Archived: Angels Assisted Living Services

This announced inspection took place on 7, 9, 12 and 19 June 2017.

Angels Assisted Living Services is a Domiciliary Care Service which is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing care to five people all of whom were living within the housing complex in Prudhoe. The service also provided emergency response cover to all of the people who lived in the housing complex at Prudhoe and also a similar housing complex in Alnwick.

Under its registration with the Care Quality Commission (CQC) this service does not require a registered manager, as the provider of the service is an individual in day to day charge of operations. 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.

We had recently received a number of safeguarding concerns in relation to the provider and the service offered to people they supported. These are currently being investigated by the local authority safeguarding team and we will continue to liaise with them and take further action if found necessary to ensure the safety of people.

We received mixed views from people and relatives during our inspection. We found that there had been historic blurring of the roles and responsibilities between the management of Angels Assisted Living Services and the previous manager within the housing complex in which the provider worked in Prudhoe. This had caused confusion for people, relatives, staff and visitors as to whom they should refer to when a care issue arose.

There had also been issues in connection with the level of care to be provided, particularly the emergency response element of the service with comments made indicating they thought there was not enough staff. At the time of the inspection the records reviewed and the providers explanation suggested there was sufficient staff.

Staff understood their responsibilities of reporting any allegations of abuse and knew how to raise concerns if needed. People were supported to have their prescribed medication safely.

The provider had not always acted safely, swiftly or appropriately in relation to recruitment procedures, employment checks and investigations completed with staff. This meant staff may have been employed, or employed longer than they should have, who were not suitable to work with vulnerable adults.

People’s safety was protected because risks assessments identified risks that were specific to their needs and care plans were individualised. However, the provider had no pre-assessment information available and told us they destroyed this information once they had drawn up care plans. People and their families told us they had been involved in formulating people’s care plans.

The provider’s business continuity plan needed to be finalised to ensure that if the service had an emergency, they would be able to carry on providing care to people safely.

Staff felt supported and they received supervision sessions and annual appraisals, although they were not always recorded. Training was provided and induction was based around the Care Certificate standards.

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

People received suitable food and refreshments which met their needs. People had access to healthcare professionals although not all comments received from people or relatives felt this was the case. This is being separately investigated currently by the local authority safeguarding team.

We received mixed views about the caring nature of the service and its staff, including the provider. Surveys had been sent out to gather the views of people and the majority of those returned had been positive. People and their families told us they knew how to complain if they felt they needed to.

Activities were made available to people if this was part of their care plan, including those which were facilitated in the complex in which they lived.

Communication between the provider and other agencies or services was not as good as it should have been. We found that roles had not always been clear and this included who people, relatives or staff should speak with regarding issues arising.

The provider had not always followed their own policies and procedures, including those in connection with gifts.

Quality monitoring systems were in place and when issues had been identified, actions were put in place to rectify these. Although not all the issues we had found during our inspection had been identified.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the good governance and fit and proper person’s employed.

You can see what action we told the provider to take at the back of the full version of this report.

We carried out an announced comprehensive inspection of this service on 17 and 18 December 2015. Three breaches of legal requirements were found, which related to safe care and treatment, staffing, and good governance. We took enforcement action in relation to good governance, and issued a warning notice which notified the provider why they were not meeting the regulation and required them to take action. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check they had met the requirements of the warning notice. This report only covers our findings in relation to the warning notice with regards to Good Governance. We will follow up on the other breaches of regulations at future inspections. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Angels Assisted Living Services on our website at www.cqc.org.uk

Under its registration with the Care Quality Commission (CQC) this service does not require a registered manager, as the provider of the service is an individual in day to day charge of operations. 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.

We found action had been taken to address the shortfalls identified at our last inspection.

Policies had been reviewed and updated so they were specific to this service. The safeguarding policy included information about how to contact the local authority safeguarding team, and the complaints policy detailed how any complaints would be investigated.

