Archived: Exclusive Care Services

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The principles of RSRCRC were not met, people were not always kept safe from avoidable harm and the service did not work well with other agencies to do so. Staff did not always consider a least restrictive option before limiting people’s freedom. Staff did not always have specific training to support people’s needs. Medicines were not always managed safely. People did not consistently receive safe care because staff and the provider did not learn from safety incidents. During our assessment of this key question, we found concerns around the management of incidents and accidents and the risk associated with people’s care. We found 3 breaches of the legal regulations in relation to safeguarding, safe care and treatment, and staffing. People were not protected from the risk of abuse and had been harmed. Risks to people were not adequately assessed and staff were not adequately trained or skilled to support people.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While some people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. A relative told us their loved one had a fall. A staff member had not sought any medical help for the person which had resulted in a serious injury. There was no learning from this incident and the provider had poor oversight of accidents.

The registered manager told us they ‘regretted any shortcomings’ and were ‘committed to ensuring the safety and wellbeing of the people they supported.’ The registered manager and provider told us they recognised the documentation and investigation of incidents was not robust. We asked staff if information about incidents was shared with them. Although staff told us learning was shared, they could not give any examples, including for example staff who were supporting someone who had recently sustained a burn.

Incident management and oversight was poor. Incidents were not always recorded and reported by staff. For example, one person was dropped from the hoist, and staff who were not trained picked the person up from the floor. Staff failed to report the incident to the registered manager. When the registered manager was made aware of the incident, a complete investigation was not carried out, and they could not demonstrate any leaning or improvements implemented. There was a lack of robust documentation and assessment of incidents and concerns shared about the service. The registered manager had two spreadsheets where incidents, complaints and safeguarding’s were logged, however this was not fully completed, and did not always detail actions taken to mitigate risks. In some cases it did not include further information about incidents, and had incorrect information documented.

While some people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. A relative told us when the package of care started for their loved one communication was extremely poor and staff had been given incorrect information about their loved one’s needs. The relative said the transition into the service was not smooth or easy. Some people fed back they had received a positive experience in relation to the package of care commencing.

Staff told us when assessments were completed for new packages of care, the registered manager would decide if they would take the package forward. Consultation with staff was not always completed by the registered manager to ensure there were sufficient staff, and staff had the relevant skills to support people. Some packages were implemented regardless of feedback from staff if they felt the person’s needs could not be met. People’s care journey was not monitored and managed in an effective way to keep people safe. Staff were not proactive to manage risks to people. Staff told us that due to the high volume of new packages starting, they were unable to fully assess and identify risks to people who were new to the service to ensure care plans and risk assessments were in place to inform staff of how best to support people safely.

There were not always safe systems, pathways and transitions in place to ensure people received the support they required. The complaints log evidenced when people were unhappy with the care they received, some made the decision to end the care package. For example, following an incident in December 2023 of staff neglect, the family made the decision to end the care package. The providers documentation was not accurate with the reason the care package ended. People were not always supported with a smooth transition to another care agency or left without support. From January 2023 to the time of our assessment the providers records evidenced 59 care packages had been terminated without any detail or reason why the package ended.

While some people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. A relative told us they were very concerned and upset their child had been placed at risk because the provider had not been open and transparent about the suitability of the staff supporting them. Another relative told us their loved one had hurt themselves because they had been left to shave without support. The relative said, “His face looked like a cheese grater. I don't know who gave him the razor.”

The registered manager and provider acknowledged there had been ineffective processes to report, identify and investigate safeguarding concerns. The registered manager and provider confirmed safeguarding concerns had not always been reported to the local authority safeguarding team. These included concerns raised about rough support provided during personal care, and someone sustaining a burn following staff spilling hot food on them. Most of the staff we spoke to did not have a good understanding about reporting concerns around people’s safety. They told us they would tell the office, but they did not mention whistle blowing processes if they were worried about how concerns were being dealt with internally. Staff did not tell us about other organisations they could report concerns to such as the local authority, CQC or police.

