Archangel Home Care

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt and shared, to continually identify and embed good practice.

Processes were in place to support people, relatives and staff to raise concerns about safety, so care could be improved. People and staff were encouraged and supported to raise concerns about risks to safety, and people told us when they had raised concerns, action was taken immediately.

Safety incidents were recorded and investigated. The manager told us safety incidents were used as an opportunity for learning, and staff confirmed this. Staff meeting minutes showed learning was cascaded to staff to improve care for the individual and others.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were safely supported to access health care. This included smooth transitions between health and social care services, and access to other community-based appointments such as the GP. A professional told us the provider recently supported “a safe discharge, providing an increase in care when required at short notice”.

People were supported in a way which worked best for them. Care plans showed the support a person may need, for example to make a healthcare appointment. One person told us they found it helpful when the staff member went with them to an appointment and took notes, asked questions and wrote the responses down for the person so they could access this information again

The provider supported people to understand what keeping safe means. People were encouraged and empowered to raise any concerns they had about this and were appropriately supported when they felt unsafe or experienced abuse or neglect. However, information about people who had suffered harm or were at risk of harm was not always shared with other agencies in a timely way.

The provider had informed police and local authority of safeguarding concerns when appropriate but failed to follow their obligation to inform CQC on all occasions.

Staff received yearly safeguarding training and knew how to raise concerns. The safeguarding policy had a helpful list of ‘dos and don’ts’ to guide staff. Whilst the service did not support children, there was a safeguarding children policy in place, to support staff if they had concerns if children were to visit the home of people they supported.

People told us they knew how to escalate concerns about their safety. A person said, “I feel safe because the carers are very trustworthy. I have never had any concerns, everything is absolutely fine and if I were worried, I would speak with (the manager).”

The provider had risk assessments in place for the people they supported which identified potential risk, but they were not always detailed enough, and some were not required. However, staff had a holistic approach to risk and respected the choices people made about their care.

Risks assessments did not always contain adequate information. They did not always say how staff could identify and reduce the risk to the people they support. For example, some risk assessments covered specific health conditions, but there was not always a description of the symptoms staff should look out for, or the steps they could take to reduce risk.

There were many risk assessments for each person, and some were unnecessary. For example, one risk assessment was for a long-term health condition detected by a blood test and managed by the GP. The risk assessment stated staff should notice symptoms of the person becoming unwell with this condition and call 999. However, there were no symptoms directly associated with the health condition listed and therefore it would not be possible for staff to identify if the condition worsened.

Staff supported people to take carefully managed risk to live fulfilling lives. Staff said, “I make sure I listen to what it is (people) want and encourage them to think about the pros and cons to what it is they are choosing to do. Also, I make sure that I am not judgemental about their decision and show patience and understanding.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risks in people’s own homes, where care was being completed, were identified and attempts to minimise those risks were in place. For example, where people were at risk of falls, environmental risk assessments were in place which detailed what things in the home staff should look out for and what they could do to reduce this risk. This included clearing up spills, removing clutter and putting things in easy reach.

During staff meetings, staff were reminded to carry out emergency safety checks, such as testing smoke alarms and lifeline devices that alert others in an emergency. Audits of care records showed these checks were being completed regularly, helping to ensure the environment remained safe.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Oversight of staff call timing was lacking, so the provider could not always be sure people had received the calls at the right time for the right duration. However, staff and people told us there were enough staff and there was a consistent team of staff. Where people had received a delayed start to their call, people said they had been informed about the delay. One person said, “The carers are normally on time, there have been occasions when they are delayed, but they ring me to let me know. It really has happened only a couple of times.” People also told us they felt safe with the staff. One person told us, “I got on with the carers straight away and that made me feel safe”.

Staff recruitment checks were not always sufficient. An adequate number of references had been obtained, however when there was a mixture of positive and negative feedback from past employers, this had not always been followed up. Identity documentation had not always been signed to show the original document had been reviewed.

Staff training records showed most staff were up to date with their training to be able to provide safe care; however, some staff had not received face-face basic life support training. The manager was going to address this following the CQC assessment.Staff were given an appropriate induction and opportunity for regular supervision. Staff performance and ability was regularly reviewed. Despite some lack of training provided, staff told us, “I feel well trained to do this job.” Another staff member told us, “If there is anything I am unsure on in my role there is always advice and support available.” People also said they felt staff were well trained.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff were trained and understood their role and responsibility for maintaining high standards of cleanliness and hygiene in people’s homes, as well as their own personal and hand hygiene. Staff were able to access a policy which was in line with best practice guidance. People confirmed staff took precautions to reduce the risk of infection during personal care and said staff disposed of the waste appropriately afterwards.

The provider did not always make sure that medicines and treatments were safe. However, they did ensure people’s needs, capacities and preferences were met.

Medicines people were taking were listed in their care plan. However, the main risks of the medicines were not always recorded. This meant staff did not always know what signs or symptoms to look out for if people were to be unwell due to their medicine. Where people were on medicine that made them more at risk of injury if they were to fall, this had not been identified in the care plan or risk assessments. This put the person at additional risk if they were to fall.

Staff prompted people to take their medicines and supported people to self-administer their medicines. People were happy with the support they received. One person said, “The carers help me with my tablets; they watch me take them and then write it in the book that I have had them. I would forget to take them if the carers did not come, and it makes me feel really good that they are helping me like that.”