We carried out a review of the data available to us about Xtracare Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Xtracare Ltd, you can give feedback on this service.
Xtracare is a domiciliary care agency which provides care and support for people in their own homes. Care is provided for a range of people including older people and people with dementia. The service operates in areas of west Kent. Not everyone using Xtracare receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection there were 63 people using the service.
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 2008 and associated Regulations about how the service is run.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Processes were in place to keep people safe from different types of abuse. When risks to people or the environment were identified, steps were taken to minimise them. There were enough staff to meet people's needs. Staff were recruited safely. When required, people were supported with their medicines in a safe way. People were protected by the prevention and control of infection. Lessons were learned when things went wrong.
People’s needs were assessed and care and support was delivered in line with current legislation and best practice guidelines. Staff had the skills and experience to meet people’s needs. People were supported to lead healthier lives and had access to healthcare services. People were supported to eat and drink enough to maintain a balanced diet. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
People were treated with kindness and compassion. People were supported to express their views and be involved in making decisions about their care and support. People’s families and advocates were also involved in decision making. People were encouraged to be as independent as possible. People’s dignity and privacy was respected. People’s personal information was kept confidential.
People received person-centred care that was responsive to their needs. People knew how to complain and complaints were responded to in line with the service’s policies and procedures. Staff knew how to support people who might be coming to the end of their life.
Staff said the service was open, transparent and that they felt supported by their managers. There were audits in place which checked the quality of the service being provided. Staff were involved in developing the service. The registered manager had developed links with the local community.
Further information is in the detailed findings below.
At the last inspection on 10 February 2015, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breaches were in relation to carrying out robust recruitment checks, the recording of information in people’s records regarding protection from risks and a lack of effective systems to monitor the quality and safety of the service. The provider sent us an action plan telling us how they were going to make changes to improve the service.
At this inspection we found that the provider had taken action to address the breaches from the previous inspection and had made many improvements to the service provided.
Xtracare Ltd was registered as a domiciliary care agency with an office base in Maidstone, providing personal care and support to people in their own homes. They were providing personal care services to approximately 85 people in Maidstone and the surrounding areas at the time of our inspection. The agency was privately owned and the providers were fully involved in the day to day management of the service.
There was a registered manager based 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff understood their responsibilities in keeping people safe from abuse and how to report any suspicions they had. People themselves said they felt safe and knew who to contact if this wasn’t the case.
Risks had been identified for individual people and their circumstances and measures had been put in place to reduce the risks helping to keep people safe. The home environment of people was checked for hazards before support was commenced to ensure the safety of people and staff. Most people either managed their own medicines or their family members helped them. Some people required staff assistance with medicines. The provider checked the staff were safe to administer people’s medicines by carrying out regular competency assessments.
The provider had a robust recruitment process in place to make sure new staff were suitable to work with people in their own homes. The provider recruited staff as needed to ensure they had enough staff to provide the assessed care people required.
Staff were supported to gain the skills necessary to be able to support people in their own homes. Staff had the relevant induction and training updates to feel confident in their role. Support and the opportunity to develop was given through regular one to one supervision, observational assessments and annual appraisals.
Staff had an understanding of the basic principles of the Mental Capacity Act 2005 and how it related to their role. Staff could talk confidently about how they supported people to make their own choices and decisions each day.
Staff presented a caring approach as did the staff working in the office who supported the delivery of care. People were happy with the staff and made many positive comments about the staff who supported them. The provider made sure people had information about the service people could expect within a service user guide at the commencement of care and support.
The registered manager or the assistant manager undertook a thorough initial assessment of people’s personal care needs to make sure they had the resources available to support people. People had a care plan that detailed all the individual support people required as a step by step guide for staff. People, and their families if appropriate, were involved in the process to ensure support was given in the way they wanted.
People were given information about how to make a complaint and the people we spoke to knew how to go about making a complaint if they needed to. The provider had asked people for their views of the service by sending out a questionnaire each year. The provider acted on responses, resolving issues and feeding back to people.
People and their families generally thought the service was well run. Some people said they did not see or hear from office staff very often, but said this was not a problem as they could contact the office if they needed to.
Staff felt they were well supported and their requests were responded to quickly. They found the managers approachable and would be happy to raise any concerns with them, confident they would be acted on.
The inspection took place on 10 and 11February 2015 and was announced. ‘48 hours’ notice of the inspection was given, as this is our methodology for inspecting domiciliary care agencies. At the previous inspection on 23 November 2013, we found that there were no breaches of the legal requirements.
