Excel Care Management Services Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of the legal regulation in relation to governance at the service.

This service scored 46 (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 did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

Not all of the aims and objectives set out in the provider's statement of purpose were being met. These included complying with CQC regulatory requirements, maintaining accurate care records and driving continuous improvement through learning. While we saw some progress since the last inspection, significant improvements were still needed, particularly in relation to medicines management and ensuring calls were completed on time.

Several staff described an unsupportive culture within the staff team. Some staff told us there was a divide between office-based staff and care staff. They referred to “toxic” instant messaging groups where staff openly criticised colleagues without appropriate oversight. Some described colleagues as “horrible” and spoke of ongoing “staff conflict”. Some staff also told us they were not permitted to enter the office and instead had to wait in reception to speak with managers or members of the office team. However, not all staff shared these views, and some told us they felt psychologically safe and supported in their roles.

Staff told us workforce planning and rota management affected them. They described rotas being published late, which made it difficult to plan time away from work and other personal commitments. Some staff said rotas were not confirmed until 24 hours before a shift, limiting their ability to make arrangements in advance. Several staff also told us they had submitted annual leave requests months earlier that had not yet been approved. As a result, they were unable to book holidays or make plans with family and friends with confidence.

Some staff told us morale within the team was low. They described being allocated additional calls at short notice due to staff sickness, with some reporting that 5 or 6 calls were scheduled for the same time. Staff said they had been advised by leaders not to tell people that lateness was due to staff shortages or sickness. As a result, complaints about late calls were often directed at individual carers.

Some staff also told us that when they raised personal concerns, difficulties working with colleagues or issues relating to their employment conditions, including not being paid for breaks, they did not feel listened to by leaders.

Staff further reported that travel time was not consistently factored into rotas and that insufficient consideration was given to pairing staff who drove with those who did not. They felt this affected the achievability of scheduled call times.

The provider was receptive to the feedback regarding the culture of the service and told us they had already implemented actions to improve this.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Although leaders had made some improvements since our last inspection, including audits being more consistent, having a better oversight of incidents, complaints and adding more detail to care records, there were still significant shortfalls and concerns which were identified during this inspection. These included failures to submit safeguarding notifications to CQC, ongoing delays to people’s calls, unsafe medicines management, poor risk oversight and concerns about the service culture. This demonstrated that some risks identified at the previous inspection had not been effectively addressed or mitigated.

Staff feedback about leadership was mixed. While staff consistently spoke positively about the support provided by coordinators and senior staff, confidence in the senior leadership team was less evident. For example, one member of staff told us, “I would not feel comfortable approaching the registered manager. The registered manager is never available.” Some staff reported the registered manager was not replying to them when they raised issues or concerns.

Feedback from some people and their relatives indicated low levels of confidence in the provider and the quality of the service delivered. One relative described the service as “unprofessional,” while another person stated care only met “The bare minimum standards.” One person told us they had returned to the provider due to a lack of alternative local provision rather than confidence in the service. While some people and relatives reported improvements, they often attributed these to the involvement of external professionals rather than the provider's own governance and oversight.

The provider was receptive to the feedback and have informed us they have implemented actions to improve.

Staff did not always feel they could speak up and that their voice would be heard.

The culture of the service was not always open and transparent. Staff did not feel leaders always communicated openly or acted with integrity.

Some staff told us they felt reluctant to raise concerns. They said issues they had raised were not always listened to or acted upon. Some staff reported feeling pressured to attend work when unwell, while others lacked confidence to raise concerns about annual leave requests remaining unapproved. Staff also told us they feared negative consequences for speaking up, including being removed from the rota and a resulting loss of income. The provider disagreed with the staff claims and described a number of ways in which they felt staff were supported.

The provider did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The staff provided a mixed response to whether the service treated staff equitably. Some staff told us the leaders offered flexibility, contractual arrangements were adhered to and there was no discrimination within the service. In contrast, some staff reported perceived favouritism in relation to annual leave approval, call allocation, sickness support and rota management. One staff member felt leaders treated staff differently depending on their confidence and understanding of their employment rights.

Some staff told us how they were welcomed into the office and had a good relationship with the registered manager, compliance lead and office staff, whilst others spoke of not being allowed to enter the main office and receiving PPE through a window into a reception area of the office.

Staff experiences were mixed. Some staff told us they received regular spot checks and supervision and felt well supported by leaders. In contrast, others reported not having received a spot check or supervision for a significant period, not receiving training, and feeling unsupported.

Staff described inconsistencies in how leaders responded to concerns about bullying and harassment. They provided examples of similar issues being handled differently by different members of the leadership team.

People, relatives and staff told us some internationally recruited staff were not always familiar with British food and culture, which could affect their ability to prepare meals in line with people’s preferences. We found limited evidence that leaders had identified or responded to these learning needs. One internationally recruited staff member told us they had learned how to cook staple meals from the person they supported.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider’s last 3 inspections have been rated as ‘requires improvement.’ This indicates significant shortfalls within the governance and management of the service.

The provider had increased audit activity since the previous inspection. However, internal systems had not identified a range of concerns found during this inspection, including gaps in medicines management, care records and staff training.

The providers oversight of safeguarding concerns was not effective. Several incidents identified through complaints and other sources had not been recorded on the safeguarding tracker, and we were not assured safeguarding concerns were consistently identified or escalated.

The provider had introduced a quality assurance tracking system covering complaints, safeguarding, spot checks, and staff training compliance. However, this system did not capture all relevant incidents, contained gaps in mandatory training records, and did not demonstrate that spot checks were consistently completed, particularly following incidents. As a result, we were not assured governance systems were effective in providing oversight of service quality sand safety.

The provider’s electronic call monitoring data was unreliable, showing inaccurate travel times, simultaneous logins for staff, and annually entered records. This raised concerns about the accuracy of the data and the provider’s oversight of service delivery. Although the provider describes actions such as staff retraining and increased monitoring, concerns remained regarding data integrity.

The provider’s governance systems were not fully effective. The business continuity plan did not include key risks relevant to domiciliary care, and staff feedback regarding service culture was not reflective of the feedback we received from many staff.

The provider was receptive to the feedback and told us they had already implemented actions to improve their governance of the service.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider engaged with a range of external stakeholders and agencies. One stakeholder provided positive feedback about improvements made since the last inspection, stating there had been “a major improvement in the office dynamics” and that “roles and responsibilities were defined, and each team member knows what they are responsible for.”

People’s care records evidence partnership working with a range of health and social care professionals. Staff told us they worked well with health professionals.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The provider had failed to make sustained improvements in medicines management. Concerns identified at the previous inspections remained evident. This meant known risks had not been effectively addressed over time.

While the provider had made some improvements to its governance systems and processes, these had not been sustained or embedded sufficiently to ensure effective oversight. The provider’s audits and monitoring systems had failed to identify several concerns found during this inspection, demonstrating that governance arrangements were not operating effectively.

Since the last inspection, the provider had sought to improve the systems in place for recording incidents, safeguarding concerns and complaints and concerns. However, this system was not fully embedded and contained some errors which needed improving. This meant thematic reviews were not always picking up on all available data.