Eliezer Supported Living Services Limited

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.

This was the first assessment for this service. This key question has been rated Good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The management team were open and transparent in their approach and ensured learning from events was shared within the staff team. There was a provider policy for the duty of candour. This policy guided the service to tell the person (or, where appropriate their advocate) when something had gone wrong. We reviewed complaints that had been made and saw this policy had been followed by the management team.

Regular audits and quality monitoring processes showed evidence of analysis for themes and trends. Responses to any complaints or concerns were shared with the person or their relative in a timely manner. Actions had been taken, where needed, to improve care outcomes for people.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider ensured they worked in partnership with external health and social care teams, so people received a wraparound care experience.

One person told us, “I have voice therapy, a district nurse, occupational therapy and a physiotherapist. I have a lot of support.” A relative told us, “The district nurse calls 3 times a week and works well with the carers.”

Staff told us they felt confident with the pre-admission process for the service. One staff member told us, “We are given a detailed handover when we support a new client which includes: clients medical history, mobility and use of equipment, nutritional needs, details on medication, any risks, call times, skin integrity and continence needs. A welcome pack was in place, with the support plan for clients and a care plan summary.” Another staff member said, “The management team communicate well with other professionals such as district nurses, physiotherapists, and the occupational therapists on behalf of clients.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider ensured safeguarding was a priority at the service. Each person had a service user pack, including details of local safeguarding contacts, CQC information and the provider safeguarding policy and procedure.

People and their relatives told us they felt safe with staff, and their wishes were respected.

One person said, “I feel very safe in the carers company, they are well trained and know what they are doing when they assist me. Staff know how to use the equipment. I always have 2 carers. They turn up mostly on time, if they are ever running late, they let me know. I am happy with the care I receive as they allow me to be as independent as I can, and they are always talking, which I love.” Another person gave positive feedback, and said, “I feel safe when staff assist me in moving. They allow and understand how important it is for me to be as independent as I can. I don’t feel worried, and I do feel safe.”

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

The service was in the process of transitioning onto an electronic care planning system, hosted by a new provider. We found some of the current care plans and risk assessments lacked completeness whilst these were being updated onto the new system. This left people exposed to the risk that staff would not have current information on their identified needs. We asked the provider to ensure these care plans and risk assessments were completed promptly. The provider submitted a clear action plan after our visit, which detailed their response to ensuring these actions were completed. We will review this at our next assessment.

We found no evidence that people had been harmed by the shortfalls in care planning and risk assessing. People and their relatives all gave positive feedback about their care provision and the understanding of staff regarding identified risks. One relative told us, “The carers timings are pretty good, we have a good rapport. My family member is hoisted, and the carers always check that they are comfortable and safe. My family member doesn’t show any signs of distress, and the carers know what they are doing and talk them through the process. We have a care plan, and it has been updated if there are any changes.”

The management team had processes in place for monitoring the safety of people’s home environment. For example, they documented their regular checks of fire safety, equipment and waste management and included these within robust risk assessments.

People and their relatives felt their home environment was managed safely and staff respected their personal space. People told us that staff kept their environment safe and tidy. One person said, “The carers use the key safe to enter my property. They always lock up behind them and put the key back in the safe.” Another person said, “The carers are respectful around my home and always dispose of clinical waste in the correct dustbin.” A relative told us, “The carers are very pleasant, cheerful and caring and respect our home.”

Staff knew how to monitor the safety of the environment, and where to report any concerns to. Staff were able to give examples of how they ensured they supported people to maintain a safe environment which included following risk assessments. One staff member said, “We make regular checks on equipment. For example, we always make sure people are wearing their care alarms, (Lifeline) before we leave.”

People’s home environment, inside and outside, was assessed by one of the management team when people started care, and staff carried out ongoing observations and reported any concerns regarding the environment to the management team.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider ensured they had sufficient staff to cover all of the care calls for people. Staff were sufficiently trained to ensure they could meet people’s identified needs.

People and their relatives were confident in the knowledge and skills of the staff team. A relative told us, “My family member feels totally safe with the carers and trusts them explicitly. They have built up their trust, the staff are well trained and familiar with my family member’s care needs, they understand the timings of the calls are essential.” Another relative told us, I have no issue with the carers; the carers always turn up and we have not been let down.” Staff told us they felt the service was sufficiently staffed, in order for them to complete all of their allocated care calls.

The provider followed a robust recruitment process, with all staff given an induction and probationary period, during which any further training needs were identified. All staff, during induction, were made aware of the organisation’s policies and procedures, which were also shared in regular training updates. All policies and procedures were reviewed and amended where necessary, and staff were made aware of any changes.

Regular observations were undertaken to check staff skills and competencies. Various methods of staff training were being used, including one to one, online, workbooks, group meetings, and individual supervision. External courses were sourced as required. Staff felt the training and support available to them was sufficient to ensure they had all of the skills required to support people. One staff member said, “The company provides me with the training required for optimum quality care delivery. In addition, we have extra training, like diabetes, dementia, and multiple sclerosis awareness.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had a robust infection, prevention and control policy, which people and their relatives all told us staff adhered to when on a care call.

People and their relatives were confident that care staff followed best practice guidance to prevent and control infections. The provider had a robust policy in place, which was used as part of the staff induction process. One staff member told us, “We are provided with personal protective equipment and hand sanitiser for care calls. Emphasis is given during meetings and supervision. We also have access to the infection control policy.”

One person said, “I have 4 calls a day, the carers let themselves in and always introduce themselves when entering the property. I always have 2 carers who support me with transporting from the bed to the chair. They wear protective personal equipment (PPE), when doing personal care and ask if I consent before doing anything.” A relative told us, “The staff wear PPE when doing personal care and always talk through any processes. They are very good at calming my family member down if they see they are becoming agitated.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Some people using the service did not receive support with their medicines.

The service was in the process of transitioning onto an electronic medicines management system, hosted by a new provider. We found some shortfalls in the current medicines care plans, risk assessments and administration charts, which were yet to be embedded into this new system. This left people exposed to the risk that staff would not have current information on their medicines. We asked the provider to ensure these medicines care plans and risk assessments were completed promptly. The provider submitted an action plan immediately after our site visit. We will review the actions taken at our next assessment.

We found no evidence that people had been harmed by any gaps in medicines documentation. The completed plans which we reviewed were person centred, detailed, and gave staff clear guidance on any adverse impacts of specific medicines. People and their relatives were confident in the support they received with medicines. One person said, “I have four calls a day, the carers prompt me with my medication.”

Where people required ‘as required’ medicines, for example, for pain relief, the protocols in place were clear. However, these had not been reviewed or signed off by the prescriber, which we requested the provider to action promptly. The provider confirmed this had been actioned the day after our site visit.

The provider carried out regular audits of medicines, to improve practice and learn lessons from any errors. These were shared with staff during supervision and as part of competency checks on staff skills.