service has been in Special Measures since 02 March 2022. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall. 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.

We undertook this focused inspection to check they had followed their action plan and to follow up on intelligence we had received about the service. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to 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 St Elizabeth's Domiciliary Care Agency on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, risk management and good governance at 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

St Elizabeth’s Domiciliary Care is a supported living service for people with learning disability and autism. The service was provided to adults in shared accommodation on their college site and in individual flats.

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 30 people were supported with the regulated activity.

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

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture

Right support

People had care plans and risk assessments that in places had contradictions or missing information to identify risks people faced and how staff should manage these. Staff were not always knowledgeable about the content of these risk assessments.

Due to staffing restrictions there were times where people could not have a fulfilling and meaningful everyday life. People were not always supported to pursue their interests, although there had been more opportunity than at the last inspection., People told us they were not able to go out with in the local community as much as they wished to.

The provider failed to ensure people were supported with their medicines in line with safe and best practice to achieve the best possible health outcomes. We found the same areas requiring improvement that were identified at the last inspection.

The provider failed to support people to have maximum possible choice, control and independence in terms of their day to day support.

Right Care

The service failed to ensure there were enough appropriately skilled staff to meet people’s needs and keep them safe.

People were not always supported by a service that had effective systems in place to report and respond to accidents and incidents. Accidents and incidents were identified however, there was a lack of action following these incidents which meant people continued to receive poor care.

Right culture

People were supported by staff who did not always understand best practice in relation to supporting people with a learning disability. The provider did not ensure people were supported by staff that had the right skills and training, however the provider had started to address this.

People’s quality of support was not always enhanced by the providers quality assurance system. Areas for improvement were not always documented, and it was unclear if these were acted on. This had an impact on people’s care.

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 inadequate (published 08 February 2022). At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since 02 March 2022 During this inspection the provider did not demonstrate that adequate improvements had been made. Therefore, the service remains rated as inadequate overall. Therefore, this service is still 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.

We undertook this focused inspection to check they had followed their action plan and to follow up on intelligence we had received about the service. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. 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 St Elizabeth’s Domiciliary Care Agency on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to keeping people safe, not having enough skilled staff which impacted on people’s day to day lives, people not receiving support that was person centred and the management oversight did not always identify and implement improvement promptly.

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

St Elizabeth's Domiciliary Care Agency is a supported living service for people with learning disability and autism. The service was provided to adults in shared accommodation on their college site and in individual flats.

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 32 people were supported with the regulated activity.

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

People were put at risk of harm due to the lack of safeguarding processes and effective systems in place to implement improvements where risks had been identified. Care plans and risk assessments did not always correlate and identify fundamental information to ensure people were supported in a safe way. People did not always receive their medicines in line with their care plans. There was a lack of staff trained to administer medicines, which had an impact on delivery of care.

People did not always get the dedicated support commissioned and this meant people were not always provided with safe support and were unable to experience new things or meet their aspirations.

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

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 the underpinning principles of Right support, right care, right culture. People did not receive support that was person-centred and gave them autonomy on their life. Relatives felt there needed to be a stronger focus on people’s interests and ensuring their support was meaningful to them. People did not have choice of who they were supported by. Support did not focus on people’s quality of life or follow best practice.

Staff told us and records confirmed there needed to be additional training to ensure there was enough appropriately skilled staff to meet people’s needs.

The management team did not always offer the support and leadership required for the staff. Staff felt there was a lack of communication between staff and management. The provider and manager had a governance system in place, which included various audits and monitoring, however, these were not effective and did not identify the issues we found.

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

Rating at last inspection

The last rating for this service was good (published September 2019).

Why we inspected

We received concerns in relation to the management of safeguarding concerns. 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 good 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 full report.

You can see what action we have asked the provider to take at the end of this full report.

Following the inspection visit the nominated individual met with CQC to discuss their evaluation of the inspection and what actions they will be starting to take following the visit. The nominated individual stated they were to develop an action plan following the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Elizabeth's Domiciliary Care Agency 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 safe management of medicines, management of risk, developing care that is person centred and the governance oversight at this inspection.

At the previous inspection we have identified breaches of regulation in relation safe care and governance and oversight. In response to the areas of risk we took enforcement action to keep people safe. This included conditions being placed on the provider's registration to restrict them from providing care to new people unless they take specific actions to ensure this is done safely.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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.

St Elizabeth's Domiciliary Care Agency is a supported living service for people with learning disability and autism. The service was provided to young adults in shared accommodation on their college site and also in individual flats in the community.

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. 12 people were supported with the regulated activity at the time of the inspection.

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

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 supported this practice.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People`s support needs were well documented and staff had guidance in place to be able to effectively support people. People achieved positive outcomes due to the structured support they received.

People were encouraged to take positive risks and live fulfilling lives. The registered manager empowered staff to act as advocates for people so that people`s choices and wishes could be shared with other professionals involved in their care.

Staff received training to understand national best practice guidance and legislation around supporting people with learning disability and autism to be included in society and be active part of their community. Staff told us they felt supported and valued by the organisation they worked for.

Staff were knowledgeable about people`s needs and how to manage any risk involved. Staff were well trained and skilled to support people safely and effectively.

People`s care plans were developed in partnership with them and evidenced their voice in terms of their likes and dislikes and what they wanted to achieve in their lives. People were given information in the format suitable for them to understand and feel involved in the care and support they received.

People lived an active life and were supported by staff to seek employment, attend college, socialise and develop new skills.

There was an effective management system in place with clear roles and responsibilities for managers and staff. This meant that systems and processes were effectively used across all the supported living sites and there were no differences in the quality of the care people received.

The registered managers were closely involved in the monitoring of the quality of the services provided to ensure these were effective and met people`s needs safely. There was effective partnership working with health and social care professionals involved in people`s care to ensure this was seamless and promoted people`s health and well-being.

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

Rating at last inspection: The last rating for this service was good (published 17 March 2016). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.