Safeguarding systems were poor and ineffective. People were at risk of and had suffered abuse or harm. Staff did not recognise when abuse occurred and did not always report incidents of abuse to the registered manager or the local authority safeguarding team. We identified 6 incidents since January 2024 that had not been reported to the local authority safeguarding team. These included concerns raised about rough support provided during personal care, and someone sustaining a burn following staff spilling hot food on them. We made safeguarding referrals to the local authority regarding these incidents. The provider failed to ensure all staff had training in safeguarding adults and children. The training matrix showed 67% staff had not completed or had expired safeguarding training. 72% of staff had not completed or had expired safeguarding children training. This placed people at risk of not being safeguarded from harm or abuse. The registered manager and provider did not always take appropriate action to report incidents of abuse or mitigate risks. For example, when a person became distressed, staff responded by restraining the person. There was no guidance in place to inform staff of safe interventions that had been agreed. This was not reported by the provider to the local authority safeguarding team. Another relative raised concerns relating to staff overdosing their loved one. This was not reported by staff, or the provider to the local authority safeguarding team. There was no details of the investigation conducted or lessons learnt.

While some people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. A relative told us the provider had not been honest about the competence of the staff who would be caring for their child which had placed them at significant risk. The provider had assured the parent the staff would have the specific training to support their child with their needs. When the relative later questioned them about this the provider said the staff member did not have the training but had been shown by another person’s relative what to do. The relative said, “I feel really burned by this, really let down. Would (provider) have told me if you guys hadn’t been in? I don’t think so.” Some people gave positive feedback about staff, for example, one person told us they were supported to transfer by staff, and felt staff had the skills and capability to support them safely.

Staff did not have a good knowledge around managing risks to people. Some people had specific health needs which could put them at risk. For example, some people had diabetes, PEGS (percutaneous endoscopic gastrostomy is a feeding tube to allow a person to receive nutrition through the stomach), catheters (a flexible tube used to empty the bladder and collect urine in a drainage bag), were at risk of choking and constipation. Some staff were not aware about people’s health conditions, told us they did not receive any training or relied on people’s relatives to support them even though in some cases they worked alone with the person. A staff member said, “Not sure if he has diabetes.” Regarding a person who had type 2 diabetes. Another staff member supported a person with cerebral palsy, used a hoist and was at risk of choking. The staff member said, “I don’t really know, I don’t go there that often. No, she’s not at risk of anything. I don’t know what her health conditions are, she doesn’t have medicine for anything apart from medicine for pain relief.” A staff member who supported a child with a PEG said, “We were supposed to do PEG training but didn’t, it was his family, his dad who showed us how to clean the PEG.” Another staff member supported a person who was at risk of constipation and did not demonstrate a robust knowledge about how to recognise concerns or when further health advice should be sought, they said, “Maybe after the first or second day of not going to the loo you would call the doctor. I’ve never had to do that, I don’t spend that much time with him, he has other carers.” Other staff commented about the people they support, “He has diabetes but doesn’t take any medicine. We don’t monitor it, his family does and he self manages. If he was unwell, he would stay in bed.” and “Yes I do support people with catheter no didn’t have training.”

There was not an effective system to identify and mitigate risks to people. Guidance to support people with complex health needs including catheter care, diabetes management, when people became distressed and for people with a PEG (Percutaneous endoscopic gastrostomy) were not always in place or sufficiently detailed to inform staff how to support the person safely. For example, one person’s care plan detailed that if the PEG was to fall out, it needed to be re-inserted within an hour. There was no information about who was trained and capable to do this, or who the staff should contact in the emergency to ensure the PEG could be re-inserted safely. The registered manager and provider told us staff did not support people with their PEG, however we identified 3 people who received support with their PEGs. Daily records showed staff supported people with their PEGs including setting up feeds, however staff we spoke with were unable to explain how they supported the person to clean or maintain the PEG. Known risks to people had not been risk assessed. For example, one person could become distressed with loud noises and their care plan stated this could cause them to ‘abscond’. There was no information about what action could be taken to prevent this, or what action should be taken if the person was to go missing. The registered manager failed to mitigate risks to people and learn from previous incidents. For example, when a person went missing, within a busy shopping centre and was located by police an hour later. Some people were at risk of choking. There was insufficient guidance in place to inform staff how to support people if they were to choke. Some people could become very distressed, guidance to inform staff how best to support them was not in place.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

While some people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. One relative told us they would often go to support their loved one because staff ‘turn up so late’. Another relative said, “They tend not to listen to requests from Mum readily and she quite often feels very rushed.” The complaints log documented several people and their relatives had raised complaints about the timings of care calls. One log stated, ‘The relative called on their loved one’s behalf regarding the carers timing and was very frustrated as to how late the carers can be and was not happy whatsoever.’ People said, “Also the carer today was 30 mins early without a text or call to say time has changed and only stayed 35 mins instead of 45 min.” Another relative said, “The care agency continually charges my mother for care that has not been received. This is either because the carer has turned up so late and I have already seen to her needs or when the call has been cancelled by us. It is unacceptable that charges are being applied when care has not taken place.”

