Exclusive Care Ltd

Updated 10 May 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

Inspection team:

This inspection was carried out by two inspectors.

Service and service type:

Exclusive Care Limited provides personal care to people living in four supported living settings so that they can live in their own home as independently as possible. It provides support to people of all ages living with a range of needs including, learning disabilities or autistic spectrum disorder, mental health conditions, sensory impairments and physical disabilities. At the time of this inspection the service provided personal care to twelve people. During the inspection, one supported living setting was transferred by the local authority to another provider. This meant Exclusive Care Limited provided personal care to nine people living across three supported living schemes.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service two working days’ notice of the inspection because the service provides care to people in supported living settings and we wanted to make sure that the registered manager was available on the day of the inspection site visit. We also gave notice of our visit so that the registered manager could seek agreement from people using the service to us visiting them in their supported living settings.

This inspection was carried out between 06 February, 28 February and 28 March 2018. We visited the office and one supported living scheme on 06 February 2018. We sought the views of professionals on 28 February 2018 and gave feedback to the provider. On 28 March we sought assurances from the provider following concerns raised about the transfer of support packages to another provider.

What we did:

Before the inspection we looked at information we held about the service. This information included:

¿ Statutory notifications that the provider had sent to the CQC. Statutory notifications include information about important events which the provider is required to send us by law.

¿ We reviewed information submitted to us in the provider information return [PIR]. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used all this information and the previous inspection report to plan our inspection.

¿ We reviewed the action plan the provider sent to us following our last inspection. This action plan addressed the issues identified at the last inspection, and following a meeting held with the provider and local authority on 16 August 2018 where further actions were set.

¿ We reviewed the service improvement plan with the provider regularly since the prior inspection. This enabled us to monitor that the required improvements would be made.

During the visit to the office we spoke with the registered manager, provider and two staff members. When we visited one of the supported schemes we spoke with a further staff member and two people who used the service. However other people were not able to verbally communicate with us, therefore, we spent time observing how staff interacted with people to understand the experience of people who could not talk with us. Following the inspection we spoke with th

Updated 10 May 2019

About the service:

Exclusive Care Limited is registered to provide personal care to people to people living in supported living settings, so that they can live in their own home as independently as possible.

People’s experience of using this service:

Previous breaches of regulations were now being met. This meant people experienced a better quality of care that was safely delivered and managed. However, some work continued to be needed to ensure that people's records were fully person centred and completed. The registered manager had an action plan to address this area.

People were kept safe from harm because assessments identified the key risks to their health and well-being. Plans were in place to respond to people’s needs. One person’s relative said, “[Person] is as safe with the staff as they are with us, I can’t fault the care at all.”

Staff received the information that they needed to provide people with individualised care and support. Staff were aware of people’s nutritional needs and supported these well.

People were supported by a sufficient number of staff who had been trained to keep people safe.

People’s medicines were now safely managed and administered as the prescriber intended.

Consent was now obtained in line with legal requirements, although improvement was required around documenting decisions made. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The newly developed policies and systems supported this practice.

People were cared for in a dignified manner. People’s confidential information was stored securely.

People were involved in the review and development of their care. People enjoyed a range of activities that met their individual interests.

Concerns and complaints were promptly responded to. People and relatives were confident to raise concerns when necessary.

People using the service and their relatives told us that the registered manager and other senior staff were approachable and could be contacted at any time.

Governance systems were now in place to monitor the quality of care provided. Leadership was now visible across the service, and staff, health professionals and relatives were all positive about the sustained improvements.

Registering the Right Support has values which include choice, promotion of independence and inclusion. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Rating at last inspection: Inadequate. The inspection was carried out on 11,13, 18 and 23 July 2018 and the report was published on 21 August 2018. At this inspection the rating has improved.

Why we inspected: This comprehensive inspection was planned based upon the findings from our previous inspection. At that inspection we found six breaches of regulations, rated the service inadequate and placed the service in special measures. This was because staff were not aware and did not respond to people’s changing needs, people were not safely supported by enough staff. Those staff employed did not know how to keep people safe from harm or abuse or how to manage and administer medicines safely. Staff were not receiving appropriate training or development or being supported by the management team through regular appraisal and supervision. Staff told us they did not feel supported. Language used to describe people's behaviours or personalities was not dignified and people’s preferences were not always met. Care was not assessed or provided in a personalised manner. Staff did not always support people to follow their own hobbies and interests when they chose. Concerns and complaints were not always responded to. People, relatives and staff told us the service was not well led. Systems were not operated effectively to identify areas that required improvement or to maintain safety with the care provided. Notifications of significant events were not made as required. The provider did not ensure effective management was in place to both ensure people received a high level of quality care, and that staff were sufficiently supported and managed. Care records were not accurately maintained as required. The service did not have a registered manager or nominated individual in post.

Follow up: The service is no longer in special measures as they have achieved a rating of good. However, we will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.