Archived: Exclusive Care Limited

Updated 21 August 2018

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.'

The inspection was prompted in part by notification of the departure of the nominated individual, who was also registering as the manager of the service. Concerns were raised about the nature of this person's departure and risks to the safety and welfare of people were also reported.

The information shared with CQC indicated potential concerns about the risk of unsafe care, insufficient staff, poor training and support to staff and a lack of overall managerial oversight. This inspection examined those risks.

This inspection took place on 11,13,18 and 23 July 2018. On 11 and 13 July 2018 we visited the office and one of the supported living schemes. On 18 and 23 July 2018 we spoke with health professionals, people's relatives and staff by telephone to gain their views. Further concerns were also reported to CQC regarding people's nutritional needs which we followed up by speaking with the local authority and the provider to ensure these needs were met. This inspection was carried out by one inspector. We gave the service 48 hours’ notice of the inspection visit because it is small and we needed to be sure management would be available to meet with us.

We asked for a Provider Information Return (PIR) to be submitted to us and reviewed this as part of our inspection planning. This is information that we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. However, during our inspection visit, we gave the provider the opportunity to give some key information about the service, what the service does well and improvements they planned to make. We reviewed the information we held about the service such as statutory notifications sent to us from the provider. A statutory notification is information about important events which the provider is required to send us by law. We looked at information shared with us by the local authority commissioners. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority.

During this inspection we spoke with the remaining company director, newly appointed nominated individual, newly employed manager, the deputy manager, a registered manager from another of the providers locations, the deputy manager, four members of staff, and five people's relatives. We reviewed care records relating to four people who used the service, along with records relating to the management of the service.

Updated 21 August 2018

This inspection took place on 11, 13, 18 and 23 July 2018 and was unannounced. This was the first inspection of Exclusive Care Ltd since it registered with the Care Quality Commission on 16 June 2017.

Exclusive Care Limited is registered to provide personal care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have a manager who was not registered with the Care Quality Commission. 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. Prior to this inspection the registered provider, who was also registering as the manager was dismissed. The remaining Director of the company identified a replacement provider, and new manager, who had both started at the time of this inspection. Throughout this report they will be referred to as the new provider and manager.

Prior to this inspection we received information of concern about the management of the service. Concerns were also raised regarding people receiving unsafe care from staff who were not sufficiently trained and supported, and management arrangements did not address these issues.

The service was registered to provide personal care from unit G.41, Business And Technology Centre, Bessemer Drive, Stevenage, SG1 2DX. On arrival we found the service had moved location to another office in the same building. This inspection was carried out at unit F.06 of the same address as they had moved location on 06 February 2018 but not informed the Care Quality Commission as required.

During the inspection, we found multiple breaches of regulations. These related to a lack of safe care and unsafe risk management, placing people at risk of harm; insufficient staff to support people safely; the safe management of medicines; poor quality staff training; care planning and review; poor-quality monitoring system and poor managerial/provider oversight.

As a result, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

People were not supported by a sufficient and consistent numbers of staff. This led to the provider closing of one of the supported living schemes and the two-people living there having to move to other services. Staff were recruited safely and employment checks carried out before they started work.

Risk management required improvement. People had some risk assessments in place but these required more information to help staff minimise the risk. Where there was no risk assessment to manage the change in a person’s physical, emotional, mental health needs, people had suffered poor standards or care. Staff were not all confident in identifying and reporting concerns about a person’s welfare. We identified incidents where people may have been at risk of harm that had not been reported as required. People’s medicines were not managed in a safe manner.

People felt that staff competency and ability to provide care effectively varied. Staff told us they did not feel all the training provided to them was beneficial, and did not all feel supported in their role. Staff did report an improvement since the new manager started.

People’s consent was sought when care was provided, however consents to care were not signed. People were supported to choose and prepare their own meals, but staff did not support people to consider healthy choices. People were supported by a range of health professionals but did at times experience a delay in being referred.

People’s relatives felt the service was caring and felt staff treated people in a dignified manner. However, we found examples where people had not received care in a dignified manner and staff had not promoted people’s own choices at all times. Staff supported people to maintain links with their families and friends. Staff knew how to keep personal information confidential.

People's care needs were assessed and care plans developed. However, some care plans were missing, some were significantly out of date, or did not contain all the required information to guide staff in supporting people in a safe manner. Staff knew people's needs well and were good at supporting them to access a range of community facilities of their choice. This helped people to remain part of their local community. People’s relatives gave a mixed response regarding raising their concerns. Some felt comfortable in doing so, however others felt they did not receive an outcome when they did.

Staff and relatives did not think the service was well led. The current provider and new manager were open and honest throughout this inspection, responding quickly when issues were identified to mitigate the risks. There was not an effective system of governance in place to monitor the quality of care people received and identify where improvements were required.

The service was incorrectly registered with the Care Quality Commission, and did not submit notifications of changes to the management team, or significant incidents as required.