Elegant Care Services was rated Requires Improvement overall following a focused inspection in November 2023, with breaches of Regulations 11, 12 and 17 identified in relation to consent and capacity, safe care and treatment (including medicines and restrictive practices), and governance. The service declined significantly from its previous Outstanding rating, though strengths remained in safeguarding awareness, infection control, health support and a positive staff culture.
Concerns (8)
criticalIncident learning: “The provider was not able to evidence they had an effective system to investigate and analyse incidents.”
critical
Medication management
: “One person had a specific PRN medicine...the staff had not been trained or assessed as competent to complete this task.”
criticalConsent / capacity: “Each person's records had a range of consent forms that had been signed by their relatives, even when the person had been assessed as having capacity.”
criticalGovernance: “The concerns we found on the inspection...were not identified through the provider's own quality monitoring systems.”
criticalCare planning: “Support plans did not include clear guidance for staff in what circumstances people should be restrained or use restrictive practices.”
moderateRecord keeping: “Some of the incident forms were not completed fully. It was not clear what remedial actions were taken including review of incidents, risks and outcomes.”
moderateStaff training: “Some of the staff required to complete their training to ensure they were able to support people with different conditions such as epilepsy, mental health, restrictive practices.”
moderateSafeguarding: “Staff did not demonstrate they had the knowledge and understanding they did everything they could to avoid restraining people.”
Strengths
· Staff were kind, caring and knew people's individual communication needs well, with relatives describing the environment as a 'home from home'.
· People were supported to access specialist health and social care, with health action plans and hospital passports in place.
· Effective infection prevention and control practices were in place, with staff using PPE appropriately.
· Staff turnover was stable, enabling consistent relationships between staff and people using the service.
· The registered manager was visible, approachable and respected by staff, people and relatives.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood