Excellence Healthcare

Updated 19 May 2018

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.

The inspection took place on the 11 April 2018 and was announced. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. The provider was given 48 hours’ notice because we needed to be sure that someone would be available to meet with us. The inspection team consisted of two inspectors and an expert by experience. An expert by experience is someone who has had experience of working with this type of service.

As part of the inspection process we looked at information we already held about the provider. Providers are required to notify the Care Quality Commission about specific events and incidents that occur including serious injuries to people receiving care and any incidences that put people at risk of harm. We refer to these as notifications. We checked if the provider had sent us notifications in order to plan the areas we wanted to focus on during our inspection. The provider had sent us a Provider Information Return (PIR) before the inspection. A PIR is a form that asks the provider to give key information about the home, what the service does well and improvements they plan to make. We reviewed regular quality reports sent to us by the local authority to see what information they held about the service. These are reports that tell us if the local authority commissioners have concerns about the service they purchase on behalf of people. We also contacted the local authority for information they held about the service and reviewed the Healthwatch website, which provides information on health and social care providers. This helped us to plan the inspection.

The provider sent us a list of people who used the service. We contacted people and/or their relatives by telephone on 12 April 2018 and spoke with four people and one relative to gather their views on the service being delivered. We also spoke with the provider and three care staff. We used this information to form part of our judgement.

We looked at four people’s care records to see how their care and treatment was planned and delivered. Other records looked at included two recruitment files to check suitable staff members were recruited. The provider’s training records were looked at to check staff were appropriately trained and supported to deliver care that met people’s individual needs. We also looked at records relating to the management of the service along with a selection of the provider’s policies and procedures, to ensure people received a good quality service.

Updated 19 May 2018

This inspection took place on 11 April 2018 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because the service provides domiciliary care to people living in their own homes and we wanted to make sure staff would be available. At the last inspection on 19 January 2017, we found that the provider was ‘requires improvement’ under the key questions of safe, effective, caring and well-led and did not meet all the legal requirements. During this inspection, we found there had been a significant improvement however, further improvement was still required.

Excellence Healthcare is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection the service supported nine people.

The registered manager was also the provider. 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 2008 and associated Regulations about how the service is run.

At our previous inspection in January 2017 we rated the service as 'Requires Improvement' as the service was not always safe because staff did not consistently have the information they required to ensure that people were protected against identified risks. It was not always clear whether people were receiving their medicines as prescribed. People's rights were not always protected because the provider was not aware of their responsibilities to ensure that care was provided lawfully. The provider had failed to respond to some of the improvements that were recommended at our inspection in January 2016. The provider had some management systems in

place to assess and monitor the quality of the service provided to people. However, some of these were not always used effectively to manage risks and to identify where improvements were needed. On this inspection we found improvements had been made and although there was some further improvement to be made, the overall rating for the service was now Good.

The provider had improved their quality assurance systems. However, further improvement was required with the consistency of updating and reviewing care plans and risk assessments, that ensured they were up to date, accurate and reflective of people’s needs and choices. The provider had taken steps to ensure they were kept up to date with current legislative practices however, their knowledge around protecting people’s rights required further improvement.

People felt safe in their homes with staff. Relatives were confident their family members were kept safe. Staff knew what action they would take if they thought a person was at risk of harm. Risks to people were assessed and people were supported by staff that was provided with guidance on how to manage people’s specific medical conditions.

People were supported by sufficient numbers of staff that had been safely recruited. Where appropriate, people were supported with their medicines by staff that had received training. Staff members were equipped with sufficient personal protection equipment to reduce the risk of infection and cross contamination when supporting people with their personal care.

Staff were trained to ensure that they had the skills to support people effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about how they wanted to receive support to ensure their health needs were met. Where appropriate, people required assistance to eat and drink. Timely referrals were made to health and social care professionals when people’s needs changed.

People had a small team of staff who provided their support and had caring relationships with them. Care was planned and reviewed with people and their family members to ensure their choices were followed. People's privacy and dignity were respected and upheld by the staff. People had care records that included information about how they wanted their care and this was reviewed to reflect any changing needs. There was a complaints procedure in place and any concerns received were investigated and responded to in line with the provider’s policy. People, their family members and professionals were asked for their feedback on the quality of the service. The provider promoted an open culture which put people at the heart of the service.