Archived: Angel Court Residential Care Home

Angel Court Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 25 older people. At the time of the inspection there were 23 people living at the service, many of whom were living with dementia.

People were not protected from the ongoing risk of potential abuse. The provider had failed to ensure robust systems were in place to identify potential abuse, ensure it was reported and investigate the concerns. The provider had failed to ensure robust plans were in place to protect people from further harm. People were also exposed to the risk of harm due to the provider’s failure to ensure their risk management processes were robust. People did not always receive topical creams as prescribed. People were also not protected by effective processes to control the risk of infection.

People were not supported by sufficient numbers of suitably trained, experienced care staff. The provider had failed to ensure training and supervision was effective and equipped staff with the skills they required to support people.

People’s human rights were not upheld by the effective use of the Mental Capacity Act 2005. People’s day to day health needs were not always met and instructions given by healthcare professionals were not always followed. People’s nutritional needs were not always fully understood and monitored by care staff.

People were not supported in a caring, dignified and respectful way. People’s independence was not always promoted. Effective systems were not in place to ensure people were communicated with effectively and given maximum choice and control.

People were not always fully involved in the development of their care plans. People’s needs were not always fully assessed and care delivered was not always in line with individual needs. People were not given access to sufficient activities and leisure opportunities tailored around their unique preferences.

People were not being supported in a service run by a provider who was keen to improve the quality of service provided to them. People were not protected by robust governance and quality assurance systems. The provider continually failed to identify the areas of improvement required within the service. The provider did not proactively seek feedback from a range of sources with a view to identifying where improvements could be made and constructively use this feedback to improve the quality of care provided. The provider failed to recognise and take responsibility for the failings within the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider was in breach of the regulations surrounding person-centred care, dignity and respect, the need for consent, safe care and treatment, staffing, effective governance and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Following the last inspection, we met with the provider and asked them to complete an action plan to show what actions they would take and by when, in order to improve the ratings of the key questions of Safe, Effective, Caring, Responsive and Well Led, from requires improvement to at least good. At this inspection, we found that although some improvements were being made, these were not consistently effective and the provider had not evidenced that improvements were sustainable.

Angel Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home accommodates up to 25 older people who may have a diagnosis of Dementia. At the time of the inspection there were 25 people living at the home.

There was a registered manager in post who was also the registered provider. 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.

Following previous incidents that had occurred at the service, people did not always feel safe. Systems in place to manage risks were not always followed to ensure people were safe. Staff had been recruited safely. Although there were enough staff available to meet people’s needs, people who required one to one supervision did not consistently receive this. Medications were given safely but there were some issues in the recording of medication. Infection control policies at the home were effective.

People were not consistently satisfied with the meals provided. People’s dietary requirements were met and people had access to healthcare services where required. People had their rights upheld in line with the mental capacity act although further work was required around the recording of decisions made in people’s best interests. The decoration of the service required improving to ensure this met people’s individual needs. Staff received training to enable them to support people effectively.

People got along well with staff but some people had not developed trusting relationships with staff due to previous incidents at the service. People’s communication needs were being met and people were treated with dignity. People were encouraged to remain independent where possible and had access to advocacy services if needed.

There were a lack of activities available that met people’s individual interests and hobbies. Complaints made had not been consistently recorded or resolved. People’s care records were reviewed and held personalised information about people’s preferences with regards to their care.

There was a high turnover of management staff at the service. Systems in place to monitor the quality of the service had been ineffective in identifying the areas of concern found at this inspection. Records held in relation to people’s care were not always accurate or complete.

We had previously carried out an unannounced comprehensive inspection of this service on 20 and 21 June 2017. The service was rated as inadequate overall and was placed into special measures. A number of breaches of legal requirements were found at the inspection. On the 18 July 2017 we served the provider with two warning notices.

The first warning notice was served for a failure to comply with Regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. We found the provider had an inconsistent approach to the assessment and recording of risk, failed to ensure the safe management of medicines and did not have sufficient care workers available to keep people safe. The provider was given until the 18 August 2017 to demonstrate compliance with the regulation. The second warning notice was served for a failure to comply with Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance. We found the provider had ineffective systems to improve the quality of the service and ineffective audits. The provider was given until the 01 September 2017 to demonstrate compliance with the regulation.