Xtracare Ltd provides personal care and support to adults in their own home. It mainly provides a service to older people, some of whom have been discharged from hospital. It also provides a service to younger adults with a physical or learning disability and people with mental health problems. At the time of the inspection it provided a personal care service to around 100 people.
The service has a registered manager who was available and supported us during the inspection. 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. Comprehensive checks were not carried out on all staff at the service, to ensure that they were suitable for their role. Applicants were interviewed and criminal record/barring checks were undertaken. However, the provider had not always assessed the person’s suitability to work with people. This included not checking the reference of one person’s last position in a health or social care setting.
Risks to people’s health and welfare had been assessed, but were not always personalised. Where a risk had been identified, details of the risk and how to minimise the risk were recorded on the assessment.
People were informed of their right to raise any concerns about the service and most people were satisfied with the action that the service had taken when they had raised a concern. We have made a recommendation about informing people of their right to independent advice if they are not satisfied with how the service has dealt with a complaint. We have also recommend that the service record all complaints raised by people, to show how they manage complaints.
Systems were in place to review the quality of the service. Feedback from people who used the service was that 83% of people rated the service overall as very good or good. However, the service had not identified and taken action to address shortfalls in relation to the recruitment of new staff and the recording of risks to ensure these were managed effectively.
People told us they received their medicines as they were prescribed. Staff had received training in the administration of medicines and clear procedures were in place which defined staff’s roles and responsibilities.
People felt safe whilst staff were supporting them in their own homes. Safeguarding procedures were in place and staff had received training in this area. Staff and the management team demonstrated a good understanding of what constituted abuse and how to report any concerns swiftly so that people could be kept safe.
The service had a programme to continually recruit staff to ensure that they were available in sufficient numbers. Staffing numbers were kept under constant review. New staff underwent a thorough induction programme, which including relevant training courses and shadowing experienced staff, until they were competent to work on their own. People felt that staff had the right skills and experience to meet their needs. Staff received training appropriate to their role and were encouraged to undertake training to further their knowledge. Staff’s performance was monitored during unannounced checks on their practice by the management team.
Staff were aware of people’s health and dietary needs and took these into consideration when providing care. People told us their consent was gained at each visit and they had also signed their care plan to confirm their consent to their care and support. Staff had received training in the Mental Capacity Act 2005 and supported people to make their own decisions and choices. The MCA 2005 provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. The registered manager knew that when people were assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.
People said the support was delivered by a staff team who were kind, caring, usually knew them well and that staff took time to talk to them. People were treated with dignity and respect and their privacy was respected.
People were involved in the initial assessment and the planning their care and support. They told us that they received personalised care as recorded in their plans of care. Care plans included
people’s preferred routines. People said a member of the management team visited periodically to review their care plan and discuss any changes required.
Staff understood the aims of the service. They said they treated people as they would want to be treated. They had confidence in the management of the service which they said was supportive and there was good communication in the staff team.
We found three breaches of the health and social care act 2008 (Regulated activities 2010). You can see what action we told the provider to take at the back of the full version of the report.
We found that the agency had reliable processes in place to carry out detailed assessments for people prior to commencing a care package. The agency management ensured that people understood the care that was being provided, and that the people receiving care consented to this.
People that we spoke to gave us very positive feedback about the standards of care they received. People's comments included: 'The care staff are very good and always do what is needed.' 'I have been very pleased with Xtracare. The staff are all very kind and helpful.' And, 'I could not say anything against them. They are all very good. We wouldn't be able to manage without them.'
We found that the agency followed clear procedures for the safe management of medication, and care staff were trained in knowing their areas of responsibility in this aspect of care.
We viewed staff training records and saw that all of the agency staff were being kept up to date with mandatory training. Staff were also taking advanced training in some subjects.
We found that the agency had suitable processes in place to obtain feedback from people using services, and from staff, and took appropriate action to initiate any relevant changes.
We obtained people's views by reading recent questionnaire responses, and comments made during telephone conversations. Some people had also given feedback to the assistant manager or senior care staff when they had carried out spot checks with care staff, or care plan reviews in people's homes.
Comments we received from relatives included the following:
'We are very pleased with the care X has been receiving.'
'I cannot speak highly enough of the agency. The care and office staff are always polite, friendly, caring and helpful.'
People receiving care said:
'The care staff look very smart and are always very respectful.'
'Most care staff are very good, experienced and well-trained, and can be relied on.'