There was not always sufficient staffing to meet people’s needs. The registered manager and provider told us that they had not ever missed a care call. Documentation they sent us confirmed that this was not the case. A staff member said, “Exclusive Care Services has been seriously mistreating it's staff. Walkers are not being paid money to travel between care calls. Time spent travelling is not paid which can be to the tune of several hours each day. Staff are not being trained properly, any mistakes are being pointed to incompetence, whereas they have not trained us well. Very disappointed as they do not respect care staff, do not want to listen to us and talk very rudely. You can be sacked from the job if you speak up. The staff we spoke to did not have a good knowledge of managing specific health needs and told us they had not received all of the required training. A staff member said, “Yes, I do support people with a catheter no didn’t have training”.

There was not always sufficient and competent staff to meet people’s needs. Staff did not always have the training and competence to support people safely with their complex health needs. We identified 3 people who had a PEG, staff supported them with their feeds, however they had not received any training or checks to ensure they were safe to do so. When incidents occurred, there was no evidence staff received training before continuing to support people following the incident. For example, when incidents where restraint was used, or when staff had been involved in incidents with supporting people to transfer safely. The registered manager and provider told us staff completed competency checks on other staff to ensure they were capable. However, not all staff completing checks had carried out the relevant training. For example, the senior staff member who carried out medication competency checks did not have any recent or in date training. The provider could not be assured they were competent to assess other staffs’ competency. Only half the staff had received a competency check in relation to medicine administration. We could not be assured people received calls as scheduled. Call logs demonstrated calls had been missed, 1 person’s daily notes evidenced they had not received 6 afternoon calls in February 2024. There was no explanation why the calls had not been completed to ensure the person was safe. Staff received supervision, however the frequency of these varied due to senior staff workload. Supervisions were not always effective as similar incidents re-occurred, for example people being overdosed and incidents with people whilst being supported to transfer. Although the provider completed checks on new staff during the recruitment process, we were not assured the providers ongoing management and recruitment of staff was robust or in line with expected guidance. We made referrals to other agencies regarding the way the provider recruited and managed its staff.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

While some people and relatives we spoke to expressed that they were generally happy with how their medicines were managed, our assessment found care did not meet the expected standards. A relative said their loved one’s medicines storage had been left open on at least 2 occasions and their medicine had been missed at least once. They reported this to the provider, but no robust action had been taken in response to their concerns. The provider said they would “Pull in the staff member.” But there was no other information about how the provider would ensure the person’s medicine would be managed safely or how they were assured staff were competent to deal with people’s medicines.

The registered manager and provider accepted medicines management was poor. Not all staff were clear about the medicines people required. For example, 1 person had a PRN medicine Lorazepam. Staff said, “We give him meds, yes it’s as and when meds,” the staff member could not remember the name of the medicine. Another staff member fed back regarding the same persons medicine “Not sure about Lorazepam, I didn’t know this was prescribed.”

There were ineffective systems in place to ensure medicines were managed safely. Some people were prescribed ‘as and when’ medicines. There was no guidance in place to inform staff when this medicine should be administered, and how to check if it was effective. One person was prescribed a PRN medicine Lorazepam to be given when they became distressed. However, we identified they had been administered the medicine 3 times in February 2024 without a documented reason for administering. The person’s daily notes documented the person had been happy on these 3 occasions. On 1 of these occasions staff administering the medication had not had any competency checks to ensure they were capable of administering medicines safely. Some people were prescribed pain patches. These are patches applied to the skin that release a measured dose of pain relief through the skin. The position of pain relief patches was not recorded. This made it difficult to know if a replacement patch was positioned on a different site to help prevent skin irritation, or possible skin breakdown. The registered manager and provider did not complete any checks or audits to ensure medicines were administered as prescribed. The registered manager and provider failed to identify that ‘as and when’ guidance was not in place, or that pain patches were being administered and documented in line with the prescriber guidance.