This inspection was completed on 13 December 2016 and was announced. The provider was given 24 hours’ notice because the service provides a domiciliary care service; we needed to ensure we would be able to meet with people where they were receiving the service. At the time of the inspection the service was supporting four people in their own homes.

There was a registered manager in post at the service; 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in February 2014. There were no breaches of regulation at that time.

At the time of our inspection the service was supporting four people living in their own homes. Each person had one member of staff supporting them at all times. This included a member of staff who would stay overnight and sleep at each person’s home. One person had two staff to support them whilst out in the community.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. People’s medicines were being managed safely. People told us they felt safe.

People were receiving effective care and support. Staff received training which was relevant to their role. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS). Staff supervisions and appraisals were being completed. People were supported to access health professionals. People could choose what they liked to eat and drink.

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. There was positive feedback from relatives regarding the management.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they liked to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people’s needs. Support plans were person centred to provide consistent, high quality care and support. Daily records were detailed and contained sufficient information for staff to read and support people effectively.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. People, staff and relatives spoke positively about the registered manager.

People expressed their views and were involved in making decisions about their care and treatment. Comments included, “My support worker encourages me to be independent” and “My support worker helps me maintain contact with my family, which is important to me”.

People were allocated a team of staff to support them in order to maintain consistency. People told us, “One of my carers has been supporting me for three years now they have got to know me and my family”.

We asked people what they would do if they were worried about something or if they were unhappy. One person told us, "I would ring the office and talk to them or discuss with my support worker as we have a good relationship”.

People that we spoke with during our visit told us "The staff are very good at caring for me " and "Staff work so hard supporting me".

We saw evidence that Care coordinators monitored the quality of service by carrying out monthly spot checks at people homes to check that staff had completed the necessary care documents for people correctly which included daily record sheets, diaries and medication records.

At the time of our visit the agency was supporting six people to live independently in their own homes providing 24 hour support. The people using the service had complex needs which meant that they were not able to directly tell us about their experiences. We therefore used a number of different methods to help us understand how people were supported.

We visited two people who used the service that were unable to communicate with us. We spoke with four staff and made our own observations of the care and support provided to people.

People were allocated a care worker or a small team of care workers, in order to keep the number of staff who visited them, to a minimum so that consistency of care was promoted.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at the records of two people who received care from Excel Living in order to see how they were supported with their care, health and emotional needs.

The provider took account of complaints and comments to improve the service. We saw details of what peoples' complaints were, actions taken and the outcome of each complaint. We saw evidence that complaints had been investigated appropriately with any actions that were taken to resolve each complaint