Archived: Angel Solutions (UK) Ltd

Angel Care Solutions (UK) Ltd is a domiciliary care agency that provides personal care to people in their own homes. 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 inspection the service was supporting eight people with their personal care needs.

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

The provider’s planning for delivery of care was unsafe. Staff rotas revealed that people were at risk of not receiving appropriate care because managers had scheduled staff to deliver care to different people in different locations at the same time. In order for people to receive their care as planned the provider was deploying individuals who were not disclosed as staff to CQC during the inspection. This meant people continued to be at risk from potentially untrained, unvetted and unsafe staff.

People were not appropriately safeguarded. The provider did not follow local safeguarding adults guidance to keep people safe. As a result we raised two safeguarding alerts during our inspection.

Concerns remained about staff training and the records related to it.

In contrast to the staff rosters we were presented with, people and their relatives told us they did not always receive care visits from regular staff or staff named on the rosters.

The service continued to be poorly managed. Managers continued to have an inadequate knowledge of regulated activity, maintained inaccurate records and were not transparent. The provider failed to display its performance ratings.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 30 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Angel Solutions (UK) Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to governance, staffing, persons employed, duty of candour and displaying of ratings at this inspection. 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.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Angel Solutions (UK) Ltd is a domiciliary care agency providing personal care to eight people at the time of the 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

Our inspection identified a number of concerns at the service. The provider sent staff into people’s homes before confirming they were safe and suitable to provide care and support. This was because recruitment processes were inadequate. Staff job applications were not fully completed. References from previous employers were not asked for and when staff had a criminal record the provider did not make sure they were safe to care for people

The provider was not transparent when dealing with other agencies which were concerned about people’s safety. For example, the provider destroyed all records relating to a person who had died and the staff who supported them. This was in violation of the provider’s own information retention policy. The provider refused to share information with a local authority which had concerns about people’s safety.

Risk assessments and plans for the management of behaviours which may challenge were inadequate. This meant that staff had no guidance on the actions they should take when people presented with behavioural support needs. This placed people and staff at risk of harm.

Governance of the service continued to be poor. Quality assurance processes were not robust. They failed to identify and address the failings we found during this inspection. No improvements had been made to the providers inadequate recruitment or risk assessing processes since our last inspection. Management records contained inaccurate information such as the wrong rota details and many of the documents we requested had been shredded or could not be found by the registered manager and administrator.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 30 April 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider remained in breach of regulations.

Why we inspected

This focused inspection was prompted in part due to concerns received from a Coroner and a health and social care professional following an inquest into the death of a person who had received care from Angel Solutions (UK) Ltd. The concerns included inadequate care, inadequate records and a failure to be open and honest. A decision was made for us to inspect and examine those risks.

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

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Angel Solutions (UK) Ltd on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Safe Care and Treatment, Good Governance and Fit and Proper Person’s Employed. 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 remains 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.

• Angel Care Solutions (UK) Ltd is a domiciliary care agency that provides personal care to people in their own homes. At the time of our inspection the service was delivering support to eight people.

• The service supports people with a range of needs including physical and mental health needs.

People’s experience of using this service:

• The quality of care people received had significantly deteriorated since the last inspection.

• People were not safe as the provider had recruited and deployed unsafe and unsuitable staff to deliver care and support in people’s homes.

• People who presented with behavioural support needs were not protected from avoidable harm because risk assessments were inadequate and did not provide staff with the guidance they required.

• People’s medicines were poorly managed. Audits were not carried out of one person’s medicines and the medicines administration records for another person contained unexplained gaps.

• Staff were not adequately trained and staff training records were inaccurate.

• The service was poorly managed. Weak systems and inadequate management meant the provider failed to identify and act upon the shortfalls we found.

• Notwithstanding our findings, people were positive in their comments about the service they received.

• The service met the characteristics of ‘inadequate’ in two of the key areas we inspected and therefore ‘inadequate’ overall.

• We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around people’s safety, staffing and the management of the service. You can see what action we told the provider to take at the back of the full version of this report.

Rating at last inspection:

• The service received an overall rating of ‘requires improvement’ at our last inspection which was published on 12 March 2018.

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Enforcement:

In respect of this inspection full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

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

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

Angel Solutions Limited is a domiciliary care service which is registered to provide personal care to adults in their own home. At the time of our inspection there were seven people receiving personal care from the service. An additional number of people received services from the provider including support with housework and companionship. The Care Quality Commission does not regulate these activities.

The service had a registered manager. 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’s needs were not always assessed adequately or recorded appropriately. Staff were not in receipt of a programme of training to keep their skills and knowledge up to date. Staff did not always receive supervision in line with the provider’s policy and none of the staff had received an appraisal.

There was a lack of good governance at Angel Solutions (UK) Ltd. Quality assurance processes failed to detect and remedy poor quality needs assessments, low training levels and infrequent supervision. However, the new manager operated an open culture and people and staff were positive in their comments about him. The provider collaborated with other services and kept the CQC informed of significant developments.

People receiving a service from Angel Solutions (UK) Ltd told us they felt safe. Staff knew people well and how to mitigate presenting risks. The provider had assured itself that staff were safe and suitable to work with people and that there were enough staff to deliver care and support as planned. Staff followed the appropriate hygiene practices when supporting people with their personal care and people received their medicines as prescribed.

Staff supported people to access healthcare services and where required to meet with healthcare professionals. People’s nutritional and hydration needs were met by staff and people gave consent to the care they received.

People considered the staff who supported them to be caring and kind. The provider ensured that people were supported by the same staff and this consistency resulted in positive relationships developing. Staff promoted people’s dignity, maintained their privacy and encouraged people to continue to be independent.

During this inspection we found breaches relating to staffing and good governance. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Angel Solutions (UK) Ltd provides domiciliary care to people living in their own homes. The agency was providing the regulated activity of personal care to six people at the time of this inspection.

The agency had a registered manager 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.

People using the service told us that care staff spoke to them politely and treated them with dignity and respect. They were positive about the care and support being provided to them.

Staff felt supported to carry out their roles effectively and were in regular contact with the registered manager. They received training relevant to the care and support they provided.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff were aware of the need to obtain people’s consent prior to them providing any care and support.

There was a system for dealing with concerns and complaints. People felt comfortable in speaking to the registered manager if they had any issues.

Effective systems were in place to assess and monitor the quality of the service. These included obtaining the views of people who used the service and monitoring the quality of service provided through spot checks, surveys and telephone contact.