This inspection took place on 10 October 2016 with an announced visit to the service. In addition, phone calls were made to people and their family members and representatives on 11, 12 and 14 October 2016.

Executive Care provides a domiciliary support service within Milton Keynes and surrounding areas. The service enables people to live independently in their own home.

The service had 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At the last comprehensive inspection on 18, 24, 27 August and 1 September 2015, we asked the provider to take action to make improvements to care plan and risk assessment documentation and in reporting statutory notifications to the Care Quality Commission (CQC).

This was in breach of Regulation 12 (1) (2) (a) (b) of the HSCA (RA) Regulations 2014 and Regulation 18 (1) (2) (e) of the (Registration) Regulations 2009.

We received an action plan from the provider telling us how the relevant legal requirements would be met. We carried out a focused inspection on 13 May 2016 to follow up on their actions and found that they had been completed. We could not improve the ratings from requires improvement, at the focused inspection, because to do so required consistent good practice over time.

The provider had carried out risk assessments to identify potential hazards for people using the service and staff. Risk assessments for moving and handling, pressure area care and nutrition were regularly reviewed to identify changes in people’s needs and they were amended accordingly.

People’s care, treatment and support was set out in a written care plan that described what staff needed to do to make sure personalised care was provided. The care plans contained sufficient detail to inform staff on the type of support people needed to maintain their health and well-being.

The provider had reported safeguarding concerns to the local authority safeguarding team and to the CQC to safeguard people from abuse or improper treatment. They had also kept CQC informed of other events at the service as required by law.

Internal quality audits, surveys and reviews, were used to monitor the service provision. However robust records were not always maintained on the actions taken by the provider, in response to the audit findings. The registered manager told us they planned to put action plans, with timescales in place. This would ensure that robust records were available to demonstrate the actions they had taken to continually drive improvement of the service.

Staff recruitment procedures ensured that only suitable staff were employed to work at the service. However robust records were not always maintained regarding checks carried out on car drivers using their vehicles for work purposes. Having proof of current insurance and MOT certificates held on file, would demonstrate the provider’s commitment to continually manage the staffs’ on-road risks.

Staff understood their roles and responsibilities to safeguard people and to report any concerns. The provider had informed the Local Authority in relation to safeguarding concerns.

Where the provider had taken on the responsibility systems were in place to manage people’s medicines safely. Medicines audits were regularly carried out to check that people consistently received their medicines safely.

People were involved in making decisions about their care; where they lacked the capacity to make their own decisions, decisions made in their best interests were made in line with the Mental Capacity Act (MCA) 2005.

Staff received appropriate training and systems were in place to ensure that staff received regular supervision and support.

People were encourag

Executive Care provides a domiciliary support service within Milton Keynes and surrounding areas. The service enables people to live independently in their own home.

The inspection was announced and took place on 13 May 2016 The service had 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The Care Quality Commission (CQC) had been informed by Milton Keynes Council safeguarding team and commissioners of concerns about the service that had required the provider to stop taking on any new clients until they had fully addressed the concerns.

We carried out an announced comprehensive inspection of the service on 18, 24, and 27 August and 1 September 2015, and found that two legal requirements had been breached. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Executive Care’ on our website at www.cqc.org.uk Following the inspection the provider sent us an action plan, setting out what they would do to meet the legal requirements.

We undertook this focused inspection to check that the provider had followed their action plan to meet the legal requirements. This report only covers our findings in relation to three question areas, is the service safe, is the service responsive and is the service well led? We found at this inspection that the provider had taken the necessary action and were now meeting the requirements.

We could not improve the ratings from requires improvement, because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Risk assessments were in place for people using the service and had been updated as and when their needs changed.

People identified at risk of developing pressure ulceration had specific risk assessments in place. Care plans were in place for staff to follow in managing and reducing the risks. They had also been regularly reviewed and updated as and when people’s needs had changed.

The provider had informed CQC of notifiable events as required by law.

Executive Care provides a domiciliary support service within Milton Keynes and surrounding areas. The service enables people to live independently in their own home.

The inspection was announced and took place on 18, 24, 27 August and 1 September 2015.

The service had 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The Care Quality Commission (CQC) had been informed by Milton Keynes Council safeguarding team and commissioners of concerns about people using the service not always receiving calls at their agreed times. The provider had agreed to stop taking on any new clients until the situation was resolved.

Risk assessments for moving and handling were not always updated when people’s needs had changed.

Risk assessments and care plans were not always put in place for people at risk of developing pressure sores.

People were encouraged to have their say about how the quality of services could be improved and knew how to raise any complaints if they needed to do so. However the complaints procedure was not made available within the care records held in people’s homes.

The provider had informed the Milton Keynes Local Authority Safeguarding Team of safeguarding incidents; however they had not always notified CQC of incidents that affected the health, safety and welfare of people who use services.

Staff understood their roles and responsibilities to safeguard people and to report any concerns. The provider was working closely with the Local Authority in relation to safeguarding concerns.

Suitable systems were in place to manage people’s medicines when they were not able to, manage them themselves.

Staff recruitment practices were robust and the staff received appropriate training. Systems were in place to ensure staff received regular supervision and support.

Peoples were involved in making decisions about their care; where they lacked the capacity to make their own decisions, best interest decisions were made in line with the Mental Capacity Act (MCA) 2005.

People were encouraged to eat and drink sufficient amounts to maintain good nutrition and hydration.

Staff contacted the relevant people in response to sudden illness or emergencies.

There was a system of quality audits, surveys and reviews, which was used to monitor the service provision.

We identified that the provider was not meeting regulatory requirements and were in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.

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