We inspected Excel Care (UK) Ltd (Excel Care) on 17 and 19 July 2017 and the first day of our inspection was unannounced. Excel Care is a domiciliary care service which provides personal care to people living in their own home. Their office is located in the New Moston area of Manchester. At the time of our inspection the agency was supporting 12 people. The previous inspection took place in November 2016 where three breaches of the Health and Social Care Act 2008 were identified. This inspection was carried out to check on the improvement actions identified in the provider's representations following our inspection in May 2016 where enforcement action was taken and a Notice of Proposal (NoP) was issued. The inspection in November 2016 found that there was not enough improvement to take the provider out of special measures and the service was rated Inadequate in the well led domain and overall ‘Requires Improvement’
This inspection was carried out to check on the improvement actions identified when we inspected in November 2016. We found that there were continuing breaches of the Health and Social Care Act 2008 and insufficient improvements made.
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”
The service had a registered manager who had been in post since March 2014. 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.
Recruitment processes needed to be strengthened to help ensure suitable candidates were employed to work at the service.
Risk assessments in place were not sufficiently detailed to guide staff on how to keep a person safe. We found an example where risks had been identified but no assessment had been done to mitigate these. This meant people were not protected from harm as care staff had limited or no guidance to manage these risks safely.
People told us they had not experienced many missed visits. They said care staff were occasionally late but that the quality of care provided had not been affected. They told us the care staff’s timekeeping had improved. Missed and late visits meant however that people had either not received care and support needed or had not received care at times that suited them. People were satisfied with the consistency of care and told us they had regular care staff supporting them.
Where required, people were supported to take their medication safely. Following our inspection in November 2016, care staff had received required medication administration training. This should help to ensure that people received their medication safely.
Staff were aware of safeguarding principles and knew what to do in the event they suspected abuse was taking place. We concluded staff had sufficient knowledge and information to help ensure people were kept safe from harm.
People and relatives told us care staff had good hygiene practices and wore personal protective equipment when carrying out their duties. This practice helped to ensure people were protected from the risk of infection.
There was a system in place for recording accidents and incidents. This helped to ensure the service took appropriate action to keep people safe from harm.
People and their relatives told us care staff were effective and well trained, and always sought their consent before undertaking any task. The registered manager and care staff we spoke with demonstrated a good understanding and knowledge of the Mental Capacity Act (MCA) and we saw there was a policy in place to guide practice. We were satisfied the service was working within the principles of the MCA.
Staff had an induction and received mandatory training in key areas such as safeguarding, manual handling and infection control prior to starting their role. Staff received regular supervisions and appraisals to help ensure they received the necessary support to carry out their roles. This meant staff had suitable knowledge and skills and received continuous support to function effectively in their caring role.
People were supported and encouraged to make healthy eating and drinking choices. This should help people to maintain a balanced diet and support their wellbeing.
People’s access to health care professionals and medical attention was facilitated, if required. This meant people were supported to receive the right health care when they needed.
People and their relatives told us they received caring and compassionate support. Care staff were friendly yet professional and some people had developed good relationships with them.
People and relatives told us they had been involved in the care planning process. This meant that people and their relatives, where appropriate, were included in making decisions about the care they received.
People were treated with dignity and respect and their independence was encouraged according to their abilities. This helped to promote people’s wellbeing.
People and their relatives found the service was responsive to their needs.
Initial assessments were carried out to help ensure the service was able to meet the specific needs of the person.
People knew the complaints procedure though no one had made a formal complaint. There was a complaints policy in place and we saw evidence the service adequately dealt with verbal concerns raised by people they supported.
The service had recently implemented quality surveys to find out what people thought about the service they received. Not everyone we spoke with had been surveyed and the results of completed surveys had not been collated or fully analysed. This meant that while the provider had sought people’s feedback on the care they received, they had not demonstrated to us how this information would be used to improve the quality of care provided.
Care plans contained information about the support people required at each visit but not all care plans contained adequate guidance to help ensure staff carried out the tasks responsively. This meant people may not receive care that was responsive to their specific needs. Care staff knew what person centred care meant and told us they always looked at people’s care records before undertaking tasks.
People and relatives told us they were happy with the services of Excel Care. Staff said they felt supported by the management team and that the registered manager was approachable and fair.
The service did not display the current rating which was ‘Requires Improvement’ at its office and on its website. This was a legal requirement.
We found that quality assurance processes in place were not robust and did not give the registered manager and provider effective oversight of the quality and safety of service. This meant that people’s care and support were not adequately monitored to ensure their safety and wellbeing.
Staff meetings took place regularly and gave care staff the opportunity to discuss their work with each other and the management team. This meant staff received adequate support which helped them to provide people with effective care.
We found four breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, fit and proper persons, governance systems and failure to display.