This inspection took place on 5, 6 and 7 September 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that the people we needed to speak with would be available. We told the registered manager we would be returning over the next two days. At the last comprehensive inspection in August 2014, with the inspection report being published in January 2015, the service was rated as ‘Good’.

Excelcare (Home Care) Limited Tower Hamlets Office is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service was supporting 335 people, but only providing personal care to 255 people in the London Borough of Tower Hamlets. This also included a children’s contract in the London Borough of Lewisham, where they supported 35 children, with four that received personal care.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The service promoted an open and honest culture and staff spoke highly of the atmosphere at the service and the support they received from management. Staff were confident they could raise issues or concerns at any time, knowing they would be listened to and acted upon.

The registered manager was aware of the challenges they faced and was proactive in looking for ways to deal with them. There were effective quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. The registered manager was fully aware of their registration requirements regarding notifiable incidents and learning from incidents was shared across the whole service.

People who required support with their medicines received them safely and all staff had completed training in the safe administration of medicines, which was refreshed annually. The registered manager had been proactive in following up concerns that had been raised within the borough and discussions were in process about improving practice.

People using the service and their relatives told us they felt safe using the service and staff had a good understanding of how to identify and report any concerns. Staff were confident that any concerns would be investigated and dealt with and the provider ensured people understood how they would protect them from avoidable harm.

Risks to people were identified during an initial assessment. Guidance was in place to enable staff to support people safely and records were updated when people’s needs changed.

The provider had a robust staff recruitment process and staff underwent the necessary checks to ensure they were suitable to work with people using the service. People had regular care workers to ensure they received consistent levels of care.

Care workers received an induction training programme to support them in meeting people’s needs effectively and shadowed more experienced staff before they started to deliver personal care independently. Staff received regular supervision and told us they felt supported and were happy with the supervision they received.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). The provider was aware of what to do and who to contact if they had concerns that people lacked capacity to make certain decisions. Care workers respected people’s decisions and gained people’s consent before they carried out care tasks.

People’s nutritional needs and preferences were recorded in their care plans and staff were aware of the level of support required. Care workers told us they notified the office if they

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an announced inspection. We gave the manager two days notice of our inspection. There were no breaches of the regulations identified at the last inspection undertaken on 21 January 2014. Excelcare (Home Care) Tower Hamlets Limited provides personal care to people living in their own home. The agency provides care and support for older adults, people with disabilities and children. There were 124 people using the service at the time of our inspection.

The agency had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We spoke with 11 people who used the service and six relatives. All the people we spoke with said they felt safe using the service. Staff were knowledgeable about risks to people and how to safeguard them from neglect or abuse. Risks to individuals who used the service were identified and managed. Staff followed policies and procedures to ensure people were safe and protected. Staff were vetted for their suitability to work with vulnerable people and there were sufficient numbers of staff to meet their needs.

All the people and relatives we spoke with were complimentary about staff and the care and support they received. The majority of people said they valued the staff, who were caring, kind and compassionate. Staff provided care in a way that was enabling and promoted the independence and wellbeing of people who used the service. Care was personalised and provided in line with people’s individual care plans. Staff communicated with people in a way they could best understand. People’s diverse needs and rights were taken into account when planning their care. People were actively involved in making decisions about their care and their care met their personal needs and preferences.

Staff were trained and supported to carry out their duties effectively. The agency worked closely in partnership with a range of health and social care professionals with specific skills to plan, coordinate and meet people’s needs. Procedures were followed in relation to the Mental Capacity Act 2005 when people lacked mental capacity to make decisions about specific issues.

Professionals were positive about the work of the agency and said staff were dedicated to providing the best possible care to support the health and general well-being of people.

All the people and relatives we spoke with said the service was flexible and responsive to their ongoing or changing needs.  People’s needs were monitored and regularly reviewed. The provider listened and took prompt action to address concerns and complaints and improve the quality of care.

Staff said they received excellent support and the service was well led and managed and people who used the service said the service was well managed. The management had developed and sustained a positive culture in the service, encouraging staff and people to raise issues of concern, which they acted upon. Management put clear vision and strong values into practice and ensured these were understood by staff and implemented. Procedures were in place to monitor and act on the quality and effectiveness of the service. There was a focus on delivering quality care that promoted continuous improvement and reflected best practice.

During our inspection we spoke with three senior staff and five care staff. We also spoke with 33 people who used the service and relatives of people by telephone. One person told us, "my care worker is very helpful, she makes me breakfast and does my personal care. She is lovely and I’ve had her ages." One relative told us, "the care worker is such a lovely young man, looks after my husband 100% perfectly."

We found that people who used the service had initial assessments and care plans in place. People's needs were agreed and consent was obtained before any care or support was provided. Care plans were then reviewed on a regular basis. This showed the provider had systems in place to gain and review consent from people who used the service.

Most of the people we spoke with were happy with the care they received. Comments included, "no one has ever been rude, nothing like that, they all very nice" and "I have the care worker every day at the same time, he’s brilliant I couldn’t manage without him."

We found there were effective systems in place to reduce the risk and spread of infection. One person told us, "the care worker always uses gloves for everything." Another person told us, "one of the care workers has an allergy to the latex gloves and has rashes in her arms so the company gave her the powdered option."

There were sufficient skilled and experienced staff to safely meet the needs of people who use the service. In the staff files we looked at we saw evidence staff had received appropriate training.

People were made aware of the complaints system. All the people we spoke with said they were confident about how to make a complaint. They told us they had not had a reason to complain, but thought the service would respond promptly and effectively if they made a complaint. One person said, "I have phone numbers and people's names in the office if I want to complain."

We spoke with 13 people who received a service or their relatives over the telephone to find out about their experiences of the support they were receiving from the agency. We also spoke with the manager, a care coordinator and a care worker.

All the people using the service told us the care workers respected their privacy and dignity and called them by their preferred name. People trusted their care workers and felt safe with them. One person said, "I have lovely carers. I am very very happy." People were happy with the quality of care and the support they received. People said that their preferences, including their cultural preferences, were taken into account by the agency.

All the people and relatives we spoke with felt they were involved in decisions about their care. People said they could raise any concerns or complaints with the agency. Two people had done this in the past and said their concerns had been resolved satisfactorily.

The Commission is currently developing new formats for questionnaires to be issued to people who use services. It was not therefore possible to do this prior to this planned review although we did look at the quality assurance feedback that the agency itself undertakes. We also made arrangements to visit a sample of people at their own homes who use the agency’s care service. We would like to take this opportunity to thank those people who agreed to meet with us. We would also like to thank the agency staff who assisted us in making these appointments.