18 August 2022
During a routine inspection
Exceptional Homecare is a domiciliary care service. The service provides personal care to people living in their own homes or flats.
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. When we commenced the inspection there were 19 people receiving care, 16 of these received personal care. Upon conclusion of the inspection there were 14 people receiving care, 11 of these received personal care.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
Right Culture:
Quality assurance systems and processes to monitor the quality and safety of the service had not been implemented in line with the provider’s policies and procedures. Therefore, the provider had not identified the concerns we found prior to this inspection. Lessons had not been learned from the findings of previous inspections. This is the third inspection we found failings relating to the quality and safety of the service.
Right Support:
Training was not always provided in line with the provider’s training and governance policies. Further improvements were needed to ensure all staff received the training they needed to undertake their role. Not all staff had received safeguarding training prior to this inspection and their competence administering medicines and undertaking moving and handling tasks had not been assessed.
Improvements were made to staffing levels during this inspection. However, the time people received care was inconsistent and they did not always know when care would be provided.
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. However, the policies and systems in the service had not always supported this practice.
Right Care:
People remained at risk of receiving unsafe care. Systems had not been put in place to monitor and promote safe care. Risk assessments were not always updated when people’s needs changed or they had fallen. Medicines were not always safely managed.
Staff did not always follow government guidance for the use of personal protective equipment (PPE) during the COVID-19 pandemic. This increased the risk of transmission of infection and COVID-19.
People were supported to eat and drink enough by staff that knew their dietary needs. Prompt action was taken to seek medical advice when people's health deteriorated. People told us they were supported by staff that knew them well and were kind and caring. Staff supported people to remain as independent as possible and treated people with dignity and respect.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 07 May 2022) and there were breaches of regulation. The provider did not complete required action plans after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated inadequate in well-led for two consecutive inspections.
This service has been in Special Measures since 06 May 2022. During this inspection the provider did not demonstrate that the required improvements have been made. Therefore, this service remains in Special Measures.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Exceptional Home Care 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 monitor the service and will take further action if needed.
We have identified breaches in relation to safe care, safeguarding and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
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. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.