Angelwings Homecare (Office)

Angelwings Homecare is a service providing care and support to people in their own home. At the time of the inspection the service was providing support to 16 people. Not everyone who used the service received personal care; only four of these people were receiving personal care. 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

People and staff spoke about the ‘Angelwings family’ and comments from people included: “A lovely bunch of people and my life would be completely different without them”, “As soon as they walk into our home they make you feel so special”, and “I’m treated like a normal person.”

The service was exceptional by placing people at the heart of the service and its values. It had a very strong person-centred approach. Staff and managers spoke passionately about the importance of the service’s ethos ‘Quality only happens when you care enough to do your best’ and told us how they provided person-centred care to people when they need it to improve the quality of their lives. People and their relatives all said they felt staff were like extended family. The deputy manager told us, “We don’t tell staff how to deliver quality care, we inspire them to do so.”

People’s needs and wishes were met by consistent staff who knew them well. We observed many examples of staff going ‘above and beyond’; for example, staff had noticed one person becoming more withdrawn and had suggested getting a pet for this person to care for. Following discussions and agreement with health professionals, staff had taken the person to choose a pet and this had significantly helped the person’s mental health.

People and their relatives told us they were treated with great respect for their privacy and dignity. There were examples of where staff had gone ‘the extra mile’; for example, one staff member had slept in the office when they were unable to get home after delivering care and the manager had provided a bed to support this, and one staff member had made an additional Christmas lunch and taken it to a person they support.

The service organised community and individual activities and considered the needs of everyone to ensure these were as inclusive as possible. For example, when planning a trip out which included a visit to a restaurant they planned different activities for people who were unable to eat. People received the same regular dedicated staff. People’s care plans were clearly written and detailed each step to ensure people received the care they had requested. Staff told us they had time to chat to people and the care they provided was not primarily task driven.

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.

The leadership and management team were praised by people and staff for their commitment and passion for the care profession. The service was committed to recruiting the best quality staff and understanding and treating them with understanding and respect. Regular staff meetings took place; these always included a buffet. Staff told us about the positive culture throughout the service and how they constantly looked to learn from each other. Staff explained how proud they were when they were stopped by members of the community whilst wearing their uniform and told they had heard how good the company was.

Thorough and regular audits were carried out and action on any discrepancies was clearly identified and recorded. People were asked their views in person and through quality surveys. These were analysed and thoughtful consideration was given to making improvements. The service took every opportunity to learn and improve.

Staff were recruited safely. They were well-trained and were supported and encouraged to undertake additional training in areas which would better support the people they cared for, as well as for their own personal development. There was always a manager on-call and people felt comfortable to ring at any time for support, for example, when they were accessing the community independently and needed additional support. Staff were very aware of how to report any concerns and were wholeheartedly confident managers would respond appropriately. Staff told us they were very well supported by managers. Managers told us, “We aim to be person centred for staff as well as people.”

People were supported safely and risks regarding their care were assessed on an individual basis and actions thoughtfully considered to mitigate risks in the best interests of the person. People who received their medicines from staff did so safely. People’s food and drink was monitored, when needed; records showed this was detailed and information included the calorific and fat content of foods regularly eaten so this could be monitored accurately.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Angelwings Homecare is a domiciliary care agency, which provides care and support services to adults in their own homes across Brighouse, Rastrick, Elland and surrounding areas. The agency provides a range of services including personal care. At the time of our inspection the service was providing personal care to five people. A registered manager was not required to be in position since the provider is a single individual.

Since our last inspection the provider had put a more robust recruitment system into place which ensured information about people's previous employment and any employment gaps were explored and documented at interview.

There were sufficient staff deployed to support people who used the service in a safe manner. People told us their relatives were supported by regular staff who understood their relative's care and support needs and stayed the appropriate length of time to offer effective care and support. Staff arrived on time, had received appropriate training to support them in their roles and were encouraged to develop their skills further through additional training and development. Staff spot checks and supervisions were in place.

People who used the service and their relatives felt safe with the care staff who supported them. Safeguarding procedures were in place and staff had received safeguarding training which was up to date. Risks to people's health and safety were assessed and plans of care put into place.

The service was acting within the framework of the Mental Capacity Act. People who used the service were given choices regarding their care and support and independence promoted where possible.

Where the service was supporting people nutritionally, they were supported to consume a varied and healthy diet.

People's relatives told us staff were kind, caring and supportive and knew their relatives well, including what they liked, disliked and what their care needs were.

Care needs were assessed prior to service commencement and plans of care put into place. Care records and comprehensive daily plans were highly individualised and person centred. Staff knew people's care needs well.

We observed and people told us the service was well managed and the manager was friendly and approachable. Staff morale was good and there was a commitment to provide good quality and effective care.

A range of audit systems were in place which the service was evolving as the service expanded.

Staff meetings were held regularly and people's opinions were sought through annual questionnaires and informal discussions.

