Excel Care Management Services Ltd

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• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to the way people’s medicines were managed.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider investigated complaints thoroughly and identified learning to improve practice. Investigation records included summaries of concerns, findings, actions and learning outcomes.

The registered manager and compliance lead demonstrated an understanding of the themes emerging from complaints and incidents. Where concerns had been raised repeatedly about staff members, leaders had considered contextual factors, implemented appropriate measures and continued to monitor their performance and conduct.

Staff understood what constituted an incident and an accident and were confident in reporting concerns.

Learning from incidents and accidents was shared through team meetings, supervision and staff communication systems to support continuous improvement.

The provider completed a 6 monthly learning report which analysed incidents, identified themes and monitored actions to improve safety and quality.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

The provider failed to reconcile people’s medicines safely. Medicines reconciliation is the process of identifying a person’s current medicines and comparing them with the list in use. This ensures any discrepancies were identified. We were not assured people’s medicines were being reconciled safely which put people at risk of harm.

Staff told us they did not always have sufficient time to read care plans and risk assessments before supporting a person for the first time. Some staff were unaware that care plans and risk assessments for people were accessible on their mobile device.

The provider had introduced ‘hospital passports’ (a document with key information about people including allergies, medications and diagnoses) which ensured important information could be shared promptly with relevant professionals including paramedics in an emergency.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The provider had a safeguarding spreadsheet in place, capturing details such as dates, individuals involved, severity, and closure dates. However, we identified multiple safeguarding concerns within complaints and investigation records that had not been recorded on this system. As a result, we could not be assured that all safeguarding concerns were consistently identified, recorded and escalated in line with local safeguarding procedures and organisational requirements.

The provider also failed to submit statutory safeguarding notifications to the CQC. The registered manager told us another organisation would submit the notifications on their behalf. However, responsibility remained with the registered manager.

Despite these concerns, there was evidence some investigations were completed to identify causes of safeguarding incidents and to support the learning of staff. Staff demonstrated a good understanding of safeguarding principles and their responsibilities to prevent, identify, and report abuse.

People and relatives generally reported feeling safe with staff, especially those they were familiar with.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them

People’s risk assessments and care records did not always contain sufficient detail to support safe and consistent care. For example, a person with swallowing difficulties and a high risk of falls did not have corresponding risk assessments in place. Records for some people living with diabetes also lacked guidance on recognising and responding to signs of hypoglycaemia and hyperglycaemia.

People’s records did not always clearly document decision making and mental capacity considerations. For example, it was unclear whether one person’s inability to manage their medicines independently was due to physical limitations, cognitive impairment or a lack of mental capacity.

Where risks had been identified, assessments did not always include sufficient information to support staff understanding.

There was a mixed response from staff regarding care records; some felt they were detailed and helpful, whilst others said they were not always up to date. Staff said tasks were not always reflective of what they were completing, they had limited time to read plans, and some did not know the care plans and risk assessments were accessible on their mobile devices, indicating they had not read them.

The provider had ensured most of the care records now had clear details of whether a person had a ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) order in place.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider had effective arrangements in place to monitor the safety and maintenance of people’s homes. Environmental and equipment risk assessments had been completed, including assessments for the use of bed rails where required.

The provider sought consent from people and their relatives for the local fire and rescue service to complete home fire safety assessments, which identified risks and provided advice or equipment to improve safety.

The provider had completed regular fire evacuations at their office location and kept detailed records of them.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

We had identified concerns regarding electronic call monitoring data at the previous inspection, and we found concerns again on this inspection. Data from April 2026, showed a high number of late calls, with some visits taking place late at night, which people and relatives told us was inappropriate. The provider acknowledged the concerns and stated actions would be taken to improve oversight and review rotas.

The provider’s electronic call monitoring data showed many calls had no allocated travel time between visits. We identified a correlation between these schedules and late calls, with some staff being repeatedly late. The provider attributed some issues to poor mobile reception and planned to provide refresher training on offline call logging.

People and relatives raised concerns regarding late, short and inconsistent calls. Some reported this had affected people’s health outcomes, including diabetes management and the safe administration of medicines. Several people also described high numbers of carers attending, which increased anxiety and reduced continuity of care.

Staff feedback regarding staffing levels was mixed. While some felt staffing was sufficient, others described overlapping calls, rota pressures, frequent lateness and insufficient cover when colleagues were absent.

The provider’s training records showed good overall compliance with mandatory training. However, training on supporting autistic people and people with a learning disability remained low, despite this being identified at the previous inspection. Staff also raised concerns regarding the quality of training, delays in refresher training and inconsistent competency assessments. Some staff told us they had learned specialist tasks, including stoma and catheter care, independently by researching them online.

Staff’s feedback regarding spot checks was also inconsistent. Some staff confirmed they took place, while others said they had never had one despite working for the service for a significant period.

The provider had robust recruitment processes to ensure all staff, including agency staff, were suitable for their roles.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had appropriate infection prevention and control (IPC) policies in place.

Staff received training on IPC which was relevant to their roles and helped them follow best practice guidance.

Staff told us there was enough PPE (personal protective equipment) available, including gloves and aprons.

People and relatives told us staff used the required PPE during care and disposed of it appropriately afterwards. A relative said, “They wear their PPE at all times and regularly wash their hands and change gloves when it is required.” People also told us staff respected their homes and left areas clean and tidy after they had provided support.

The service did not always ensure that medicines and treatments were safe or aligned with people’s needs, capacities and preferences, and people were not consistently involved in planning their medicines.

At the previous inspection, concerns were identified regarding unsafe medicines management. At this inspection, while some improvements were noted, these were insufficient to ensure safe practice.

As at the previous inspection, medicines information remained unavailable to external healthcare professionals out of hours, which could delay emergency treatment.

The provider had no information from the prescriber to confirm people’s current medicines, meaning staff could not reliably verify accuracy.

People had medication care plans in place, but they lacked sufficient detail, clinical oversight, and person-centred information.

People’s medicine administration records (MARs) did not always contain essential safety information, such as instructions regarding administration with food. In some cases, MARs contained inaccurate information, including incorrect medicine strengths and unsafe instructions for thickening fluids, placing people at risk.

The provider did not have effective plans for the administration of ‘as required’ medicines or variable dose medicines, and no arrangements to ensure time-critical medicines, such as those for Parkinson’s disease, were given at appropriate intervals.

People’s records for transdermal patches were not in place, increasing the risk of inappropriate application and dosing errors.

People receiving medicines via feeding tubes did not have a clear or complete record confirming safe administration. This is a nursing task requiring formal delegation and clinical oversight; however, this was not in place. Although most carers had received training, they had not been assessed as competent to carry out the task, placing people at risk of harm.

A recent complaint highlighted concerns, including missing medicines, failure to follow blister packs sequentially, and no evidence of medicines reconciliation or investigation to ensure people received all prescribed medicines.

Staff reported rota pressures, stating they were required to prioritise time critical medicines based on their judgment, rather than through effective scheduling systems.