We carried out a review of the data available to us about Angels Care Wirral Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Angels Care Wirral Ltd, you can give feedback on this service.
This comprehensive inspection took place on 25 September and 1 October 2018 and was announced. Following the last inspection in July 2018 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, and well led to achieve a Good rating.
At this inspection we found there had been improvements in all required areas and we found that the breaches in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014. Had been met. These breaches related to staff support, training and good governance.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. 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.
The provider had ensured robust systems were in place for reviewing, monitoring and assessing the quality of the service. The provider was undertaking their own internal audits of the records; therefore they were now able to demonstrate how they monitored and identified any shortfalls and showed they had taken action to drive improvements.
The provider had ensured that staff received regular support, training and supervision and had the skills, knowledge and experience required to support people with their care and support needs. Training materials were up to date and did reflect current good practice guidelines and legislation.
People received their medicines on time and the information available to staff about people's medicines was up to date. There were risk assessments in place so that staff would had the guidance they needed to ensure people received their medicines safely.
People's risk assessments were in place and had been updated and reviewed to reflect changes in their needs.
Care records were informative and up-to-date. Each person using the service had a personalised support plan and risk assessment. All records we saw were complete, up to date and regularly reviewed. We found that people and their relatives were involved in decisions about their care and support.
We found that recruitment practices were in place which included the completion of pre-employment checks prior to a new member of staff working at the service and disciplinary procedures had been followed appropriately and in accordance with policies. Staff received a comprehensive induction programme, regular training and supervision to enable them to work safely and effectively. There was also an up to date staff handbook that all staff were given and also staff were informed when there were any updates.
People's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary and when people requested their support.
The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place and training to guide staff in relation to safeguarding vulnerable adults.
The service had quality assurance processes in place including service user questionnaires. The service’s policies and procedures had been reviewed and updated in 2018 by the provider and these included policies on health and safety, confidentiality, mental capacity, medication, whistle blowing, safeguarding and recruitment.
People told us they were happy with the staff and felt that the staff understood their care and support needs. The three people we spoke with and two relatives had no complaints about the service. The provider had a complaints procedure in place and this was available in the ‘Service User Guide’ and in place at the homes of the three people we visited.
We carried out an unannounced comprehensive inspection of this service on 6 April 2016 at which breaches of legal requirements were found. We identified concerns in relation to the assessment of risk and a lack of quality assurance, monitoring and oversight of the service. Following the inspection the provider wrote to us to say what action they would take to ensure they were meeting the requirements of the law. At this comprehensive inspection which took place on the 11 July 2017 we found that although some improvements had been made the provider was still in breach of legal requirements.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.
The provider had not ensured robust systems had been implemented for reviewing, monitoring and assessing the quality of the service. The provider was not undertaking their own internal audits of the records. Therefore they were unable to demonstrate how they monitored and identified gaps in the records and whether standards of care were falling. The absence of a robust quality assurance framework meant the provider had no systems to identify shortfalls and take action to drive improvement. This is an area of practice that requires improvement.
The provider had not ensured that staff received regular support, training and supervision and had the skills, knowledge and experience required to support people with their care and support needs. Training materials were out of date and did not reflect current good practice guidelines and legislation. This is an area of practice that requires improvement.
People received their medicines on time. However the information available to staff about people's medicines was not robust Therefore there was a risk that staff would not have the guidance they needed to ensure people received their medicines safely. This is an area of practice we have identified as needing improvement.
At the last inspection we found the provider had not always ensured people’s risk assessments had been updated and reviewed to reflect changes in people’s needs. At this inspection we found improvements had been made. Individual assessments identified environmental and individual risks. They were up to date and detailed guidance for staff to follow to reduce these risks effectively.
Staff knew the people they were supporting well and were aware of their personal preferences, likes and dislikes. Care plans were in place detailing how people wished to be supported and people and or their representatives were involved in making decisions about their care. People’s comments included, “They are nice people, nice to chat to” and “They are very caring and understanding”. A staff member told us “It’s a small company. We have really good relationships with our customers and have time to spend with people”. People were supported with their healthcare needs and staff liaised with their GP and other health care professionals as required.
People’s privacy and dignity was respected. Staff had a firm understanding of respecting people within their own home and providing them with choice and control. People said the service met their needs and encouraged them to be as independent as possible. One person we spoke with told us “I’m very independent and want to stay that way. The more I do the longer I’ll be able to do things. They know that and let me do things for myself”. People were asked for their views of the service and complaints and concerns raised had been responded to promptly.
People, relatives and care workers spoke highly of the service, the management and staff. Staff felt supported within their roles, describing an ‘open door’ management approach, where the registered manager and management team were available to discuss suggestions and address problems or concerns. One person who used the CQC web site to provide feedback on the service wrote 'It is a small and personal service. When things have gone a bit wrong they will listen and try to do what is required'.
People confirmed they felt safe with the staff. Systems were in place to protect people from abuse and harm and staff acted on any concerns they had. When concerns had been identified these had been passed to the local authority for them to consider under local safeguarding protocols.
Staff worked in accordance with the principles of the MCA and sought people’s consent before delivering care.
We found two areas where the provider was not meeting the requirements of the law you can read what action we have told the provider to take at the back of the full version of the report.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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 that the care plan and risk assessment review records were not all up to date or had not reflected the changes of the health of people using the service.
The provider had systems in place to ensure that people were protected from the risk of harm or abuse. Staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager or a supervisor immediately.
We found that recruitment practices were in place which included the completion of pre-employment checks prior to a new member of staff working at the service. The procedure required updating and auditing as there were gaps in the documentation. Staff received regular training to enable them to work safely and effectively. The policies and procedures in place required updating as they had not been reviewed since 2010.
The responses from people who spoke with the inspector were that the service was either very good or excellent. People told us they were very happy with the staff and felt that the staff understood their care needs. People confirmed that staff stayed for the length of time allocated and arrived on time. People also confirmed that calls were rarely missed and that an on-call system was always available. All of the people we spoke with had no complaints about the service.
The staff employed by Angels Care Wirral Ltd knew the people they were supporting and the care they needed. People who used the domiciliary service and staff told us that Angels Care Wirral Ltd was well led and staff told us that they felt well supported in their roles. We saw that the manager was a visible presence and it was obvious that they knew the people who they supported really well.
At this inspection we found a number of breaches relating to risk assessments records that were not being completed thoroughly by staff when a risk was identified, a person’s care and treatment plan must be designed to make sure it meets all their needs. Systems were not in place to effectively monitor the service.
You can see what action we told the provider to take at the back of the full version of the report.