Archived: Executive Care

Updated 1 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 October 2016 and was announced with a visit to the service. Following the visit, phone calls were made to people, their family members and representatives on 11, 12 and 14 October 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that staff and people would be available to speak with us. The inspection was undertaken by two inspectors.

Prior to the inspection we reviewed information we held about the service including statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us by law. We also gathered information from Local Authority Commissioners. We spoke with one person using the service, three relatives and a representative of a person using the service. We also spoke with the registered manager, the recruitment manager, an administrator and four care staff.

We reviewed the care records belonging to four people who used the service to ensure they were reflective of their current needs. We looked at the recruitment files of four staff and other records in relation to staff supervision and training. We also looked at records in relation to the quality monitoring of people’s care and the overall management of the service.

Updated 1 December 2016

This inspection took place on 10 October 2016 with an announced visit to the service. In addition, phone calls were made to people and their family members and representatives on 11, 12 and 14 October 2016.

Executive Care provides a domiciliary support service within Milton Keynes and surrounding areas. The service enables people to live independently in their own home.

The service had a registered manager in post. 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 in the Health and Social Care Act and associated Regulations about how the service is run.

At the last comprehensive inspection on 18, 24, 27 August and 1 September 2015, we asked the provider to take action to make improvements to care plan and risk assessment documentation and in reporting statutory notifications to the Care Quality Commission (CQC).

This was in breach of Regulation 12 (1) (2) (a) (b) of the HSCA (RA) Regulations 2014 and Regulation 18 (1) (2) (e) of the (Registration) Regulations 2009.

We received an action plan from the provider telling us how the relevant legal requirements would be met. We carried out a focused inspection on 13 May 2016 to follow up on their actions and found that they had been completed. We could not improve the ratings from requires improvement, at the focused inspection, because to do so required consistent good practice over time.

The provider had carried out risk assessments to identify potential hazards for people using the service and staff. Risk assessments for moving and handling, pressure area care and nutrition were regularly reviewed to identify changes in people’s needs and they were amended accordingly.

People’s care, treatment and support was set out in a written care plan that described what staff needed to do to make sure personalised care was provided. The care plans contained sufficient detail to inform staff on the type of support people needed to maintain their health and well-being.

The provider had reported safeguarding concerns to the local authority safeguarding team and to the CQC to safeguard people from abuse or improper treatment. They had also kept CQC informed of other events at the service as required by law.

Internal quality audits, surveys and reviews, were used to monitor the service provision. However robust records were not always maintained on the actions taken by the provider, in response to the audit findings. The registered manager told us they planned to put action plans, with timescales in place. This would ensure that robust records were available to demonstrate the actions they had taken to continually drive improvement of the service.

Staff recruitment procedures ensured that only suitable staff were employed to work at the service. However robust records were not always maintained regarding checks carried out on car drivers using their vehicles for work purposes. Having proof of current insurance and MOT certificates held on file, would demonstrate the provider’s commitment to continually manage the staffs’ on-road risks.

Staff understood their roles and responsibilities to safeguard people and to report any concerns. The provider had informed the Local Authority in relation to safeguarding concerns.

Where the provider had taken on the responsibility systems were in place to manage people’s medicines safely. Medicines audits were regularly carried out to check that people consistently received their medicines safely.

People were involved in making decisions about their care; where they lacked the capacity to make their own decisions, decisions made in their best interests were made in line with the Mental Capacity Act (MCA) 2005.

Staff received appropriate training and systems were in place to ensure that staff received regular supervision and support.

People were encouraged to eat and drink sufficient amounts to maintain good nutrition and hydration. Staff contacted the relevant healthcare professionals in response to any sudden illness or emergencies.

Relationships between staff and people receiving support consistently demonstrated dignity and respect at all times. Staff took the time to explain things to people and provided them with sufficient information before carrying out any care tasks.

People using the service and their relatives were involved in planning their care and the staff were knowledgeable of people’s needs. Systems were in place to seek feedback from people using the service on the quality of the care they received. The provider had a complaints procedure and complaints made to the provider had been responded to appropriately.

The registered manager had an open door policy and was available to people using the service, their relatives and staff. Communication between the provider and the staff was effective and staff felt supported in their development.