This inspection took place on 11 April 2018 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because the service provides domiciliary care to people living in their own homes and we wanted to make sure staff would be available. At the last inspection on 19 January 2017, we found that the provider was ‘requires improvement’ under the key questions of safe, effective, caring and well-led and did not meet all the legal requirements. During this inspection, we found there had been a significant improvement however, further improvement was still required.

Excellence Healthcare is a domiciliary care agency registered to provide personal care to people living in their own homes. At the time of the inspection the service supported nine people.

The registered manager was also the provider. 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.

At our previous inspection in January 2017 we rated the service as 'Requires Improvement' as the service was not always safe because staff did not consistently have the information they required to ensure that people were protected against identified risks. It was not always clear whether people were receiving their medicines as prescribed. People's rights were not always protected because the provider was not aware of their responsibilities to ensure that care was provided lawfully. The provider had failed to respond to some of the improvements that were recommended at our inspection in January 2016. The provider had some management systems in

place to assess and monitor the quality of the service provided to people. However, some of these were not always used effectively to manage risks and to identify where improvements were needed. On this inspection we found improvements had been made and although there was some further improvement to be made, the overall rating for the service was now Good.

The provider had improved their quality assurance systems. However, further improvement was required with the consistency of updating and reviewing care plans and risk assessments, that ensured they were up to date, accurate and reflective of people’s needs and choices. The provider had taken steps to ensure they were kept up to date with current legislative practices however, their knowledge around protecting people’s rights required further improvement.

People felt safe in their homes with staff. Relatives were confident their family members were kept safe. Staff knew what action they would take if they thought a person was at risk of harm. Risks to people were assessed and people were supported by staff that was provided with guidance on how to manage people’s specific medical conditions.

People were supported by sufficient numbers of staff that had been safely recruited. Where appropriate, people were supported with their medicines by staff that had received training. Staff members were equipped with sufficient personal protection equipment to reduce the risk of infection and cross contamination when supporting people with their personal care.

Staff were trained to ensure that they had the skills to support people effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about how they wanted to receive support to ensure their health needs were met. Where appropriate, people required assistance to eat and drink. Timely referrals were made to health and social care professionals when people’s needs changed.

People had a small team of staff who provided their support and had caring relationships with them. C

This inspection took place on 19 January 2017 and was an announced inspection. We gave the provider 48 hours’ notice that we would be visiting the service. This was because we wanted to make sure staff would be available to answer any questions we had or to provide us with the information that we needed. We also wanted the registered manager to ask people who used the service if we could contact them. At our last inspection in January 2016, the provider was found to require improvements in four out of the five areas we looked at; safe, effective, caring and well-led. During this inspection, we found that some of these improvements had been made. The provider now had safer recruitment processes and staff training had also improved. However, we found that other areas continued to require further improvements, which included record keeping and the quality monitoring systems and processes.

Excellence Health Care is a domiciliary care service which is registered to provide personal care to people in their own homes. At the time of our inspection Excellence Health Care was providing care and support to eight people.

Excellence Health Care is required to have a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

The service was not always safe because staff did not always have the information they required to ensure that people were protected against identified risks and it was not always clear whether people were receiving their medicines as prescribed.

People’s rights were not always protected because the provider was not aware of their responsibilities to ensure that care was provided lawfully. However, people were supported by staff who understood their responsibilities to ensure that care was provided with consent, where possible.

The provider had failed to respond to some of the improvements that were recommended at our last inspection to enhance the safety and quality of the service. The provider had some management systems in place to assess and monitor the quality of the service provided to people. However, some of these were not always used effectively to manage risks and to identify where improvements were needed.

People were supported by sufficient members of staff who has been safely recruited. They were also protected from abuse and avoidable harm because staff understood the different types of abuse and what actions were needed to keep people safe.

People were supported by staff who were caring, kind and respectful and who took the time to get to know them. People were encouraged by staff who understood the importance of supporting them to be as independent as possible so that they maintained some control over their lives.

People were able to make informed decisions about the care and support they required and took a lead role in the planning of their care. People knew how to complain if they were unhappy and were confident that their concerns would be responded to.

This inspection took place on 12 January 2016 and was an announced inspection. Excellence Healthcare is a new provider and this was their first inspection since registering with the commission in June 2015.

Excellence Health Care is a domiciliary care service which is registered to provide personal care to people in their homes. At the time of our inspection Excellence Health Care was providing care and support to seven people.

Excellence Health Care is required to have a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post at the time of our inspection.

People were not always supported by staff that had received the training they needed to carry out their role safely and effectively, including safe medication management.

The provider had some management systems in place to assess and monitor the quality of the service provided to people. However, some of these were not always used effectively to manage risk and identify where improvements were needed.

People were protected from abuse and avoidable harm because staff understood the different types of abuse and what actions were needed to keep people safe.

People’s human rights were protected because they consented to the care they received.

People reliably received the care and support they required because the service had sufficient staff to meet their needs.

People were supported by staff who were caring, kind and respectful.

People were supported to have food that they enjoyed and that helped them to remain healthy.

People were encouraged by staff who understood the importance of supporting them to be as independent as possible so that they maintained some control over their lives.

People were able to make informed decisions about the care and support they required and took a lead role in the planning of their care.

People knew how to complain if they were unhappy and were confident that their concerns would be responded to.