Archived: A New Angle Ltd (Scarborough)

A New Angle Ltd (Scarborough) is a domiciliary care service providing care and support to people with a range of support needs living in their own homes. There were eleven people being supported at the time of our inspection.

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.

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

The safe running of the service was directly impacted by a lack of financial resources/management. Operational issues such as late payment of staff wages and non-payment of office utilities had put people and staff at risk.

The manager left during the inspection and the provider had no oversight of the service. Staff, relatives and stakeholders had lost faith in the provider due to persistent concerns about operational issues. Many staff had left the service due to ongoing payment issues with the provider.

The provider had not always been open and honest. Notifications about ‘events that stop the service’ had not been submitted when required.

Quality assurance systems in place did not monitor the service fully and did not identify the shortfalls we found during the inspection.

People’s risks associated with health conditions were not risk assessed or care planned to support staff with action to take to support people. People were not protected from the risk of spread of infection such as COVID-19 as the service was not following up to date government guidance in relation to staff testing. The risk assessments and guidance to staff in relation to COVID-19 was also out of date and lacked detail.

We could not be sure that medicines were being safely administered as prescribed due to various systems failures such as gaps in recording, protocols missing and missing information. There was no records of accidents and incidents and no evidence of any lessons learnt.

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

Rating at last inspection

The last rating for this service was good (published 17 March 2018).

Why we inspected

We received concerns in relation to provider operational issues which resulted in a high turnover of staff. This included staff not being paid on time. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, infection prevention and control, governance, financial position, keeping the statement of purpose for the location up to date and telling CQC when things have happened. Please see the action we have told the provider to take at the end of this 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.

Follow up

We will request an action plan for 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 is registered to support people with a wide range of needs including dementia, learning disabilities, autistic spectrum disorder, mental health conditions, older people, and people who have physical disabilities. The service supports people who live in and around Scarborough.

We inspected the service on 31 October, 1 November and 22 December 2017. The provider was given 48 hours' notice of our visit; because we needed to be sure that someone would be in the location's office when we visited. At the time of our inspection, there were 58 people using the service, 70% of whom who were receiving support with personal care, primarily the service supported older people and adults with physical disabilities.

At the last inspection in January 2016, the service was rated Good overall. At this inspection, we found the service remained Good.

The service had a registered manager in place. 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.

Staff demonstrated knowledge of how to support people who may be vulnerable. They were able to identify elements of potential abuse and neglect and they knew how to report incidents. They knew the people they supported well. People we spoke with told us they felt safe, respected and well cared for.

Staff had good shared knowledge about people’s needs. They worked well together as a team, sharing knowledge and idea’s which would enhance the service.

All staff that were employed at the service were recruited safely. References were sought prior to employment commencing and employment checks were completed to support the registered manager in making safe decisions about who they employed. A comprehensive induction and training package was available to all staff and they were supported through regular supervision and appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and encouraged them to remain independent. Staff understood that people should be consulted about their care and they understood the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards. Best interest decisions involved people’s representatives when required.

Staff worked in a person centred manner and treated people with dignity and respect. Staff had positive, genuine relationships with the people they supported. People were treated with kindness and compassion and they told us staff were caring.

Care plans were centred on the needs and preferences of the person and detailed individual requirements. Care plans were regularly reviewed and kept up to date when people's needs changed. People were involved in devising their care plan and they had active input into the reviews of their care. People’s choices and preferences were valued and recognised.

We received consistently positive feedback from people who used the service, their relatives and friends and visiting professionals. People knew how to complain and they were confident that any complaint made would be dealt with.

The registered manager supported the staff to be effective in their role. Staff told us the manager was responsive to their needs and very supportive.

The provider sought people’s views on the service through surveys and questionnaires. Where issues were identified the provider took action to resolve them.

The registered manager and the provider completed regular audits and quality assurance checks of the service and this supported them to identify and resolve potential service issues at an early stage.

Further information is in the detailed findings below.

All the care plan files we looked at had the appropriate amount of detail and information in relation to the level of need and complexity of the care and support. Staffing levels were seen to be appropriate and were closely monitored.

There were systems in place to allow for staff and people who used the service to give feedback. One new staff member said 'I think the communication is great, it is definitely two way'. We spoke with people who used the service about opportunities to give feedback or raise any suggestions or concerns. One person told us 'They always listen to me and take action when it's needed'. The quality of the service was monitored by managers. There was an effective complaints system in place. Records were detailed and were managed and stored appropriately.

Staff told us that they received good support from the management team. They told us that the management team had changed in the last year and that since the change they had more confidence in the management of the service. They told us that they felt able to approach the management team if they needed any support. They also told us they accessed training on a regular basis, especially in topics specific to the people they were looking after.