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Review of
compliance
The Congregation of the Daughters of the Cross of
Liege
St Elizabeth's Domiciliary Care Agency
Region:
Location address:
South End
Much Hadham
Hertfordshire
SG10 6EW
Type of service:
Date of Publication:
Overview of the service:
St Elizabeths Domiciliary Care Agency
provides a service to people with a
learning disability who attend St
Elizabeth's college in order to support
them with everyday living.
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Our current overall judgement
St Elizabeth's Domiciliary Care Agency was meeting all the essential
standards of quality and safety.
The summary below describes why we carried out this review, what we found and any
action required.
Why we carried out this review
We carried out this review as part of our routine schedule of planned reviews.
How we carried out this review
We reviewed all the information we hold about this provider, carried out a visit on 22
November 2011, observed how people were being cared for, looked at records of people
who use services, talked to staff and reviewed information from stakeholders.
What people told us
One person who uses the service we spoke with told us that this was the best place they
had been. They said that their last home was not as nice as this and that they were happy
here. We were told that the staff are really nice and will do all they can to assist. We were
told that staff monitor the person's illness and have come to recognise signs of
deterioration. We were also told that this is very useful and allows the person some control
over their illness.
Relatives we spoke with told us that the care provision is fantastic, that the staff are skilled,
competent and understanding. We were told that the staff 'get it' in relation to the care of
the young people who use the service. We were also told that the service puts a big
investment in staff training and learning.
What we found about the standards we reviewed and how well St
Elizabeth's Domiciliary Care Agency was meeting them
Outcome 04: People should get safe and appropriate care that meets their needs
and supports their rights
The provider is compliant with this outcome because the people who use the service have
their care and welfare needs assessed and met.
Outcome 07: People should be protected from abuse and staff should respect their
human rights
The provider is compliant with this outcome staff are trained and have the appropriate
for the essential standards of quality and safety
Summary of our findings
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knowledge to recognise and respond to any signs of abuse.
Outcome 13: There should be enough members of staff to keep people safe and
meet their health and welfare needs
The provider is compliant with this outcome because there are sufficient trained staff on
duty to meet the identified needs of the people.
Outcome 14: Staff should be properly trained and supervised, and have the chance
to develop and improve their skills
The provider is compliant with this outcome because staff are trained to meet the needs of
the people who use the service. Staff are supported and supervised to care for people.
Outcome 16: The service should have quality checking systems to manage risks
and assure the health, welfare and safety of people who receive care
The provider is compliant with this outcome because the service has effective monitoring
and reviewing procedures in place to ensure the people's needs are recognised and met.
Other information
Please see previous reports for more information about previous reviews.
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What we found
for each essential standard of quality
and safety we reviewed
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The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we
reviewed, linked to specific regulated activities where appropriate.
We will have reached one of the following judgements for each essential standard.
Compliant
means that people who use services are experiencing the outcomes relating to
the essential standard.
A
minor concern
means that people who use services are safe but are not always
experiencing the outcomes relating to this essential standard.
A
moderate concern
means that people who use services are safe but are not always
experiencing the outcomes relating to this essential standard and there is an impact on
their health and wellbeing because of this.
A
major concern
means that people who use services are not experiencing the outcomes
relating to this essential standard and are not protected from unsafe or inappropriate care,
treatment and support.
Where we identify compliance, no further action is taken. Where we have concerns, the
most appropriate action is taken to ensure that the necessary improvements are made.
Where there are a number of concerns, we may look at them together to decide the level
of action to take.
More information about each of the outcomes can be found in the
compliance: Essential standards of quality and safety
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Outcome 04
Care and welfare of people who use services
What the outcome says
This is what people who use services should expect.
People who use services:
* Experience effective, safe and appropriate care, treatment and support that meets their
needs and protects their rights.
What we found
Our judgement
The provider is compliant with Outcome 04: Care and welfare of people who use
services
Our findings
What people who use the service experienced and told us
One person who uses the service we spoke with told us that this was the best place
they had been. They said that their last home was not as nice as this and that they
were happy here. We were told that the staff are really nice and will do all they can to
assist. We were told that staff monitor the person's illness and have come to recognise
signs of deterioration. We were also told that this is very useful and allows the person
some control over their illness.
Relatives we spoke with told us that the care provision was fantastic, that the staff were
skilled, competent and understanding. We were told that the staff 'get it' in relation to
the care of the young people who use the service. We were also told that the service
puts a big investment in staff training and learning.
Other evidence
We visited St Elizabeth's Domiciliary Care service on the 22 November 2011. During
our visit we did not identify any areas of concern in relation to the care and welfare of
the people who use the service.
We were told by the manager that St Elizabeth's aim is to prepare young people for a
more independent life in the community by working closely with the St Elizabeth's
College where they learn life skills. The care staff have duel roles, that of carer and that
of educators in the college. We were told by staff that this offers a seamless service to
the person using the service by ensuring their learning on promoting their
independence in the college is integrated into their daily lives.
