Background to this inspection
Updated
11 January 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team was made up of two inspectors and two members of the CQC medicines team.
Service and service type
This service provides care and support to people living in eight 'supported living' settings, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post, however there was a manager present who was going through the application process to become registered.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We communicated with 9 people who used the service and 13 relatives about their experience of the care provided. People who used the service who were unable to talk with us, so we used different ways of communicating including using Makaton (a type of sign language), pictures, photos, symbols, objects and their body language. We are improving how we hear people's experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. For this inspection, we used this communication tool with 1 person to tell us about their experience.
We spoke with 12 members of staff including the nominated individual, managers, human resources and support workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 6 people's care records and multiple medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
Updated
11 January 2023
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
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.