Excel Healthcare Services Ltd improved from Inadequate to Requires Improvement across all inspected key questions, exiting Special Measures, but remained in breach of Regulations 11, 12, and 17 relating to consent/MCA, risk assessment, and governance. Continued weaknesses in capacity assessment, incomplete care planning, inconsistent auditing, and late staff visits present ongoing risks to people's safety and wellbeing.
Concerns (11)
criticalCare planning: “where a person required assistance to mobilise using a hoist. No specific risk assessment or care plan was in place to give staff guidance about how to safely move this person.”
criticalConsent / capacity: “The registered manager did not have appropriate knowledge and skills in relation to the principles of the MCA. People's capacity was not assessed appropriately.”
criticalConsent / capacity: “No staff had received training in relation to the MCA. The provider recognised improvement was required in this area.”
criticalGovernance: “Some audits were not completed in a timely manner and did not always identify concerns found during our inspection.”
criticalRecord keeping: “Records used for monitoring risks to people's skin, mobility and consent forms were not fully completed. There were no accurate records of people's ability to make decisions.”
moderateMissed or late visits: “Records showed multiple occasions where staff were late for calls, it was not evident what action had been taken to address this.”
moderateSupervision / appraisal: “Some supervisions were not conducted in a timely manner and robust systems were required to ensure staff received regular supervision meetings.”
moderateStaff training: “Staff still required training about the MCA and how this is applied into practice.”
minorMedication management: “Staff had received medicines training and initial competency checks. Improvement was needed to ensure staff received ongoing medicines competency assessments.”
minorCommunication with families: “Some people and their relatives told us they were sometimes having trouble communicating with some staff due to English not being their first language.”
minorPerson-centred care: “Some records remained vague about people's choices... Care plans could be improved to provide more person-centred detail about people's choices and wishes.”
Strengths
· Medicines were safely managed and people received their medicines as prescribed, with accurate records monitored via an online system.
· Safeguarding systems were implemented; concerns were logged and reported to CQC and local authority as required.
· Staff were recruited safely with DBS checks in place for all staff.
· New online system introduced to monitor accidents and incidents with lessons learned from these.
· Complaints systems were effective in recording, investigating and responding to complaints.
Quality-Statement breakdown (17)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
safe: Preventing and controlling infectionRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture; managers and staff being clear about their roles and understanding quality performance, risks, and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people, continuous learning and improving care, working in partnership with othersRequires improvement
Excel Healthcare Services Ltd received an overall Inadequate rating on its first inspection, with breaches of seven regulations spanning safeguarding, medicines management, consent, person-centred care, recruitment, complaints, and governance. The registered manager demonstrated inadequate oversight and failed to make statutory notifications, resulting in the service being placed in special measures.
Concerns (15)
criticalSafeguarding: “During the inspection we made three safeguarding referrals to the local authority, which had not been previously raised by the registered manager.”
criticalMedication management: “Two relatives told us that medicines errors had occurred. These were not recorded by the service, therefore it is unclear what action was taken arising from these errors.”
criticalCare planning: “One person's care plan stated the person required the use of a hoist and later stated the person was mobile. This did not support staff to understand people's needs.”
criticalGovernance: “Auditing systems were not effective in identifying or actioning concerns. Audits lacked information and did not detail issues found during our inspection.”
criticalStaffing levels: “People were not receiving staff at the appropriate times or for the allocated time to meet their needs. One person said, 'I am supposed to have 2 staff to help me, but they often send 1.'”
criticalIncident learning: “Accidents and incidents were not accurately recorded or monitored. Records did not detail if an investigation or root cause analysis was undertaken.”
criticalConsent / capacity: “The provider was not working in line with their own policies... No assessments were undertaken for people. This meant consent to care and treatment was not always sought.”
criticalComplaints handling: “Complaints were not accurately recorded. Relatives told us they had raised complaints with the registered manager. These were not provided to us through the service's complaints logs.”
criticalPerson-centred care: “Care records contained little or no background information about people or their choices, likes and dislikes. One person told us, 'I haven't got a care plan.'”
criticalLeadership: “The registered manager did not have an adequate understanding of their role, regulatory requirements and lacked oversight of the service.”
moderateStaff training: “Staff training records covered a range of topics studied in 1 day. Multiple training topics were covered in one day, meaning staff were not provided with enough time to develop their learning.”
moderateStaff competency: “The majority of relatives we spoke to told us they were concerned about staff competency. One relative said, 'The staff are like they have come with no training.'”
moderateInfection control: “Staff did not always wear appropriate personal protective equipment (PPE). One staff had supported a person during the night without wearing a uniform or PPE.”
moderateRecord keeping: “Records containing information relating to care call times were not always completed. The registered manager could not produce documents in a timely manner throughout our inspection.”
moderateCommunication with families: “A relative told us, 'The service does not ring and check up on [name] and they don't inform us of any changes.' Some people and relatives told us there were barriers to communication.”
Strengths
· People told us staff treated them with respect, kindness and dignity: 'Staff are very kind and caring, I couldn't wish for anyone nicer.'
· Staff received induction and regular supervision meetings and felt supported by the registered manager.
· Staff were knowledgeable about how to recognise abuse and felt able to report concerns.
· Weekly staff meetings took place to discuss concerns.
· Staff told us manager was approachable and morale was high.
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and management; learning lessons when things go wrongInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionInadequate
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Staff support: induction, training, skills and experience
Inadequate
effective: Supporting people to eat and drink enough to maintain a balanced dietInadequate
effective: Staff working with other agencies; supporting people to live healthier lives and access healthcareInadequate
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated; respecting equality, diversity, privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlInadequate
responsive: Meeting people's communication needsInadequate
responsive: Improving care quality in response to complaints or concernsInadequate
well-led: Promoting a positive culture; managers and staff understanding quality, performance, risks and regulatory requirementsInadequate
well-led: Duty of candour; working in partnership with othersInadequate
well-led: Engaging and involving people and staff; continuous learning and improving careInadequate