On 11 September 2017 we undertook an unannounced focused inspection of the service to check the progress that had been made by the provider to meet the legal requirements in respect of the key questions of Safe and Well-Led. At this inspection, we found that the provider had made improvements. We concluded that the legal requirements in respect of the breach of Regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as referred to in the warning notice, had been met. We were however unable to conclude that the provider had improved sufficiently to meet the legal requirements in respect of the breach of Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection we requested details from the provider about how they planned to meet the requirements of Regulation 17.

At this, most recent inspection we found the provider had continued to make improvements in some areas. However, we were again unable to conclude that the provider had made sufficient improvement to demonstrate they had met the legal requirements of Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Angel Court Residential Care Home is registered to provide accommodation for up to 25 older people, who require personal care and support, some of whom are living with dementia. On the day of the inspection there were 22 people living at the home. There was a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 risks to people were not always dealt with consistently by the staff team. Staff did not always follow the guidance in people’s care records. People told us they felt safe living at Angel Court. Staff were aware of how to raise concerns for people’s safety and wellbeing. There were sufficient numbers of staff to meet people’s care and support needs and people received their medicines as prescribed. The provider was working towards an improvement action plan in relation to infection control and standards at the home had improved since the last inspection, although further improvements were still required.

We found staff did not always have the appropriate skills, knowledge and experience to meet people’s needs. The provider had not assessed the competency and knowledge of staff to ensure they could provide effective care and support. Although people received sufficient amounts to eat and drink people’s mealtime experience was not always positive as staff did not provide care that was consistent with people’s care plan. Staff at Angel Court worked in partnership with other agencies to ensure people’s health needs were met. Where people required support from external healthcare professionals visits were arranged by staff. Although some improvements had been made to the home’s environment, further action was required to ensure people’s bedroom were decorated and furnished to a high standard. People were asked for their consent before care and support was provided and where restrictions were in place the provider had acted lawfully to ensure people’s rights were protected.

Although we found that individual staff were kind towards people, the provider’s systems and processes did not always ensure that people’s overall experience was caring. Language used by staff towards people was not always age appropriate or dignified. People were supported to make day to day decisions about their care and support. People’s privacy was respected by staff and their friend and family members were made welcome when they visited the home.

Although a programme of activities was available people did not always receive support to follow their own individual interests and pastimes. People and their relatives were involved in the planning and review of their care and support. Staff understood people’s individual needs and preferences. People knew how to raise a concern if they were unhappy about the service they received however the provider needed to ensure their complaints procedure was available in an accessible format.

While some improvements had been made the provider had failed to established systems to offer assurances about the effective oversight of the service. As a result people were placed at potential risk of harm. The provider had failed to ensure staff were appropriately trained and their competency to work effectively in their roles had not been assessed. The provider did not have clear strategy in place to ensure people received a high quality service and instead reacted to feedback given by other external agencies. People and staff felt they had the opportunity to give feedback to the provider, although it was not clear how this feedback had been used to drive improvements.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The first warning notice was served for a failure to comply with Regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. We found the provider had an inconsistent approach to the assessment and recording of risk, failed to ensure the safe management of medicines and did not have sufficient care workers available to keep people safe. The provider was given until the 18 August 2017 to demonstrate compliance with the regulation.

The second warning notice was served for a failure to comply with Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance. We found the provider had ineffective systems to improve the quality of the service and ineffective audits. The provider was given until the 1 September 2017 to demonstrate compliance with the regulation.

On 11 September 2017 we undertook an unannounced focused inspection of the service to check the progress that had been made by the provider to meet the legal requirements in respect of the key questions of Safe and Well-Led. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Angel Court Residential Care Home on our website at www.cqc.org.uk”.

At this inspection, we found that the provider had made improvements. We concluded that the legal requirements in respect of the breach of Regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as referred to in the warning notice, had been met. We were however unable to conclude that the provider had improved sufficiently to meet the legal requirements in respect of the breach of Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Angel Court Residential Care Home provides accommodation for up to 25 people who require personal care. On the day of this inspection there were 25 people living at the home. A number of the people at the service lived with dementia, frailty and physical disabilities.

There was a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. At this inspection the registered manager was unavailable. We were assisted by the newly appointed manager, who we were informed would be applying to become the registered manager of this service.

