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Angels Care At Home Ltd Requires improvement

Reports


Inspection carried out on 25 November 2020

During an inspection looking at part of the service

About the service

Angels Care at Home Ltd, referred to as Angels Care at Home in this report, is a domiciliary care agency registered to provide personal care to people living in their own homes. The service operates in Swindon and Hertfordshire. On the day of the inspection 13 people received regulated activity.

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

People told us they were safe. However, we found concerns around management of medicines. Staff told us the management team supported them well during the pandemic and ensured they had sufficient personal protective equipment in place.

People were supported to have choice and control of their lives and staff respected their rights to make own decisions. People's care records contained information of people's dietary likes and people had been supported with meals preparation when needed.

The provider’s quality assurance processes remained ineffective and systems to monitor safeguarding concerns, accidents and care records needed improving. The provider did not ensure the necessary improvements had been made, sustained and lessons learnt where necessary.

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 requires improvement (published 10 February 2020) and there were breaches of regulations found. We issued requirement notices in relation to the regulations around the quality assurance systems, consent and the failure to notify us about reportable incidents. We agreed with the provider they will submit to us monthly updates about the progress made. The provider had not sent to us the evidence as agreed, for example, there was a gap of two months where we had received no updates. When we had an update, the evidence sent was not demonstrating sufficiently that improvements were being made. We had been receiving mixed messages about the improvements planned, of which some had not materialised.

At this inspection we found the provider was still in breach of regulation around good governance. This was their third consecutive breach of the Regulation 17 Good Governance.

Why we inspected

We undertook this focussed inspection to check the provider was compliant with the regulations and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions: Safe, Effective and Well-led, which contain those requirements. 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 remains requires improvement. This is based on the findings at this inspection. This is the third consecutive requires improvement overall rating for the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Angels Care at Home Ltd on our website at www.cqc.org.uk

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.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 17 January 2020

During a routine inspection

About the service:

Angels Care at Home Limited, referred to as Angels Care at Home in this report, is a domiciliary care agency registered to provide personal care to people living in their own homes. The service operates in Swindon and surrounding areas. On the day of the inspection 29 people were supported by the service. 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:

People said they were safe. The provider ensured staff were safely recruited. Where people needed help with taking medicines they were supported to do so. People’s care plans contained risk assessments where people were found to be at risk. However, we found when people’s needs changed the records had not always been promptly updated. Staff adhered to infection control good practice and had access to protective personal equipment.

People told us they were supported to have choice and control of their lives and staff respected their rights to make own decisions. However, we found the records surrounding capacity assessments were not in line with the Mental Capacity Act Code of Practice.

People’s needs were assessed prior to commencement of the service to ensure these can be met. People had the help where needed to meet their nutritional needs and people’s care plan described he help people required around their meals in details. Staff received ongoing training and told us they were well supported.

People said staff remained caring and people’s dignity and privacy was respected. People’s care records showed people were involved in care and their independence was promoted.

People’s care plans were detailed and included people’s life history, hobbies and communication needs. People knew how to raise concerns and said when they complained their concerns had been addressed.

The provider’s systems to monitor the quality of the service were not fully effective and the provider was in a process of implementing a number of improvements as outlined in their action plan. The registered manager failed to meet some of their regulatory requirements, such as submitting notifications. The management were open and honest, staff said the culture at the service improved. The team worked with external partners as needed.

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 requires improvement (report published 18 January 2019). There was a breach of regulation identified around the records and quality assurance. We issued a requirement notice and asked the provider for an action plan. The provider sent their action plan to us in which they stated actions they implemented to achieve compliance. We also made a recommendation surrounding documentation that related to Mental Capacity Act.

At this inspection we found some improvements had been made, people’s care plans were being updated and the provider was in a process of implementing a new electronic system for the care planning. We however found the quality assurance systems were not always in place or fully effective. You can see what action we have asked the provider to take at the end of this full report. We also found concerns around people's care plan surrounding consent and that the provider did not always notify us about reportable incidents.

Why we inspected:

This was our scheduled, planned inspection based on previous rating.

