Excel Healthcare Services Ltd

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.

A new call monitoring system was in place, this allowed the senior team to monitor care call times. Records showed multiple occasions where staff were late for calls, it was not evident what action had been taken to address this. People told us they were informed when staff were going to be late. Staff were recruited safely, and pre-employment checks were in place.

Since our last inspection the provider had implemented systems and processes to protect people from the risk of abuse. Safeguarding incidents were logged and the service reported concerns to the CQC and local authority as required.

Medicines were safely managed. Daily records showed people received their medicines as prescribed. Staff had received medicines training and initial competency checks. Improvement was needed to ensure staff received ongoing medicines competency assessments.

People and relatives told us staff wore personal protective equipment (PPE) and followed good hygiene practices when carrying out personal care. Accidents and incidents were now recorded and monitored on an online system and action was taken to learn lessons from incidents.

Since our last inspection, some improvements had been made to care records. Care plans detailed some choices and preferences, such as people's religious needs and history. Further improvements were needed to provide more in-depth detail about how people like to be cared for. Staff had access to peoples records via an online system. We received positive feedback from people and relatives about the care provided.

New staff received an induction and staff received supervisions which allowed them to raise concerns. Some supervisions were not conducted in a timely manner and robust systems were required to ensure staff

received regular supervision meetings.

Where people required support to eat and drink, records showed people were provided with choice. People and relatives told us some improvements could be made about how staff prepare food. Staff worked with external agencies to meet people's needs, and records were kept of these.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The service did not always work in line with the principles of the MCA. Training for staff and management was required in this area to ensure that people had their capacity assessed appropriately and that external agencies could become involved where required.

Since our last inspection, new systems were implemented for dealing with complaints and these were effective in recording, investigating, and responding to complaints. Relatives told us they had not had to make complaints but felt comfortable to do so if required.

New systems for auditing the safety and quality of the service were in place. These required organising and strengthening to ensure they were undertaken consistently. Since our last inspection, the registered manager had gained knowledge and confidence about their role and responsibilities. They were open and honest during the inspection process and had reported notifiable incidences to CQC and the local authority. New policies and procedures were in place to provide staff with appropriate guidance.

Improvement plans were ongoing. The service continued to work closely with external quality teams. Daily meetings were held to discuss concerns and systems had improved staff recording of the support provided to people. A recent engagement survey was completed for people and relatives, and results were overall positive. These could be further strengthened by adding actions to the ongoing improvement plan.