The provider was working within the principles of the Mental Capacity Act 2005. People's capacity to make decisions had been assessed. We saw evidence their choices and decisions about their care and treatment were respected.

People's care records had been updated. Assessments and care plans were specific to people's individual needs and contained a good level of detail.

The provider was involved in planning and delivering care. She told us this meant she monitored the quality of the service provided on a daily basis. She acknowledged that some of the assurances and checks she carried out were informal, but we noted that systems related to ensuring staff competency in their role and gathering feedback from people who used the service, had been improved.

This meant that the provider was now meeting Regulation 17.

We have not changed the rating of the service at this inspection. This was because we wanted to be reassured that improvements made would be sustained over a longer period of time.

This inspection took place on the 17 and 18 December 2015 and was announced.

Under its registration with the Care Quality Commission (CQC) this service does not require a registered manager, as the provider of the service is an individual in day to day charge of operations. 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.

People spoke highly of the provider as did the staff who worked for the provider. People told us they felt safe and happy with the care workers who visited their homes and they believed the provider delivered a good service.

Policies and procedures were in place to manage the service; however we found these to be generic, basic and under developed. There was no system in place to record or monitor incidents of a safeguarding nature. We identified some incidents of a safeguarding nature which the provider had not recognised as safeguarding matters and therefore they had not reported them on to the local authority or CQC.

Staff supported people at home with their care needs and the service had assessed some risks. However, risks associated with personal care tasks had not always been assessed. There was evidence that reviews of people’s care needs had taken place. We observed care workers assisted people to take their medicines safely; however the medication needs and risk assessment documentation did not always reflect the current support being provided.

People told us they didn’t feel rushed by staff when they delivered care and staff confirmed that they had enough time to complete the tasks required and travel between each care call. The provider manually devised the rotas based on her own knowledge and experience of each individual’s needs and geographical locations. We found the provider employed enough staff to manage the service effectively.

Staff files showed that when recruiting care workers, the provider had carried out pre-employment vetting checks, however, references were not always from a suitable person. Training was provided to care workers by an external training provider. We reviewed the assessments of learning contained in some staff files. We found that some staff were working unsupervised before their competency had been properly assessed.

CQC monitors the application of the Mental Capacity Act (2005). There was evidence to show that staff understood their responsibilities under this act and training related to this had been provided to care workers. However, the service had not considered people’s capacity during assessments of their needs or alternatively they had not sought information from the local authority when they received initial referrals.

People were supported by care workers to maintain a balanced diet. They told us that staff made nice meals and always offered them a choice. One person told us “X (care worker) helped me make a pasta bake for lunch”. Staff had undertaken equality and diversity training and people told us that they were treated as an individual. Care workers understood people’s likes and dislikes, although these preferences were not recorded in people’s care plans.

People told us their care workers were caring, compassionate and treated them with dignity and respect. We observed care workers respecting people’s privacy and their belongings when we visited people within their own homes.

The provider held information about complaints, compliments and comments, as well as accidents and incidents. We found this information was lacking in detail and the provider told us that no formal complaints had been received; only areas of concern. We found information in a care record which was a complaint. Although this had been investigated and an explanation given to the complainant, the complaint had not been identified as such and therefore was not recorded in the complaints file for monitoring purposes. The same incident should have also been raised with the local authority as a safeguarding concern but had not been.

The provider monitored the quality of the service by carrying out spot checks on care workers and an annual stakeholder survey. Although both methods were undertaken, the results were not collated and actions were not documented to address any shortfalls. Similarly, audits were carried out, but these were not robust and had not identified the issues we highlighted to the provider during our inspection.

The provider had a wealth of experience in care services and staff told us they found her supportive and approachable. Office staff told us they had been welcomed into the team and that the provider was more than happy to hear their suggestions for improvements to the service. The provider personally managed all of the daily operations and was in the process of handing over some responsibilities to the newly appointed administrative staff. The provider had a clear vision for the service and wanted to concentrate on improving and growing the business.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.