We found there had been an improvement to the way risks were assessed and managed. Care workers had received clear instruction regarding reporting and recording incidents which enabled appropriate changes to be made to people’s care plans to reduce risk.

People told us they felt safe at the service. We found changes had been made to the building to improve safety for people and reduce the risk of infection identified at our last inspection.

The provider had restructured staff rotas to enable sufficient care workers to be available to meet the needs of people, and to protect them from harm, throughout the day and night.

The provider had begun to assess and record people’s capacity to make decisions, and where required considered best interest decisions for people. We found however that concerns identified at our last inspection, and in the warning notices served regarding the use of covert medication had not been fully addressed. The new manager informed us the matter would be dealt with as a matter of urgency.

People received sufficient amounts of food and drink for their health and wellbeing. Each person had a risk assessment completed for nutrition to allow their weights to be monitored and kept within safe levels.

The provider had maintained a record of safety checks undertaken at the service, and the equipment used by care workers when providing personal care had been tested.

The provider had introduced new systems and processes to improve and monitor the quality of the service however insufficient time had elapsed since our inspection in June 2017 to determine if the changes would be able to sustain improvement at the service.

The overall rating for this service has been determined to be inadequate and the service will therefore remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Angel Court Residential Care Home is registered to provide accommodation for up to 25 older people, some of whom are living with dementia, who require personal care and support. On the day of the inspection there were 25 people living at the home. There was a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks were not consistently assessed or managed which meant some people were at risk from avoidable harm. Incidents and accidents had not always been reported which meant people’s care had not been reviewed to reflect changes in their behaviours, which may put them at risk. People expressed concerns about night time staffing levels and recent incidents indicated that there were not always sufficient staff available at night to meet people’s needs. People received their medicines as prescribed, but improvements were required to the systems used to manage medicines. People told us they felt safe and staff knew how to report and escalate concerns for people’s safety.

The provider had not acted lawfully when seeking people’s consent for care and support. People’s capacity to make certain decisions had not been assessed or recorded and care records did not reflect how decisions had been made in people’s interests. Staff did not always have the skills and knowledge to provide people with consistent care. People received sufficient amounts of food and drink and staff made referrals to relevant health care professionals to support people’s health needs when required.

Some language used by staff was not dignified. However, people described staff as kind and caring and told us they were involved in day to day decisions about their care. People told us staff were respectful. Staff promoted people’s independence where possible and visitors were made welcome by staff who knew them by name.

People were not supported to take part in activities or pastimes that interested them. There were minimal activities available to people which meant people did not receive person centred support. People and their relatives had been involved in the assessment, planning and review of their care. People and relatives knew who to contact if they were concerned about any aspect of their care and support.

Systems used to monitor the quality of the service had not been effective at driving improvement or identifying concerns. The provider had failed to notify us of events as required by law. People continued to be placed at risk of harm as the communication systems within the home had failed to ensure information about serious incidents was shared with the management team. As a result action had not been taken to mitigate future risk to people’s safety. People and relatives expressed mixed views about whether the provider had sought their feedback on their experiences of living at Angel Court. Improvements were required to the overall environment of the home and the provider had an improvement plan in place.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection we found 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.

Angel Court Residential Care Home is registered to provide accommodation for up to 25 people who require personal care and support. On the day of the inspection there were 24 people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People told us they felt safe. Staff knew how to report any potential abuse. There were enough staff to meet people’s needs and provide them with effective care and support. People received their medicines safely when they needed them and medicines were stored securely.

People were supported by staff who had the skills, knowledge and experience to meet people’s needs. People’s consent was sought before care was provided. People liked the food provided and received the food and drink they required. Arrangements for meeting people’s healthcare needs were in place and people had access to appropriate healthcare professionals when they needed them.

People were supported by staff who were caring and treated them with respect. Staff understood people’s needs and preferences. People were involved in making decisions about their care and support. People were treated with dignity and offered choices in a way they could understand.

People felt able to express their views to the staff or the registered manager. There were systems in place to manage complaints.

The provider had not consistently followed local procedures when reporting issues relating to people’s safety. People, relatives, professional visitors and staff felt the home was well managed. Risks to people were recorded and understood by staff. The provider had systems in place which monitored the quality of service the home provided.

The suspension on new placements at the home by Walsall Local Authority was ongoing at the time of our visit. Walsall Local Authority have ongoing and longstanding investigations about the home. Outstanding safeguarding investigations were being considered by another agency at the time of our visit.

