Archived: Community Angels Ltd

Updated 26 June 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This inspection took place on 8 and 9 April 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in.

The inspection team consisted of one inspector and two experts-by-experience who made phone calls to people who use the service to gather their views on the care provided by Community Angels Ltd. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. One expert’s area of expertise was elderly care, stroke and rehabilitation, and they had a background in occupational therapy. The other expert had personal experiences of receiving care services.

Prior to the inspection we reviewed information we received about the service and looked at notifications received from the provider. A notification is information about important events which the provider is required to tell us about by law. We spoke with two social care professionals to obtain their views on the service and the quality of care people received. We asked the provider to complete and send a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. However this was not submitted at the time of the inspection.

On the day of the inspection we spoke with 22 people who used the service, 15 relatives and two visiting social workers. We interviewed eight care workers, the deputy manager, Finance assistant and two office staff. The registered manager was not available as they were living in another country.

We reviewed a range of records about people’s care and how the service was managed that included the care plans for 10 people, risk assessments, medicine records, daily reports of care, incident logs, minutes of meetings, and specific records relating to people’s health and choices. We looked at recruitment and supervision and training records for eight staff members and service quality audits.

Updated 26 June 2015

This inspection took place on 8 and 9 April 2015 and was announced. This inspection was brought forward in response to concerning information received.

Community Angels is a community based service providing personal care and live-in care to people in their own homes. The service provides support and personal care to children, adults, older persons and people with physical and learning disabilities or continuing health care needs. At the time of our inspection the service were not providing support to children. There were 208 people using the service supported by a team of 98 care workers and nine office staff.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

There was a registered manager in post who was responsible for the day to day running of the service. However the registered manager lived abroad and was not available to manage the service on a day to day basis. 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 were at risk because the provider did not prepare staff effectively to recognise and prevent abuse and avoidable harm. Staff did not feel confident to raise concerns.

Recruitment and selection processes were not robust, appropriate checks had not been completed appropriately and in line with relevant guidance and the fitness of applicants had not been requested or explored, completed or checked. Gaps in employment and previous employment history had not been explored or completed on most application forms. Some applicants had met service users and shadowed staff members before the selection process had been correctly initiated.

Staffing levels did not always meet the needs of people. People’s care had been cancelled on a number of occasions due to not having a member of staff to send to them. People were not happy with care workers whose first language was not English because the language barrier caused problems when communicating care needs. People were withdrawing from the service because there was not enough staff to meet their needs and provide the right care.

People, relatives and staff felt risks to people and staff were well managed and had no concerns. However we were not able to access all records relating to this.

Staff did not receive training that would effectively support people receiving care. Induction and training programmes were ineffective and did not equip staff with the confidence and knowledge they needed to support people safely. Supervisions were not completed in line with the provider’s policy and did not effectively support staff.

The Mental Capacity Act 2005 was not understood and as a result could not be appropriately applied. Staff did not receive training on the Mental Capacity Act 2005.

People confirmed staff were caring however their privacy and dignity was not always respected.

People did not always receive care and support that was responsive to their needs. They told us of problems with late calls, rushed calls and cancelled calls. They found the office staff were not always responsive to complaints raised and requests were not always followed up. People’s care plans were not always reviewed in line with the provider’s policy which meant information about people could be out of date.

There was little evidence of leadership in the service and as a result the service was unorganised. Office staff did not know their responsibilities. Staff members that the registered manager advised would be responsible for the day to day running of the service were not always available or working at times to suit the running of the service. Notifications of important events and information about the running of the service were not always submitted to us.

There were few systems in place for auditing the service. These had not been followed up or acted on and recent questionnaires had not been collated or analysed and results had not been fed back to people.

Information requested was not at hand which should be available at all times. For example, care plans were not always made available as paper copies had been archived and computer files were not always completed.

We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found two breaches of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.