We last inspected this service in June 2014 and found it was meeting all of the regulations inspected at that time.

At the time of the inspection four people were receiving personal care from the service.

A registered manager was not required to be in place as the provider is a single individual.

Relatives we spoke with were all very complimentary about the quality of the service provided to people. They all said people received a high level of personalised care from familiar staff who understood people’s needs very well. They all said they received a reliable and consistent service from day to day with staff arriving on time and completing all the required tasks.

The provider could not assure us that safe recruitment procedures were in place as information of people’s conduct in previous employment was not always present. The provider agreed to ensure more robust documentation was kept in future.

Relatives told us people were safe using the service. Risks to people’s health and safety were assessed and clear plans of care put in place. Staff demonstrated a good understanding of how to keep people safe. People received support at safe times each day and there were no reports of any missed or late calls.

There were sufficient staff to ensure people received a high quality and reliable service. The provider was diligent not to take on any additional care packages without first ensuring sufficient staff were available to provide care.

Relatives told us staff had a good level of skill and knowledge and provided effective care. People received care from a small team who were able to get to know people well and their individual needs and preferences.

The service was acting within the legal framework of the Mental Capacity Act. People were given sufficient choices in relation to their care and support.

People were supported appropriately to maintain good nutrition.

Relatives all told us that staff were very pleasant and friendly and treated them well. Staff demonstrated a commitment to providing high quality and compassionate care.

Care records contained evidence people’s needs were fully assessed. Staff understood each person they cared for and how to meet those peoples’ needs.

A system was in place to log, investigate and respond to complaints. No complaints had been received and relatives spoke very highly about the service.

The service was well run and managed. People and staff said the provider was approachable and friendly and dealt with any minor issues raised.

The quality of the service was regularly checked through both formal and informal checks on staff practice and documentation. People and their relatives were periodically asked for their views on the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations. You can see what action we asked the provider to take at the back of this report.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

Is the service safe -

Safeguarding procedures were robust and staff understood their roles and responsibilities in safeguarding the people they supported.

The people we spoke with told us they were confident the agency only employed people suitable to work with adults at risk and knew how to make a complaint and who to contact if they had a problem.

One person made the following comment 'I have always found the staff to be extremely trustworthy and I have no doubt my relatives is well cared for." Another person said "The staff are absolutely brilliant which I can only assume is down to the way they were recruited and trained."

Is the service effective -

People who used the service told us they were involved in planning their care and support and were pleased with the standard of care they received. They also told us the manager was very approachable and they could contact them at any time if they had a problem.

We saw support plans were in place for all people who used the service and they were generated from the initial needs assessment. We saw people had signed a support plan agreement which showed that the plan had been explained to them and they had agreed and understood the content. We looked at four support care plans and found they were person centred and provided staff with the information they needed to carry out their roles effectively and in people's best interest.

We saw staff completed a comprehensive induction programme which took into account recognised standards within the care sector and was relevant to their workplace and their roles. In addition, records showed that following induction training all new staff shadowed a more experienced member of staff until they were confident that they were able to carry out their roles effectively and unsupervised.

Is the service caring -

People who used the service told us they were involved in the planning of their care and support and were pleased with the standard of care they received. They also told us the manager listened to them regarding how they wanted their care and support to be delivered and all the staff were kind, caring and friendly.

One person said "I agreed the initial support plan with the agency and they have never failed to deliver what we agreed." Another person told us "The manager made it clear from the onset that I was in control of how and when my care and support was provided which means I now have a support plan tailor made to meet my needs."

Is the service responsive -

People who used the service told us the initial assessment process was thorough and they were given information about the service and encouraged to ask questions. They said this had helped them to make an informed decision about whether or not the agency could meet their needs.

One person told us the agency had a flexible approach to providing care and support and had acted on their request to change their support package quickly and without fuss. Another person said "Although the agency had only supported them for a short period of time they were responsive to their changing needs and adjusted their support package accordingly."

Is the service well led -

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

The manager told us as part of the quality assurance process they carried out random spot checks on staff as they worked in people's homes. This was to make sure care and support was being delivered in line with their agreed care plan. The manager also told us both they and other senior staff worked alongside the staff on a regular basis. This meant they were able and to talk with people who used the service and/or their relatives and observe the standard of care and support being provided.

People who used the service and their relatives told us they had confidence in the manager and senior staff team. They said they were approachable and were in contact with them on a regular basis. One person said "I would have no hesitation in recommending this agency to anyone in need. The manager listens to what you have to say and the staff are very reliable and conscientious."

The staff we spoke with confirmed that although they had only worked at the agency for a short period of time they were well supported by the manager and senior staff team. They said they could contact them at any time if they had concerns. All the staff we spoke with told us the communication between management and staff was excellent. This ensured the needs of people who used the service were met in line with their agreed support plan.