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During our review of care plans we found they contained a range of information on all
aspects of the person's life including 'looking after yourself and your home, looking after
your health and assistance with medication. Looking after money and paying bills.
Going out into the community staying in touch with family and friends'. This ensured
that they were prepared for an independent life in the community.
We were told that each person had a named worker and they had a 24 hour support
service should the person need assistance at night. We were told that this service gave
the person confidence to move to a more independent lifestyle especially when they
had recently moved from their homes were new to the service and to the college. .
All care plans included an easy read version that allowed the person to understand and
to input how they wanted their care delivered. An example of this was directions on
how a person expresses themselves. There were clear instructions for the staff on how
long it takes the person to formulate and verbalise their thoughts. Should they not be
able to verbalise their thoughts after a given time they should be offer a pen and paper
and given the opportunity to write their needs down.
The people who are cared for were predominately young people and we saw that their
need for communication with other people and their social integration was addressed.
An example of this was facilitating people to travel to a local town to work in a workshop
making jewellery.
We observed a staff member assist and instruct a person on how to make a simple
meal at lunchtime. The member of staff conducted the task with skill and good humour
we saw the person being supported enjoyed the session as well as learning cooking
skills.
Our judgement
The provider is compliant with this outcome because the people who use the service
have their care and welfare needs assessed and met.
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Outcome 07
Safeguarding people who use services from abuse
What the outcome says
This is what people who use services should expect.
People who use services:
* Are protected from abuse, or the risk of abuse, and their human rights are respected and
upheld.
What we found
Our judgement
The provider is compliant with Outcome 07: Safeguarding people who use services
from abuse
Our findings
What people who use the service experienced and told us
People we spoke with told us that they feel very safe and that if they had a problem
they would go to a staff member for assistance. They all know the service manager and
said that they could go to her office if they had a problem.
Other evidence
During our visit we spoke with the person who takes responsibility for the safeguarding
of the people who use the service. We were told that the policy and procedures were
under constant review and that the service works closely with the Local Authority (LA)
this ensured the safety of the people who use the service because the service was
working with the most up to date information.
We were told that staff kept up to date on current policies and new thinking by attending
conferences held by Education and Health professionals. This means that the staff had
access to the current thinking and practices on the care of the people who used the
service.
We were told that all incidents or signs of abuse or suspected abuse were reported to
the most senior person on duty who then made a referral to the LA if appropriate. Staff
told us that they are vigilant in observing signs of abuse at all times. An example of this
was a young person who was showing signs of distress on returning from a home visit.
The reasons for the distress were investigated and an action plan was drawn up and
implemented.
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We were told that safeguarding training is completed as part of induction training, we
saw evidence that all staff had completed this training and were aware of what to do to
protect the person.
The information, we hold on this services demonstrates that the home informs CQC
appropriately of any incidents that occur in the service.
Our judgement
The provider is compliant with this outcome staff are trained and have the appropriate
knowledge to recognise and respond to any signs of abuse.
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Outcome 13
Staffing
What the outcome says
This is what people who use services should expect.
People who use services:
* Are safe and their health and welfare needs are met by sufficient numbers of appropriate
staff.
What we found
Our judgement
The provider is compliant with Outcome 13: Staffing
Our findings
What people who use the service experienced and told us
We did not speak to the people who use the service about this outcome.
Other evidence
During our visit we were told by staff and the people who use the service that there was
always enough staff on duty to meet the people's needs. We were told that the
workforce was stable with a very small turnover of staff. This means that the people
who use the service received a consistent service from staff they knew.
We saw that there were management structures in place and all the staff we spoke with
knew what their responsibilities were. Staff told us that there were clear procedures in
place for the delivery of care and that they were familiar with the care plans of the
people who use the service.
Staff told us that they try to be as flexible as possible and will volunteer to cover
colleagues who are off sick to ensure the people get the service they need. They also
told us that there are 'bad weather' arrangement in place should the need arise. An
example of this was during last winter's snow overnight accommodation was arranged
for staff who had difficulty in travelling this meant that the service was able to operate
normally.
Our judgement
The provider is compliant with this outcome because there are sufficient trained staff on
duty to meet the identified needs of the people.
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Outcome 14
Supporting staff
What the outcome says
This is what people who use services should expect.
People who use services:
* Are safe and their health and welfare needs are met by competent staff.
What we found
Our judgement
The provider is compliant with Outcome 14: Supporting staff
Our findings
What people who use the service experienced and told us
We did not speak to the people who use the service about this outcome.
Other evidence
During our visit the staff we spoke with told us that they felt really well supported by the
management team. They told us that they were listened to and could approach the
manager with any problems they may have had and felt confident that they would be
listened to.
