This inspection took place on 5, 6 and 7 September 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that the people we needed to speak with would be available. We told the registered manager we would be returning over the next two days. At the last comprehensive inspection in August 2014, with the inspection report being published in January 2015, the service was rated as ‘Good’. Excelcare (Home Care) Limited Tower Hamlets Office is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was supporting 335 people, but only providing personal care to 255 people in the London Borough of Tower Hamlets. This also included a children’s contract in the London Borough of Lewisham, where they supported 35 children, with four that received personal care.
There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The service promoted an open and honest culture and staff spoke highly of the atmosphere at the service and the support they received from management. Staff were confident they could raise issues or concerns at any time, knowing they would be listened to and acted upon.
The registered manager was aware of the challenges they faced and was proactive in looking for ways to deal with them. There were effective quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. The registered manager was fully aware of their registration requirements regarding notifiable incidents and learning from incidents was shared across the whole service.
People who required support with their medicines received them safely and all staff had completed training in the safe administration of medicines, which was refreshed annually. The registered manager had been proactive in following up concerns that had been raised within the borough and discussions were in process about improving practice.
People using the service and their relatives told us they felt safe using the service and staff had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with and the provider ensured people understood how they would protect them from avoidable harm.
Risks to people were identified during an initial assessment. Guidance was in place to enable staff to support people safely and records were updated when people’s needs changed.
The provider had a robust staff recruitment process and staff underwent the necessary checks to ensure they were suitable to work with people using the service. People had regular care workers to ensure they received consistent levels of care.
Care workers received an induction training programme to support them in meeting people’s needs effectively and shadowed more experienced staff before they started to deliver personal care independently. Staff received regular supervision and told us they felt supported and were happy with the supervision they received.
Staff understood the principles of the Mental Capacity Act 2005 (MCA). The provider was aware of what to do and who to contact if they had concerns that people lacked capacity to make certain decisions. Care workers respected people’s decisions and gained people’s consent before they carried out care tasks.
People’s nutritional needs and preferences were recorded in their care plans and staff were aware of the level of support required. Care workers told us they notified the office if they had any concerns about people’s health and we saw evidence of this in people’s care records. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, occupational therapists and district nurses.
Staff treated people in a way that respected their privacy and dignity and promoted their independence. There was evidence that language and cultural requirements were considered when allocating care workers to people using the service.
People and their relatives told us care workers were kind and compassionate and knew how to provide the care and support they required. Regular care workers knew the people they supported and showed concerns for people’s health and welfare.
People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. Care was personalised to meet people’s individual needs and preferences and was reviewed if there were any significant changes.
People using the service and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. There were monitoring systems in place to allow people using the service and their relatives the opportunity to feedback about the care and treatment they received. Extra surveys had been carried out when the number of people using the service increased during a local authority restructure in April 2017.