Archangel Home Care

About the service

This domiciliary care service is owned by Archangel Enterprises Limited and is registered to provide personal care to adults within their own homes. The agency offers support primarily to people with a learning disability mainly within the Winsford and Northwich areas of Cheshire. The service is run from an office situated on the outskirts of Winsford. The service provides care and support to both people living in 'supported living' settings and people living in their own home. Supported living settings are designed so that people can live in their own home as independently as possible. Not everyone who used the service received 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. At the time of our visit 57 people were being supported by the service.

People’s experience of using this service and what we found

Right Support

Improvements were required so everyone receiving support could develop and pursue their interests.

People were supported by staff who had the skills and knowledge to meet their individual needs.

Competent staff supported people to manage their medicines. Medicine care plans clearly described people’s individual needs.

People were supported to participate in some activities of their choice. Some people and their relatives did not feel they had enough opportunities to undertake activities of their choice.

People were supported with their communication. Staff understood and supported people with their individual communication styles. Information was not consistently made available in accessible formats, such as, easy read and pictorial.

Staff supported people to make decisions following best practice in decision making. People were offered some daily choices and staff respected people’s views.

Right Care

Risks associated to people’s care and choices were set out in their care records, but improvements were required to ensure all risks were individual to the person, held sufficient detail and were regularly reviewed.

People were not always supported by a consistent staff team. This was due to a high turnover of staff. Staff and relatives told us this impacted on people’s lives.

People received compassionate care from staff they described as kind. Staff respected people’s privacy and dignity.

Right Culture

Some staff had left recently and the remaining staff team were stretched to ensure sufficient staffing levels were maintained.

Some people and those important to them were not always involved in planning and reviewing their care. The registered manager was working to address this.

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

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

The inspection was prompted in part due to concerns received about staffing levels, areas of risk relating to moving and handling and opportunities for people to undertake purposeful activities. A decision was made for us to inspect and examine those risks.

Enforcement

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in regulation relating to risk management and governance.

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.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This domiciliary care service is owned by Archangel Enterprises Limited and is registered to provide personal care to adults within their own homes. The agency offers support primarily to people with a learning disability mainly within the Winsford and Northwich areas of Cheshire. The service is run from an office situated on the outskirts of Winsford within an established industrial estate.

The service provides care and support to both people living in ‘supported living’ settings and people living in their own home. Supported living settings are designed so that people can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living or in people’s own homes; this inspection looked at people’s personal care and support. At the time of our visit 90 people were being supported by the service.

There was a registered manager employed to work at the service. 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

People told us they felt safe using the service and felt safe with the staff team. Staff demonstrated an understanding of the types of abuse that could occur and had confidence in systems in place to report these.

Medication management was safe with people able to manage their own medication independently.

There were sufficient staff in place to meet the needs of people who used the service. Recruitment of new staff was robust with appropriate checks in place to ensure that they were suitable to support vulnerable people.

The risks faced by people in their support and in their living environments were taken into account. The registered provider sought to enable people to take risks in a safe manner in order to increase independence in their daily lives.

Staff received the training and supervision they needed to perform their role. People told us that the staff knew their needs and preferences.

The registered provider was aware of the principles of the Mental Capacity Act 2005 but was not routinely involved in assessing whether people should be the subject of deprivation of liberty safeguards. People were consulted about the support they received, agreed with it and had the opportunity to become more independent through discussions with staff through positive risk taking.

People’s nutritional needs were met and people were supported to be involved in the preparation of food in line with their abilities.

People always received support in accessing medical services when needed.

People and relatives felt that the staff team were caring and took their privacy into account at all times. People’s personal information was kept secure and confidential.

Staff interactions were respectful and positive.

People had their communication needs taken into account with staff able to effectively communicate with those with limited verbal communication.

Care plans were person centred and people who used the service were involved in their creation.

The registered provider supported people in leisure activities as well as voluntary work and paid employment.

A robust complaints procedure was in place.

People told us they knew who the registered manager was and felt that the service was well run.

A range of audits were in place to check the quality of the service provided. The views of people who used the service, relatives and other relevant professionals were gained to assist in quality assurance.

The registered provider was aware of their responsibilities as a registered service and always let CQC know of any significant events that had happened.

This domiciliary care service is owned by Archangel Enterprises Limited and is registered to provide personal care to adults within their own homes. The agency offers support to older people and people with learning disabilities, sensory impairments, physical disabilities and dementia. The service is situated on the outskirts of Winsford within an established industrial estate.

The service is provided to people living in their own accommodation, rented through a partner landlord. This arrangement is often known as ‘supported living’. At the time of our inspection there were 24 people who received a service in this way. A further 41 people were supported by staff in their own homes. At the time of this inspection 65 people were being supported by the agency and they employed 53 staff members.

There was a registered manager employed to work at the service. 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.

People and relatives told us that the staff were “Caring” and “Really nice”. They said they usually had the same group of staff supporting them and they were always made aware of who this would be prior to the visit. People said they were comfortable with their staff team and enjoyed getting out and about in the community and keeping in touch with family and friends.

Systems were in place to keep people safe. These systems included safe medicines management procedures and assessing and minimising risks to people and in and around their homes.

People were protected by safe recruitment practices that ensured appropriate checks were carried out prior to a member of staff starting their role. This also helped ensure that only suitable staff were employed by the service.

People were supported by staff who received regular training and support for their role. This helped to ensure that people received safe and effective care and support from a well-trained staff team.

Plans of how people needed to be cared for were available. The plans contained specific information which was person-centred about individuals’ that staff needed to know when they were delivering care and support to people.

Staff supported people to access the services of health care professionals, when requested to do so. Details of the visits were recorded in the care plan file.

A complaints procedure was in place and people told us that if they needed to complain they felt they would be listened to. Complaints had been well documented and dealt with in a timely manner.

We saw that there was an open and honest culture within the agency and staff confirmed this. Staff said that the registered manager was approachable and caring and that she “Went the extra mile” when necessary. People and relatives made positive comments about the registered manager, which included “She is brilliant” and “She cares about the people”. One person commented about the agency that “They are the best”.

Policies and procedures were available to the staff team. Having access to this information helped ensure that people received the care and support they required as staff had up to date knowledge of best practice available to them.

"Staff are really nice and really kind"

"I feel safe there"

"They are always there to help me"

"I decided to retire and they helped me with this decision"

"I have no worries"

"I do voluntary work, it was my decision and staff helped me with this"

"I have a support plan and I can get it changed"

"Staff listen to me"

"I have a support plan and it is changed when I want it to"

"If I have any problems I can go to the staff, they will listen to me"

"Staff are very approachable"

"I have a support plan and I can look at it anytime I want"

"They respect my privacy"

"They listen to me, everything is going well. Sometimes I go out on my own and other times it is nice to have someone with me and they always help with this"

"They listen to me and give me opportunities I never had before"

"They are honest and I can trust them"

"They are really supportive"

Our visit found that the agency was compliant with all the outcome areas that we looked at. People who used the service were supported in their daily lives and were protected from harm. They were supported by staff who had been recruited robustly and were supported in their role. All people who used the service had their opinions about their support taken into account and the agency checked the quality of the service it provided on a regular basis.

We found people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with staff and found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Comments from staff included "I feel the company recognise the good work that we do'.

We saw the provider had an effective system to regularly assess and monitor the quality of service that people receive.