Excel Care Management Services Ltd

Updated 12 April 2023

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 1 inspector, a medicines inspector and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was announced. We gave a short period notice of the inspection. This was because we needed to be sure the provider or registered manager would be available to support the inspection.

Inspection activity was carried out between 10 and 31 January 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. . We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 14 relatives and 21 people who used the service about their experience of the care provided. We spoke with 23 members of staff including the registered manager, nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 10 care plans and associated medication records. We looked at 10 staff recruitment files, staff training records and records associated with the provider's quality monitoring systems.

Updated 12 April 2023

About the service

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