About the service EL Marsh Supported Living is registered to provide personal care to adults in their own homes. People had differing support needs including learning disabilities, mental health conditions and physical disabilities.
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 six people were receiving support with personal care.
People’s experience of using this service and what we found
Staff were not always wearing personal protective equipment (PPE) correctly and some staff were not being tested regularly for COVID-19. Some people were supported by staff who hadn’t had the training to meet their specific needs. People and most relatives told us they felt safe.
Governance systems had not identified the shortfalls we found on the inspection and some concerns identified at our last inspection had not been addressed. The provider had not always ensured that staff practices were in line with their own policies. Some relatives felt communication with management was improving but not all.
People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not always support this practice. Mental capacity assessments did not clearly indicate how the individual had been included and there were inconsistencies in the recording of best interest decisions.
Improvement was required to ensure staff had training in all relevant areas. People were supported to make choices about food and the service worked with relevant health professionals to ensure people’s health care needs were met.
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 some of the underpinning principles of Right support, right care, right culture. Some staff were not trained in restrictive interventions techniques. The provider was not consistently evidencing how people were included in mental capacity assessments and best interest decisions and were not adhering to their own policy.
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 requires improvement (published 04 October 2019) and there was a breach in regulations.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to how people who displayed distressed behaviours were supported, staff not wearing PPE in line with guidance and the oversight of the service. 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 requires improvement 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 report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for El Marsh Supported Living 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 regulation 12, safe care and treatment and regulation 17, governance at this inspection.
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
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.