Excel Care Management Services Ltd

Excel Care Management Services is a domiciliary care service located in Wigan. It provides personal care to people living in their own houses and flats. Not all people using the service were receiving a regulated activity. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People's experience of using this service and what we found

Medicines were not always managed safely, and some people did not receive them as prescribed. Although staff were recruited safely. DBS risk assessments were not always completed appropriately. Some people who used the service and relatives said personal protective equipment (PPE) was not always worn by staff when delivering their care. There were enough staff working for the service, although some people raised concerns with us about the timeliness of their care visits during the day. We have therefore made a recommendation regarding staffing levels.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

There were limited governance systems in place at the time of our inspection and the service were unable to evidence audits, spot checks and competency assessments were carried out consistently for all staff. There was mixed feedback about management and leadership and not all staff said they felt there was a positive culture within the service.

Rating at last inspection

The last rating for this service was good (published July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about recruitment of staff, medication, staffing and leadership. A decision was made for us to inspect and examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to requires improvement based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Excel Care Management on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We have identified breaches in relation to safe care and treatment and good governance. We will continue to monitor the service and will take further action if needed.

You can see what action we have asked the provider to take at the end of this full report

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Excel Care Management is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people living with dementia, older people, children and people with a physical disability or autistic sensory impairment. The service is a member of the local authorities ‘Ethical Community Services Framework’ and was awarded the contract for provision of care in Leigh. At the time of the inspection, there were 129 people receiving a service from Excel Care Management.

The service was last inspected in March 2017, when we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to good governance (two parts of the regulation) and staffing. Following this inspection, the service was rated as requires improvement overall and in the key lines of enquiry (KLOE's); safe, effective, responsive and well-led. The service was rated as good in caring.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; safe, effective, responsive and well-led to at least good. The service has been provided ongoing support and monitoring by the local authority through the ‘Ethical Framework’. We reviewed the progress the provider had made as part of this inspection and found that all the breaches identified at our last inspection had been fully addressed. At this inspection the service was found to be complaint with all the regulations.

At the time of the inspection there was 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 2008 and associated Regulations about how the service is run.

All the people and their relatives we spoke with said they felt the service was safe. We saw there were suitable safeguarding policies and procedures in place. Staff had all received training in safeguarding vulnerable adults and demonstrated a good understanding of how to report both safeguarding and whistleblowing concerns.

We saw effective recruitment procedures remained in place to ensure staff working for the service met the required standards. The registered manager had also implemented pre-interview telephone screening to ensure staff had the required values before progressing to formal interview.

At our last inspection we identified concerns with documentation relating to the management of medicines. At this inspection, we confirmed medicines were managed safely, all guidance to support the safe administration of medicines were in place and audits completed timely to ensure signature omissions had been identified and addressed.

The provider had appropriate assessments in place which were reflective of people’s needs and provided guidance for staff on the measures needed to reduce risks. There was an effective system in place to manage accidents and incidents, and to reduce the likelihood of re-occurrence.

Since our previous inspection, staff had received a comprehensive training programme and were working towards the care certificate with an identified timeframe for completion. Staff had a personal development plan (PDP), received quarterly supervision and staff in post over a year had completed an annual appraisal.

The staff demonstrated they knew the requirements of the Mental Capacity Act 2005 and acted in accordance with this legislation. Care files contained sufficient information to determine whether people had a lasting power of attorney (LPA’s).

All the people and their relatives we spoke with were complimentary about the staff and the care and support received. People told us staff respected their privacy and dignity and promoted their independence.

We saw examples were staff had used their own initiative to improve the quality of people’s life and well-being. This included a staff member that had sourced a wheelchair to enable a person to access the community and a second member of staff that had purchased a talking clock to assist a person to distinguish between night and day.

People received person centred care that was responsive to their needs. Support plans were reviewed and updated regularly to respond to people’s changing needs.

The provider continued to provide complimentary hours to people who were identified as being at risk of social isolation. This enabled people two hours in a month to engage in a social activity of their choosing, with the hope that people would continue the activity upon building confidence and establishing the community networks.

Complaints processes were clear and we received positive feedback regarding the registered manager’s response to a complaint whilst the inspection was ongoing.

The provider was committed to being part of the community it supports. This was evident from the decision being made to re-locate the office to Leigh to be central and accessible to the people that the service supported.

