The inspection took place on 17 July 2018 and was an announced inspection of the agency office. We also spent time speaking with people who used the service their relatives and staff.

The last comprehensive inspection took place in June 2017 when the service was rated requires improvement. The service was found to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to care records that contained unexplained gaps and the quality assurance systems were not robust and there was not an established system in place for identifying, recording, handling and responding to complaints. The overall rating for the service at that time was requires improvement.

Following the last inspection the provider sent a report of the actions they would take to meet the legal requirements of these regulations. We checked whether these regulations had been met as part of this comprehensive inspection.

At this inspection, we found evidence to show improvements had been made in responding to complaints. However, we found continued breaches of regulations 12: Safe care and treatment and regulation 17: Good governance. You can see what action we told the provider to take at the back of the full version of the report.

Excell Homecare is a domiciliary care agency. It provides personal care to people living in their own houses and flats It provides a service to older adults and younger disabled adults. The agency office is based in the Mosborough area of Sheffield. At the time of our inspection the service was providing personal care for approximately 67 people.

Not everyone using Excell Homecare receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager on the day of our inspection. 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.

The provider did not have adequate systems to ensure the safe handling, administration and recording of medicines to keep people safe.

People told us about their experiences of receiving care from Excell Care Limited and gave positive feedback.

Staff we spoke with told us how dignity and care underpinned their work.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role. Staff understood their role and what was expected of them. They were happy in their work, motivated and confident in the way the service was managed.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). In most cases people had given their consent to their care and support, although we discussed with the provider some areas this could be strengthened.

Staff had a good knowledge of their safeguarding responsibilities.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that considered dietary needs and preferences so that health was promoted and choices could be respected.

Peoples care and support was monitored so that the provider could respond to any changes, altering care packages as required to ensure people’s needs were met.

People using the service and/ or their relatives had been asked their opinion via questionnaires. The results of these had been audited to identify any areas for improvement.

Individual aspects of the service were monitored however there was no overarching assessment of quality in place which me

This was an announced inspection carried out on 15 and 16 May 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. This was the first inspection we have carried out at this location.

Excell Home Care Limited provides care and support to people in their own homes.

There was a manager at the service who was in the process of registering with CQC. 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 and associated Regulations about how the service is run.

Some people were supported to take their medicines. We found medicine administration records were not always signed by staff to confirm the medicine had been given. This could put a person’s health and wellbeing at risk.

Risk assessments were not always in place which would help to reduce or eliminate the risk of a person becoming harmed.

People told us they felt safe in the support and care of the staff who worked for Excell Home Care.

Staff understood their responsibility with regard to safeguarding and said they would raise any concerns with managers.

Recruitment checks were in place for the safe recruitment of new staff. These checks were undertaken to make sure staff were suitable to work with people who used the service.

People were supported by staff that had received regular training. Staff told us the training and management support provided them with the knowledge and skills to carry out their jobs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

People were positive about the care staff and said they received appropriate, consistent support from caring and kind staff. When we spoke with staff they understood the importance of people being supported to make decisions for themselves. Staff liaised with healthcare professionals at the appropriate time to help monitor and maintain people's health and wellbeing.

There was not an established system in place for identifying, recording, handling and responding to complaints.

Each person had a care plan in their home. The care plans seen required more person centred information to ensure people’s individual needs were identified and the care provided met their personal preferences.

We identified the audit systems to check such things as medicines and care plans were not robust enough to effectively act upon risk in order to demonstrate compliance with regulations.

We found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in regulation 12: Safe care and treatment, regulation 16: Complaints and regulation 17: Good governance.

You can see what action we told the provider to take at the back of the full version of the report.