Excel Living Limited

Excel Living Limited is a domiciliary care agency providing personal care to people living in their own homes. There were five people using the service at the time of the inspection who had a learning disability or mental health illness. The service supported a further four people that were not receiving 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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and or autism to live meaningful lives that include control, choice and independence.

People’s experience of using this service and what we found

People received a high level of individualised care and were supported by staff that were kind, caring and compassionate. Staff valued people as individuals and had formed supportive relationships with people. Staff knew how people preferred their care and support to be provided. People were placed at the centre of the service and were consulted on every level. Respect for privacy and dignity was at the heart of culture and values of the service.

People continued to receive exceptional, person-centred care from the outset. Their wishes were understood and close relationships between people, staff and families had developed. Family members told us the care their relatives received was exceptional and had far exceeded their expectations. There was a high quality, bespoke and flexible approach towards people’s changing needs and preferences. The service was responsive to people’s needs and was able to accommodate sudden changes in people’s needs. People were empowered to achieve their goals. Activities were promoted by staff to prevent social isolation.

People showed they felt safe with staff who were highly motivated, knowledgeable and skilled to provide each person with the support they needed. Staff were fully aware of policies and procedures to keep people as safe as possible and rigorously followed risk assessment guidelines to ensure nobody was put at risk. Staff supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider followed their recruitment procedure which ensured all staff were safely employed. Induction training was thorough and the training for staff was kept up to date which meant they could provide effective care. People received medicines from staff that had been trained and their competency assessed.

Staff had received training to meet the needs of people using the service. They had also received regular supervision and an appraisal of their work performance. People's health needs were identified, and they were supported to maintain regular appointments and screening. People were supported to eat and drink. Specialists were involved when required for people who were nutritionally at risk.

The staff team were passionate at promoting people’s independence and ensuring people’s homes and facilities where appropriate to meet people’s needs. The staff team had taken steps to support people to make the appropriate adaptations to their homes. This included air conditioning being installed and a garden area adapted which had improved people’s wellbeing.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People benefitted from a service that was well led by a committed and skilled management team who led by example. The management promoted a positive culture that was open and transparent. They used effective checks and audits of care to provide high quality, person-centred care. There was an ongoing plan of development for the service. The staff team were well trained and supported, and communication was good. Staff were motivated and reflected pride in their work. They talked about people in a way which demonstrated they wanted to support them as much as possible and provide the best standards of care.

Why we inspected

This was a planned inspection based on the previous

Rating at last inspection The last rating for this service was good (published 09 March 2017).

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Excel Living Limited on our website at www.cqc.org.uk

There was a registered manager in post at the service; a registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in February 2014. There were no breaches of regulation at that time.

At the time of our inspection the service was supporting four people living in their own homes. Each person had one member of staff supporting them at all times. This included a member of staff who would stay overnight and sleep at each person’s home. One person had two staff to support them whilst out in the community.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. People’s medicines were being managed safely. People told us they felt safe.

People were receiving effective care and support. Staff received training which was relevant to their role. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS). Staff supervisions and appraisals were being completed. People were supported to access health professionals. People could choose what they liked to eat and drink.

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. There was positive feedback from relatives regarding the management.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they liked to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people’s needs. Support plans were person centred to provide consistent, high quality care and support. Daily records were detailed and contained sufficient information for staff to read and support people effectively.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. People, staff and relatives spoke positively about the registered manager.

We visited two people who used the service that were unable to communicate with us. We spoke with four staff and made our own observations of the care and support provided to people.

People were allocated a care worker or a small team of care workers, in order to keep the number of staff who visited them, to a minimum so that consistency of care was promoted.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the records of two people who received care from Excel Living in order to see how they were supported with their care, health and emotional needs.

The provider took account of complaints and comments to improve the service. We saw details of what peoples' complaints were, actions taken and the outcome of each complaint. We saw evidence that complaints had been investigated appropriately with any actions that were taken to resolve each complaint

People were allocated a team of staff to support them in order to maintain consistency. People told us, 'One of my carers has been supporting me for three years now they have got to know me and my family'.

We asked people what they would do if they were worried about something or if they were unhappy. One person told us, "I would ring the office and talk to them or discuss with my support worker as we have a good relationship'.

People that we spoke with during our visit told us "The staff are very good at caring for me " and "Staff work so hard supporting me".

We saw evidence that Care coordinators monitored the quality of service by carrying out monthly spot checks at people homes to check that staff had completed the necessary care documents for people correctly which included daily record sheets, diaries and medication records.