Since our previous inspection, the provider had set up the excel charity foundation. The charity was in its infancy but was an exciting initiative that would enable local people the opportunity to access monies to improve their well- being.

The provider utilised a range of systems and processes to monitor the quality and safety of the service. Staff meetings were held to pass on key messages and there were actions taken to continue to improve the service provided.

Excel care management is a domiciliary care agency, which provides personal care and support to people in their own home. The service provides support to people living in Leigh and the office has recently moved to Leigh to support the care delivery. At the time of our inspection, there were 82 people using the service. The service is part of the ethical framework for community services in Wigan so the majority of people who used the service had their care funded by the local authority.

The inspection took place on 15 March 2017 and was announced. We gave the provider of the service 48 hours' notice of the inspection. This was because the location provides a domiciliary care service. We needed to be sure that the manager would be available to speak with us.

Our last inspection of Excel was in December 2015 where the service was rated as ‘Requires Improvement’ overall and for the key questions of Safe, Effective, and Well-led. The key questions for Caring and Responsive were rated as Good.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to good governance (two parts of the regulation) and staffing. You can see what action we have taken at the back of the full version of this report.

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 2008 and associated Regulations about how the service is run.

There were appropriate policies and procedures in place. Staff demonstrated a good understanding of safeguarding, whistleblowing and how they would report concerns.

We found medicines were managed safely but there was no information recorded to guide staff when administering medicines which were prescribed to be given “when required” (PRN). The registered manager commenced addressing this during the inspection and sent confirmation that this had been rectified.

We saw employment checks had been conducted prior to staff commencing with the service and current staffing levels were sufficient to meet the care packages. People told us missed visits were not a regular occurrence and that staff were generally on time for the scheduled visit.

People did not always have risk assessments that reflected their current needs or care plans to mitigate these risks. Staff did not have detailed guidance about the care people required.

We found there were gaps in records. People did not have sufficient guidance recorded to mitigate risks and the registered manager was unable to demonstrate how they captured, reviewed and monitored any trends or patterns for accidents and incidents or shared information with staff to prevent re-occurrence and to promote learning.

Staff received an induction that was aligned with the care certificate. We saw there were gaps in the training staff received which meant the provider had not ensured staff had the required knowledge and skills to support them to fulfil the requirements of their role.

We found people did not consistently have the required support plans in place and staff were following an overview of people’s support needs which was prescriptive detailing how care was to be delivered and did not incorporate individualized, measurable and achievable goals.

People were complimentary about the staff and support they received. People were supported by a regular staff team and told us they were treated with dignity and respect and felt able to contribute to the care they received.

People were encouraged to engage in activities and a complimentary service had been developed to enable people to access two hours per month support to engage in activities of their choosing.

There were systems in place to monitor the quality of the service being provided, however it was not effective given the areas of concern we identified during the inspection.

They said that staff were "really great," ' the staff always ask me what I want and go beyond the call of duty, ' ' they do whatever I need them to do,' " staff are excellent, " " I can't fault the staff ' and "really good staff .'

People spoken with said that they knew who to speak with if they had any issues or concerns. They said " I can sort things out with the people in the office" and " I have no complaints staff are brilliant ."

Staff spoken with confirmed that training takes place, they are supported and have formal supervision.

They all said that it was a good place to work.

Comments such as "very happy with the service' ' staff are marvellous they go the extra mile' and " the staff are very good never have any trouble" were made.

We visited and spoke to people who used the service. We saw that care records in the homes of people who used the services were individual and personalised. Daily record sheets in all the homes we visited were up to date. People who used the service told us: 'I'm very happy with them, they're very good'.

We found that staff had received training in the safeguarding of vulnerable people and the staff we spoke to were aware of policies and procedures in place to help protect people using the service from harm or abuse.

We spoke to a professional from one of the local authorities who had involvement with the service and they had no concerns at the time of our inspection.

We found that there was a robust recruitment process in place. All relevant checks on staff had been completed and the staff we spoke with confirmed this process. This meant that people who were employed by the service were of good character and suitable to perform their job.

We looked at the systems in place for the storage, and recording of information for people who used the service in the office and checked that it corresponded with records kept in peoples own homes. We found that recording systems were fit for purpose.