4 May 2023
During an inspection looking at part of the service
Excel Healthcare Services Ltd is a domiciliary care agency and provides personal care and support to people who require assistance in their own home. At the time of our inspection there were 17 people being supported by the service.
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.
People’s experience of using this service and what we found
Whilst care records had improved since our last inspection, not all risks to people had been appropriately assessed. Records did not always contain enough guidance for staff about how to safely support people. Daily records showed people received care in line with their needs, however risk assessments and care records required improving to ensure they contained a full detail of risks posed to people.
A new call monitoring system was in place, this allowed the senior team to monitor care call times. Records showed multiple occasions where staff were late for calls, it was not evident what action had been taken to address this. People told us they were informed when staff were going to be late. Staff were recruited safely, and pre-employment checks were in place.
Since our last inspection the provider had implemented systems and processes to protect people from the risk of abuse. Safeguarding incidents were logged and the service reported concerns to the CQC and local authority as required.
Medicines were safely managed. Daily records showed people received their medicines as prescribed. Staff had received medicines training and initial competency checks. Improvement was needed to ensure staff received ongoing medicines competency assessments.
People and relatives told us staff wore personal protective equipment (PPE) and followed good hygiene practices when carrying out personal care. Accidents and incidents were now recorded and monitored on an online system and action was taken to learn lessons from incidents.
Since our last inspection, some improvements had been made to care records. Care plans detailed some choices and preferences, such as people's religious needs and history. Further improvements were needed to provide more in-depth detail about how people like to be cared for. Staff had access to peoples records via an online system. We received positive feedback from people and relatives about the care provided.
New staff received an induction and staff received supervisions which allowed them to raise concerns. Some supervisions were not conducted in a timely manner and robust systems were required to ensure staff received regular supervision meetings.
Where people required support to eat and drink, records showed people were provided with choice. People and relatives told us some improvements could be made about how staff prepare food. Staff worked with external agencies to meet people's needs, and records were kept of these.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The service did not always work in line with the principles of the MCA. Training for staff and management was required in this area to ensure that people had their capacity assessed appropriately and that external agencies could become involved where required.
Since our last inspection, new systems were implemented for dealing with complaints and these were effective in recording, investigating, and responding to complaints. Relatives told us they had not had to make complaints but felt comfortable to do so if required.
New systems for auditing the safety and quality of the service were in place. These required organising and strengthening to ensure they were undertaken consistently. Since our last inspection, the registered manager had gained knowledge and confidence about their role and responsibilities. They were open and honest during the inspection process and had reported notifiable incidences to CQC and the local authority. New policies and procedures were in place to provide staff with appropriate guidance.
Improvement plans were ongoing. The service continued to work closely with external quality teams. Daily meetings were held to discuss concerns and systems had improved staff recording of the support provided to people. A recent engagement survey was completed for people and relatives, and results were overall positive. These could be further strengthened by adding actions to the ongoing improvement plan.
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 inadequate (published 5 December 2022) and there were breaches of regulation.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations relating to person centred care, safeguarding, complaints and staffing.
At this inspection we found whilst improvements had been made, the provider remained in breach of regulations in relation to consent, assessing risks and governance.
At our last inspection we recommended that the provider ensures staff are suitably trained to provide safe care and support to people. At this inspection we found further staff training was in place. However, training was still required about how staff work within the principles of the Mental Capacity Act.
This service has been in Special Measures since 5 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Excel Healthcare Services Ltd on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to consent, assessing risks and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.