We were told that the staff were encouraged to work in an open and transparent
manner and if a member of staff sees care delivery they were not happy with they were
expected to challenge that staff member. We were told that this is done in a positive
manner and that all staff knew it was to ensure the best possible care was given to the
people who used the service. The staff gave us examples of how this had been done in
the past and told us that this worked well and that they used each other's experiences
to learn from and to improve the service.
All the staff we spoke with had had an induction programme on commencing
employment at the service. They told us that they were all clear that their main duty was
to ensure the best possible care of the person. We were told that they were clear about
the rights of the person using the service and that it was important to them to ensure
their rights were promoted at all times. They feel they can deliver good quality care at
all times because they feel supported by the management of the service.
We were told that the staff's learning and development needs are identified through
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regular supervision with their line manager. Staff told us that they are encouraged and
facilitated to identify any training that will improve the delivery of care to the person.
Our judgement
The provider is compliant with this outcome because staff are trained to meet the needs
of the people who use the service. Staff are supported and supervised to care for
people.
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Outcome 16
Assessing and monitoring the quality of service provision
What the outcome says
This is what people who use services should expect.
People who use services:
* Benefit from safe quality care, treatment and support, due to effective decision making
and the management of risks to their health, welfare and safety.
What we found
Our judgement
The provider is compliant with Outcome 16: Assessing and monitoring the quality of
service provision
Our findings
What people who use the service experienced and told us
We did not speak to the people who use the service about this outcome.
Other evidence
During our visit to the service we were told that the service is regularly monitored to
ensure that optimum care is given to the people who use the service. A survey is
carried out annually. We were given copies of the results of the surveys for 2010, 2009
and 2008. The results of these surveys are compared and contrasted so that lessons
could be learned. We saw that action plans were drawn up and implemented to address
any issues identified. An example of this was the most recent incident that was
addressed was when a new freezer taking too long to be delivered. This was impacting
on the life of the people and they wanted it addressed as soon as possible. We saw
evidence that this issue was resolved promptly.
The independence and dignity of the people who use the service is promoted through
the use of appropriate risk assessments. This means that all aspects of their lives were
looked at and where possible measures were put in place to facilitate their
independence.
All the people who use the service have access to a complaints procedure the care
plans we looked at contained one in an easy read format. The people we spoke with
had not made a complaint. The information we hold on the service showed that we did
not receive any complaints or concerns about the service in the past year.
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Staff told us that they are vigilant in ensuring good practice at all times in caring for the
people. We saw evidence that all incidents were recorded and if necessary an action
plan was drawn up and implemented.
We saw that records were maintained and stored appropriately this included care plans
and staffing files. By doing this the service promoted the dignity and human rights of the
person and avoided unauthorised people gaining access to confidential information.
Our judgement
The provider is compliant with this outcome because the service has effective
monitoring and reviewing procedures in place to ensure the people's needs are
recognised and met.
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What is a review of compliance?
By law, providers of certain adult social care and health care services have a legal
responsibility to make sure they are meeting essential standards of quality and safety.
These are the standards everyone should be able to expect when they receive care.
The Care Quality Commission (CQC) has written guidance about what people who use
services should experience when providers are meeting essential standards, called
Guidance about compliance: Essential standards of quality and safety
CQC licenses services if they meet essential standards and will constantly monitor
whether they continue to do so. We formally review services when we receive information
that is of concern and as a result decide we need to check whether a service is still
meeting one or more of the essential standards. We also formally review them at least
every two years to check whether a service is meeting all of the essential standards in
each of their locations. Our reviews include checking all available information and
intelligence we hold about a provider. We may seek further information by contacting
people who use services, public representative groups and organisations such as other
regulators. We may also ask for further information from the provider and carry out a visit
with direct observations of care.
When making our judgements about whether services are meeting essential standards,
we decide whether we need to take further regulatory action. This might include
discussions with the provider about how they could improve. We only use this approach
where issues can be resolved quickly, easily and where there is no immediate risk of
serious harm to people.
Where we have concerns that providers are not meeting essential standards, or where we
judge that they are not going to keep meeting them, we may also set improvement actions
or compliance actions, or take enforcement action:
Improvement actions:
These are actions a provider should take so that they
continuous compliance with essential standards. Where a provider is complying with
essential standards, but we are concerned that they will not be able to maintain this, we
ask them to send us a report describing the improvements they will make to enable them
to do so.
Compliance actions
: These are actions a provider must take so that they
compliance with the essential standards. Where a provider is not meeting the essential
standards but people are not at immediate risk of serious harm, we ask them to send us a
report that says what they will do to make sure they comply. We monitor the
implementation of action plans in these reports and, if necessary, take further action to
make sure that essential standards are met.
Enforcement action:
These are actions we take using the criminal and/or civil procedures
in the Health and Social Care Act 2008 and relevant regulations. These enforcement
powers are set out in the law and mean that we can take swift, targeted action where
services are failing people.
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Information for the reader
Document purpose
Review of compliance report
Author
Audience
Further copies from
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