Elements Medical

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 6 quality statements from this key question. We have combined the score for this area with scores based on the rating from the last inspection in 2021, which was good. Our rating for this key question has deteriorated to inadequate. We found concerns in all 6 quality statements which included shared direction and culture, capable, compassionate, and inclusive leaders, Freedom to Speak Up, governance, management, and sustainability, learning improvement and innovation and partnerships and communities. We found 7 breaches of the legal regulations, specifically dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, fit and proper persons employed, need for consent and good governance. The provider could not demonstrate a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service and where people felt and were encouraged to speak up. The provider and some staff did not act with openness, honesty, and transparency. There was a disregard for the duty of candour. Issues identified during the assessment were not raised with us by staff. Where people had been placed at significant risk of harm by the service, we saw no evidence that they had been informed of this. There were no clear and effective governance, management and accountability arrangements which resulted in the significant concerns identified during the assessment. They could not demonstrate that they worked in partnership with key stakeholders, when required to support joined-up care. The provider took no account for the actions, behaviours and performance of themself and other staff. The provider and staff were not open and transparent.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not receive any feedback in respect of this key question.

The significant concerns identified during the assessment meant the provider did not demonstrate a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service. The findings suggest the provider was not focused on learning and improvement. The provider could not demonstrate that there was a shared vision and strategy and that staff in all areas knew, understood and supported the vision, values and strategic goals. The provider could not demonstrate that where relevant, equality and human rights legislation was considered. Staff had not completed training in equality and diversity.

We did not receive any feedback in respect of this key question.

The significant concerns identified during the assessment meant we could not be assured that the provider had the integrity to ensure regulated activities were offered to people appropriately. The findings suggest leadership was not safe or effective which compromised staff working at the service and which may have affected the quality of care people received. They evidenced that they knowingly took action to put people at potential risk of harm and did not make them aware of such risk. They could not demonstrate that they were aware of, and followed, best practice guidelines. Issues identified at the inspection in 2021 had not been addressed, and as identified, had significantly deteriorated at this assessment.

Staff told us that sometimes at an individual level, they felt personally empowered to raise concerns, but there was no governance system to support this. Not all staff felt empowered to do so or felt confident that their voices would be heard without detriment.

There was no identified Freedom to Speak Up Guardian outside of the service. We did not see evidence or processes to support staff in line with a named freedom to speak up guardian. There lacked a culture of speaking up where staff could actively raise concerns without fear of detriment. When concerns were raised, we saw no evidence that leaders investigated sensitively and confidentially, or that lessons were shared and acted on. The policies and procedures provided to us by the provider on the day of the assessment were not service-specific and did not contain the level of detail we would expect to see. The CQC assessment team did not feel that all staff, including the provider, acted with openness, honesty, and transparency during the inspection visit. There was a disregard for the duty of candour. Where people had been placed at significant risk of harm by the service, we saw no evidence that they had been informed of this. People were not accurately informed of the medicines being used as part of their treatment and of the risks we identified during the assessment. Issues identified during the assessment were not raised with us by staff.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider was unable to demonstrate through discussion or by the records made available to us that they had clear and effective governance, management, and accountability arrangements in place. They demonstrated a disregard for the safety of staff and people using the service and staff, confidentiality, and information security. The provider told us they did not hold formal staff meetings. No records of staff meetings were available. Staff confirmed this. We were told that daily informal staff meetings took place.

Systems to ensure accountability and good governance to manage and deliver good quality care, treatment and support were not in place. There was no evidence that the provider acted on information about risk, performance and outcomes and that such information was securely shared with people using or working at the service. This resulted in the significant concerns identified during the assessment. The provider took no account for the actions, behaviours and performance of themself and other staff. Information was not used effectively to monitor and improve the quality of care. Policies and procedures and identified lead members of staff that contributed towards the governance of the service were not in place. For example, significant events, medicine management, emergency equipment, recruitment of staff, safeguarding, infection prevention and control or dealing with major incidents were not identified, out of date, missing, or not supplied to us when requested on the day of our assessment.

Our assessment found care and treatment people received did not meet the expected standards relating to partnership and communities.

We were unable to gain feedback from partners as part of this assessment. However, our assessment found care and treatment people received did not meet the expected standards relating to partnership and communities.

The provider and staff were not open and transparent. They could not demonstrate that they worked in partnership with key stakeholders when required to support joined-up care. The lack of recording of significant incidents, complaints, staff supervision and learning meant we could not be assured that the provider shared learning with other services which had the potential to lead to better outcomes for people.

Staff we spoke to told us they were encouraged to upskill themselves in their aesthetics role within the service, and this was paid for by the provider. However, we saw that the same commitment to training and development which would keep people safe from harm and improve the quality of regulated activity was not given the same priority. The provider told us they relied on staff having completed what they deemed as mandatory training for areas including (but not limited to) safeguarding, health and safety, anaphylaxis, basic life support and information governance in their other employment but did not seek confirmation that this training had been completed.

There was a lack of processes to ensure that learning happened when things went wrong, and no sharing of good practice. Leaders did not actively encourage reflection and collective problem-solving.