During our visit we spoke with one relative, three staff members and the provider/manager. The relative told us: "I cannot fault them, they are marvellous". We found that the provider had taken appropriate steps to protect people from the risk of abuse or neglect.

We found that required improvements had both been made and maintained in relation to safe and appropriate staff recruitment. This meant that appropriate systems were in place to protect people who lived in the home against unsuitable people working for the service.

Walsall and Birmingham Local Authorities have ongoing concerns about the service and have suspended all new placements at the home until required improvements can be maintained and they will also continue to monitor this service.

During our visit we spoke with two people who lived at Angel Court, three staff members and the provider/manager. One person said: "I am happy here".

We found that maintenance requirements previously identified had been addressed. The availability of building safety maintenance records provided assurance of the upkeep and safety of the building.

We found that there were some improvements in relation to safe and appropriate staff recruitment. However a failure to ensure that information about the conduct of the staff member in their previous place of employment meant that the requirements of the regulations and our warning notice were not met. This meant that vulnerable people were not adequately protected against unsuitable people working for the service. We are considering further enforcement action against the service whilst ensuring that required improvements continue to take place.

During our visit we spoke with two people who lived at Angel Court, three staff members and the acting manager. People told us that they were happy living in the home.

When we visited last time we found that improvements were needed to ensure that people were protected against the risk of abuse. This inspection found that this had not been fully addressed and there was a need for further improvement.

We found that the home was mostly clean and people were protected against the risk of cross infection. The forthcoming replacement of floor covering in rooms where a malodour was evident will mean people have a pleasant place to live.

Maintenance requirements previously identified had and were being addressed. However the lack of some building safety maintenance records meant that we were not fully assured of the safety of the building.

Bathing facilities were found to more fully met people's needs. The new shower also provided people with a choice of either a bath or shower.

Recruitment procedures for staff were not effective and put people at increased risk of abuse.

Required information was available which accurately detailed the service provided.

We found that although some improvements had been made further improvement was needed to give assurance that people would be protected from harm.

During the inspection we spoke with five people who lived at the home and two relatives. We also spoke with three members of staff and the proprietor.

People we spoke with said that they were happy living in the home. One person said; "I like it here". We found that care records confirmed people had received the care they needed.

Staff required greater understanding of safeguarding procedures to ensure that appropriate actions would be undertaken to keep people safe. We identified a need for the involvement of independent services to support people to make safe and informed decisions.

There were improved systems in place to support people to raise concerns and be confident that their concerns would be responded to.

We found that there was a malodour in some bedrooms and the upstairs corridor. There was a need for effective cleaning to ensure that people live a pleasant environment.

There was a need to ensure that bathing facilities meet the needs of people who lived in the home, An ongoing refurbishment plan for the home was not available.

Improvements had been made to check that people who lived in the home were protected from the risk of inappropriate care. There was a need for accurate and up to date information about the home and people it could support to be available.

During the inspection we spoke with two people who used the service and one relative who was visiting, one senior carer and the proprietor.

We found that the home was cold and there was a problem with the heating. We found that additional arrangements were not made to ensure that people were warm and comfortable until the problem with the heating system was addressed.

We found that people's care plans were not person centred or individualised. We saw that body maps were in place but where marks or bruises were recorded there was no suitable process for reporting to other agencies properly. We saw that receipts were not available to individuals when they used the hairdressing service. We could not find a process for managing lost property, or helping people keep personal possessions safe.

We found that the complaints system was not easily available to people who used the service or their personal representatives. Staff held a book for residents concerns. The people who used the service could not write in this without support. There was insufficient evidence to demonstrate that concerns were responded to and when needed improvements were not made in response to the concerns raised.

The service did not have an effective quality assurance system that protected people against the risk of receiving unsafe or inappropriate care.

We found that although people had a care plan they did not include all people's care needs or how they should be met. We found that shortfalls in care records put people's health and wellbeing at risk.

Improvements had been made since our last inspection in the way that staff were supervised. The new arrangements provided greater assurance that staff would provide safe and appropriate care to people who lived at Angel Court.

Three people told us that they were unhappy about the service but there was only limited information available about complaints that had been made. We found that the complaints system was not effective and did not reduce the risk of people receiving unsafe or inappropriate care.