Excelle Home Care

Excelle Home care is a domiciliary care agency and is based in the London Borough of Havering. The service provides personal care to adults in their own homes. Not everyone who used the service received 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 was supporting 11 people with personal care at the time of the inspection.

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

At our previous inspection of this service on 26 April 2021, we found robust quality assurance systems were not in place to identify shortfalls we noted with risk assessments and staff time keeping. At this inspection, we found improvements had been made and quality assurance systems were in place to identify shortfalls and take prompt actions to ensure people were safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The previous rating for this service was requires improvement (published 12 June 2021) and there were breaches of regulation. We issued requirement notice for breach of Regulation 18 (Staffing) and a warning notice for breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check if there were improvements regarding the concerns we identified at the last inspection about governance of the service and if the service was compliant with the warning notice we served. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on warning notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Excelle Home care is a domiciliary care agency and is based in the London Borough of Havering. The service provides personal care to adults in their own homes. Not everyone who used the service received 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 was supporting 11 people with personal care at the time of the inspection.

People’s experience of using this service

Some people and relatives told us staff had been late for care visits. Staff rotas showed that care calls were booked back to back with no time given to staff to travel in between appointments. This increased the risk of late and missed calls.

The provider’s audit systems, to monitor staff time keeping, were not effective.

Although staff were aware of risks associated with people, accurate records of risk assessments had not been kept consistently to ensure people received safe care. We made a recommendation in this area.

Quality assurance systems were not in place to ensure care plans and risk assessments were accurate to ensure people received safe care.

Systems were in place to record incidents and take appropriate action. Medicines were being managed safely. Pre-employment checks had been carried out to ensure staff were recruited safely.

Systems were in place to obtain feedback from people and relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 14 February 2020). We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last three consecutive inspections.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Excelle Home care is a domiciliary care agency and is based in the London Borough of Havering. The service provides personal care to adults in their own homes. Not everyone who used the service received 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 was supporting 26 people with personal care at the time of the inspection.

People’s experience of using this service

Some people and relatives told us staff were late for care visits. Records confirmed that staff were late to attend calls, which could put people at risk of harm.

An effective audit system was not in place to monitor staff time keeping to ensure late calls could be identified and prompt action taken to ensure people received timely care.

Systems were in place to record incidents and take appropriate action. However, analysis of incidents had not been carried out to ensure lessons were learnt and to minimise the risk of re-occurrence. We made a recommendation in this area. Quality assurance systems were in place to review care plans, risk assessments and medicines.

Although staff were aware of risks associated with people, accurate records of risk assessments had not been kept consistently. Medicines were being managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Assessments had been carried out prior to people receiving a service to determine if they could be supported effectively. Care plans were person centred to ensure people received personalised care.

People told us that staff were caring. Staff treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

Staff had been trained to perform their roles effectively. Systems were in place for infection control.

Systems were in place to obtain feedback from people and relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 12 January 2019). We identified two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk assessments, medicine management and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the rating of the last inspection.

Enforcement

We have identified breaches in relation to staff time keeping and good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will speak with the provider prior to the report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection on 30 March 2016, we rated the service ‘Good’. At this inspection, we found concerns with risk assessments, medicine management and quality assurance systems. Therefore, the service has been rated ‘Requires Improvement’.

The service had a registered manager. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks to people were not always robustly managed. We found some care plans did not contain suitable and sufficient risk assessments to effectively manage risks. This placed people at risk of not being supported in a safe way at all times.

Staff had been trained to manage medicines safely. However, we found gaps in some people’s medicine records and could not be assured people had received their medicines at the times prescribed.

Effective quality assurance systems were not in place. Audits had not identified the shortfalls we found during the inspection.

Accurate and complete records had not been kept to ensure people received high quality care and support.

Staff time-keeping and attendance was being monitored. We noted where staff were late, this was not being pursued by office staff to minimise the risk of late calls or missed visits. We made a recommendation in this area.

Care plans included the support people required. People’s ability to communicate were recorded in their care plans. However, daily notes did not include accurate information to confirm people had received person centred care. We made a recommendation in this area.

Regular supervisions had not been carried out in accordance with the provider’s supervision policy. We made a recommendation in this area.

Full pre-employment checks had not been carried out to ensure staff were suitable and of good character to support people in a safe way. We made a recommendation in this area.

We received mixed feedback from staff, relatives and people about the management team.

Staff had received mandatory training to perform their roles effectively.

People’s feedback was sought from surveys. Surveys were analysed to ascertain what the service was doing well and what areas required improvement.

People’s privacy and dignity were respected by staff. People and relatives told us that staff were caring and they had a good relationship with them.

A complaints policy was in place to manage complaints. Staff were aware of how to support people with complaints

Spot checks of staff supporting people had been carried out to observe staff performance.

We identified two breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to risk management, medicine management and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.

At the time of our inspection, the service provided care and support to twelve people, who received personal care and support, including three people who were admitted to hospital.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered care homes, 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 moved its location in November 2015 and registered the new location with the Care Quality Commission. However, the service’s name was registered as the same name of the new location because of an error during the registration process. During our inspection, the service was in the process of re-establishing its previous name of Excelle Home Care with the CQC.

People were supported and cared for by staff who had an understanding of people’s needs and who demonstrated knowledge of safeguarding people from different types of potential abuse and how to respond. People had their individual risks assessed and had plans to manage them.

Staff had been recruited following appropriate checks and the provider had arrangements to make sure that there were sufficient care workers to provide support to people in their own homes. People told us they received care from care workers who understood their preferences for care and support.

People were listened to and were involved in making decisions about their care and support. Care workers were caring and supportive in the support they provided. Care workers provided care that ensured people were treated with privacy and dignity. People were supported by care workers to maintain their independence as much as possible. People were encouraged to express their views and give feedback about their care.

People told us that care workers listened to them and they felt confident they could raise any issues and that action would be taken. Care workers felt supported by the registered manager and that the registered provider gave them opportunities to develop in their roles. The registered manager was committed to improving the service to support the care provided to people. The provider ensured regular checks were completed to monitor the quality of care that people received and look at where improvements could be made. However, some paper files in the office were not always organised appropriately and there was a risk of important information being lost.

We found one area where we have made a recommendation to the service, which is detailed in the report.