Elite Careplus Ltd, a domiciliary care agency serving 33 people, was rated Good across all five key questions at its September 2023 inspection, with the caring domain improving from Requires improvement at the previous 2018 inspection. The service demonstrated strong safeguarding practices, consistent staffing, effective governance and an open, person-centred culture.
Strengths
· People felt safe and staff demonstrated good knowledge of safeguarding procedures and processes.
· Robust recruitment practices including DBS checks and pre-employment references ensured safe staffing.
· Classroom-based training praised by staff as more effective than e-learning, with comments such as 'Best training I've done with any agency'.
· Consistent allocation of regular care workers enabled trusting relationships, improving on a previous 'Requires improvement' rating for caring.
· Technology used effectively to inform people promptly about potentially missed or late calls.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Leaders and the culture they created promoted high quality, person-centred careGood
well-led: Engaging and involving people using the service, the public and staff; Continuous learning and improving careGood
Elite Careplus Ltd improved from 'Requires Improvement' to 'Good' overall, resolving all five previous regulatory breaches including medicines management, recruitment, governance, notifications, and person-centred care. The single remaining weakness was in the 'Caring' domain, where irregular staff were consistently reported by people as unfriendly, uninformed about care needs, and lacking the relational warmth of regular staff.
Concerns (3)
moderatePerson-centred care: “When she was on holiday the staff who came to support me did not say much and didn't really know what I needed them to do.”
moderateStaff competency: “My regular carer is lovely, but when I had a carer I did not know they were unfriendly and cold in their attitude to me. They didn't really know what support I needed either.”
minorCommunication with families: “People said they were not so satisfied with times when they were supported by staff they did not know. People said those staff were less friendly and did not know their needs so well.”
Strengths
· Significant improvements made to medicines administration records and recruitment procedures, resolving previous breaches
· Staff trained in adult safeguarding and knew how to identify and report concerns about potential abuse
· Risk assessments were thorough, regularly reviewed, and included clear instructions to minimise risks
· Staff received regular supervision, annual appraisals, and up-to-date training including induction and shadowing
· Care plans redesigned to be comprehensive, person-centred, written in the first person, and signed by people
Elite Careplus Ltd was rated Requires Improvement overall at its first CQC inspection in January 2017, with five regulatory breaches identified covering unsafe recruitment, unsafe medicines management, poor care planning, inadequate governance, and failure to submit statutory notifications. While staff were praised for their caring attitude and the service demonstrated good training practices and MCA awareness, significant risks to people's safety and wellbeing were undetected by the provider's own quality monitoring systems.
Concerns (10)
criticalMedication management: “Staff had not always signed MAR charts correctly to evidence they had administered the person's medicines. We also reported our concerns about medicines management to the local authority as a safeguarding alert.”
criticalSafeguarding: “They had not informed us of an allegation of abuse in relation to a service user. Regulation 18 Registration Regulations 2009 Notifications of other incidents.”
criticalStaff competency: “Two staff members did not have a criminal records check [DBS]. One staff member started working six weeks before their DBS check was received.”
criticalGovernance: “The registered manager had not submitted to CQC the notifications of relevant events and changes as they are required to do by law.”
moderateCare planning: “None of the support plans we looked at had been signed by the person receiving the support or their representative to show they had agreed to these.”
moderatePerson-centred care: “Elite Careplus matched a person to staff by staff availability only and did not consider the person's support needs, background history, cultural or religious needs.”
moderateRecord keeping: “Care files and staff records were not stored securely. We found other files containing personal information of staff or people who used the service on the floor of the office in a large cardboard box.”
moderateIncident learning: “Incidents, accidents and complaints were not recorded centrally so these could be analysed in a systematic way for action to be taken where possible to help prevent further occurrences.”
moderateCultural competency: “They were unable to match the person's support needs, background history, cultural or religious needs to a suitable staff member.”
minorSupervision / appraisal: “Records we looked at showed some staff did not receive formal supervision on a regular basis but were able to speak with the manager at any time.”
Strengths
· Staff were knowledgeable in recognising signs of potential abuse and the action they needed to take; all people and relatives said they felt safe.
· Staff received appropriate training with numerous current certificates of completed training courses evidenced in staff files.
· The registered manager had a good understanding of responsibilities in relation to the Mental Capacity Act 2005 with up to date policies and procedures.
· People and relatives consistently praised staff as caring, kind and attentive, with positive comments including 'I have the best carer, she does any job needed and is always smiling.'
· Individual risk assessments were in place covering a range of daily activities with risk management plans where risks were identified.
Quality-Statement breakdown (16)
safe: Recruitment practicesRequires improvement
safe: Medicines managementRequires improvement
safe: Safeguarding awarenessGood
safe: Risk assessmentsGood
effective: Staff training and supportGood
effective: Mental Capacity Act complianceGood
effective: Health needs coordinationGood
caring: Privacy and dignityGood
caring: Person-centred matching and care planning
Requires improvement
responsive: Support plan comprehensivenessRequires improvement
responsive: Complaints policy and procedureGood
responsive: Communication and responsiveness to peopleRequires improvement
well-led: Quality monitoring and governance systemsRequires improvement