Excel Care Management Services Ltd

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

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 provider was in breach of regulations in relation to the safe management of medicines and for mandatory training compliance of autism and learning disability training.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were not always learnt from concerns about safety events and used to subsequently identify and embed good practice. There was some evidence of learning from incidents, complaints and safeguarding concerns raised. For example, staff now received cultural training, however, there was no clear process in place. Learning from complaints, incidents and safeguarding concerns was not always formally identified and shared with staff. A staff member told us, “We get no feedback regarding any themes of complaints, and I don’t know how the service is performing.”

There was some evidence risks were not being overlooked or ignored. For example, we could see contact had been made with the local authority via email for the incidents, accidents and complaints we reviewed. We saw evidence of handwritten, paper versions of incident forms being completed, however these were not stored on individual care plans or staff personnel files, as stated in the providers’ accidents and incidents policy. The policy provided example proformas for reporting accidents and incidents and a proforma of an accidents and incidents log, which was not being used. Most people and relatives told us if they had raised any concerns these had mainly been resolved.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care; they did not always make sure there was continuity of care, including when people moved between different services.

The registered manager told us the majority of people using the service had been referred by the local authority at Wigan; they told us when a person first started using the service, staff used assessment documentation from the local authority which contained details of the person and their needs; this informed the provider’s care plans. This was then followed up with the person and/or their relatives as appropriate, to form a more detailed care plan.

The registered manager told us people’s life history was not always identified in the initial referral documentation received, and staff went out to compete these with the person and their relatives, if needed. Although we saw examples of detailed life histories in some care files, others contained little information.

People did not have ‘hospital passports’ in place, which is a document designed to provide health and social care professionals with essential information about a person to help ensure people receive the right care and treatment; the absence of this information may lead to people’s health outcomes not being maximised.

We reviewed the care notes for a person who had fallen, however, there was nothing in the care notes detailing the nature of the fall, the harm caused, and any actions taken in response, such as a referral to the falls team.

Feedback from relatives and people indicated that the care needs of most people had been assessed, and they met with staff from the service before, or soon after their care package started. There was evidence some people’s care needs had been amended at the person’s request, following the initial 3-month review of care provision.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns with the local authority, as required. Staff had completed safeguarding training.

We reviewed a safeguarding incident for 1 person; there was evidence a safeguarding referral form had been completed, an investigation had taken place, and appropriate actions taken in respect of staff. The registered manager told us staff were asked to visit the office premises immediately following an incident occurring, to fill in the correct form. If this was not practically possible, staff were to attend the office within 24 hours, after sending an initial alert email to management. The registered manager informed us of a new a feature being introduced into the electronic care planning system which would allow staff to fill in forms immediately without the need to attend the office.

There was no overarching safeguarding matrix to enable the registered manager to track and monitor the progress of any safeguarding investigations, and instead, this information was placed into different folders. Whilst managers felt confident in understanding which stage any investigation was at, it was difficult to track this without searching all the associated folders individually.

People told us they felt safe around staff and knew who to contact if they had any concerns about abuse of neglect. One person said, “I have got used to carers visiting and do feel safe with them here.” Information on how to raise concerns with the provider, CQC and other organisations was given to people in an information folder provided to them at the start of care provision. The provider had a safeguarding policy in place.

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. The registered manager told us they had completed meetings with staff regarding risk assessments and all had undertaken risk assessment training.

Some people’s risk assessments lacked detail. For example, 1 person had fallen in the previous 6 months, but no further detail was provided. Another persons’ care plan stated they had fallen in November 2023 and June 2023 and ‘some more.’ It was unclear what level of need people required in relation to falls, or if they were known to the falls team.

Environmental risk assessments did not always offer sufficient detail, for example, the electrical cut- off point for 1 person was documented as ‘in the lounge’ with no further detail provided. The risk assessment section of people’s care plans stated: ‘Independent’, ‘Needs minor help’, ‘Needs major help’ and ‘Unable’; this information was not clear, including what these meant in terms of staff support. However, more details were identified in the section identifying tasks required to be completed by staff at each visit.

The ‘Do not resuscitate’ details for 3 people we reviewed, were not filled in correctly or were vague in their detail. Some people’s medication support needs were not clearly identified. The tasks outlined for staff to follow when supporting people with medicines were not always documented. We saw ‘I statements’ in care plans which indicated care plans were written with the involvement of the person and their relatives, where appropriate, which helped them to be more person centred. However, most people and relatives told us they were unsure if they had been involved in developing care plans.

The provider did not always detect and control potential risks in the care environment; they did not always make sure equipment, facilities and technology supported the delivery of safe care.

The environmental risk assessments in relation to peoples' own homes were not always fully completed.

The office building where managers and staff worked from needed renovating. There were holes in the ceilings, it was extremely cold in the upstairs staff training room, and the staff male toilet door did not close properly. The registered manager told us they had met with the building landlord who planned to renovate the whole of the top floor and was awaiting planning permission. The electrical appliances at the office premises had been inspected and tested for electrical safety and certificates were in place.

The provider did not always ensure staff received effective support, supervision, and development. Supervisions were not always completed on time, and spot checks were inconsistent. There should have been 10 spot checks per month, but records showed these were not completed regularly. Some checks were unsigned, and staff involved in incidents were not always assessed. A staff member involved in an October 2024 incident had not received a spot check until February 2025.

A staff trainer had been recruited, another was being hired, and a new training system was in place. However, since 1 July 2022, only a small number of staff had completed legally required training in supporting people with learning disabilities and autistic people.

People and relatives mostly received care from regular staff, but some felt their preferences regarding staff gender were not always met. Whilst most people said staff arrived on time, some felt visits were too short, with staff not staying for the full duration.

The provider sent us ECM data for a limited number of people who used the service despite being asked for data for all service users receiving regulated care. The data reviewed looked at calls for 45 people who used the service over a 28-day period in January 2025, in total 4251 calls were reviewed.

From the calls reviewed, 31% were not delivered within 15 minutes of the scheduled time and 11% were more than 45 minutes late. Of the calls attended, 167 were less than half of the planned duration. Timely staff support is essential for people relying on care as people depend on carers for support such as medication administration, toileting and meal preparation.

Some calls required 2 members of staff to attend; from 1242 calls, 54 calls had no overlap recorded between staff which suggested staff were not together at the same location at the same time.

Planned travel time was not seen in 43% of calls, and 1504 calls showed ‘instant travel’ which meant staff logged out of 1 call and straight into another; which suggested staff were not logging in and out when they arrived or concluded a call.

The provider did not always assess or manage the risk of infection.

The provider had an infection, prevention and control (IPC) policy which contained relevant information regarding IPC practices. People and relatives were generally complimentary in relation to staff wearing personal protective equipment (PPE), such as gloves and aprons, and washing their hands regularly. Most people and relatives told us staff wore PPE, and on the whole feedback was positive. A relative told us, “Hygiene is good, and carers wear gloves.” A person said, “Staff wear PPE and keep the kitchen tidy.” However, another person told us, “Staff do not wear gloves, aprons or masks and I have never seen them wash their hands.” A relative said, “I have seen staff wear gloves and aprons but not masks. I have not seen staff wash their hands.”

Environmental risk assessments had been completed for people’s own homes, in all the 17 care files we reviewed, except 1.

The provider was not completing IPC audits, despite the providers’ IPC policy stating an audit and a review of themes and trends in relation to IPC should be completed. We did not see evidence of IPC champions, despite this being mentioned within the policy. Roles and responsibilities around IPC were not clearly identified.

Medicines were not always administered safely, and medicines records were not always accessible to healthcare professionals or relatives when needed out of normal working hours.

Medication care plans lacked detail about people’s needs and preferences. For example, 1 person was prescribed a medicine which needed to be taken at specific times 5 times a day, the call logs showed the carers’ visits were frequently cancelled which meant the person was at risk of missing vital doses of their medicine. The manager told us that the person’s friend gave them their medicine, however the care plan failed to detail that they received any other support with medicines from family or friends.

Other people’s care plans about medicines also lacked information for example, they failed to detail exactly what each medicine was prescribed for.

There were no protocols for staff to follow about how to administer medicines prescribed ‘to be taken when required’ to ensure that medicines prescribed in this way could be given safely.