Enforcement

At this inspection we identified breaches in relation to consent, the fact the provider did not always notify us about reportable incidents and there was a lack of effective systems to monitor the quality of service. During this inspection we identified breaches of regulations 11 and 17 of the Health and Social Care Act 2008 (Regu

Inspection carried out on 11 December 2018

During a routine inspection

This comprehensive inspection took place on the 11 and 12 December 2018 and was an announced inspection. The last inspection took place on the 28 and 29 November 2017. This is the first time the service has been rated requires improvement.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people with a range of needs, including people living with dementia, people who have particular health conditions and people with physical disabilities. At the time of our inspection 34 people were receiving personal care in their home and their care was paid for through either the council, direct payments or people were paying for their own care.

Not everyone using Angels Care At Home Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

There was a registered manager in post. 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.

There were some systems in place to ensure people safely received their medicines. However, due to recording errors and a lack of effective regular medicine administration record audits, we could not be confident that people always received their medicines correctly. Audits had not always been recorded and did not always effectively identify where improvements needed to be made.

This was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation for the provider to consider guidance on completing Mental Capacity Act assessments to ensure people who might struggle making decisions about their care were supported appropriately. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Risk assessments were in place, however some risks were not identified to provide sufficient or accurate information to provide direction for staff, or information about how to reduce risks.

People’s care records gave guidance to staff on how to support people to meet their needs. Attention needed to be paid to ensure they were all person centred and not just focused on the agreed tasks that needed to be carried out.

People were supported to maintain good health. People were supported to meet their nutritional needs.

Staff treated people with kindness and compassion. People and relatives spoke positively about the care staff.

Staff received support and training and understood their responsibilities to identify and report concerns related to harm or abuse.

Staff worked with health and social care professionals in order to meet people’s varied needs.

There were sufficient staff deployed to meet people's needs. The provider had recruitment and selection processes in place, these included completing checks to make sure new staff were safe to work with vulnerable people.

Inspection carried out on 28 November 2017

During a routine inspection

This was an announced inspection which took place on 28 and 29 November 2017.

Angels’ Care at Home is a domiciliary care agency. It provides care to people living in their own houses. Not everyone using the service receives a regulated activity. The Care Quality Commission only inspects the service being received by people provided with personal care, help with tasks related to personal hygiene and eating. The agency provides a service to older adults.

At the last inspection, on 10 February 2016, the service was rated as good in all domains and therefore overall good. At this inspection we found the service was still rated as overall good but rated good in four domains. It requires improvement in the safe domain.

People, staff and visitors were generally protected from harm but care staff did not always follow the medication procedure, complete medicine care plans and record medicine administration as safely as they could. The registered manager did not always check the full work history of care staff applicants. We made recommendations around these areas. People benefitted from adequate staffing because the service did not accept a package of care unless they were able to provide staffing to meet the individual’s needs safely.

Safety was maintained by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect the people in their care and knew what action to take if they identified any concerns. General risks and risks to individuals were identified and appropriate action was taken to reduce them, as far as possible.

There was a registered manager running 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 were supported by staff who were appropriately trained and supported to make sure they could meet people’s varied needs. Care staff were effective in meeting people’s needs as described in plans of care. The service worked closely with health and other professionals to ensure they were able to meet people’s needs, as appropriate.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The service was not depriving anyone of their liberty nor ever had. They were fully aware of the action they would need in the unlikely event this became necessary.

People were supported by a staff team who delivered care with kindness, respect and understanding. They built caring relationships with people to enable them to meet their needs more sensitively. The service and care staff were aware of people’s equality and diversity needs and endeavoured to meet them. People were supported to be as independent as they were able to be by well-informed care staff.

The service was person centred and responsive to individual’s needs. It was flexible and adapted their care packages to meet people’s individualised and specific needs. People’s needs were regularly reviewed to ensure the care provided was up-to-date. Care plans included information to ensure people’s communication needs were understood.

The registered manager and the management team ensured the service was well-led. It was described as open, approachable and supportive. The registered manager and her team were committed to ensuring there was no discrimination relating to staff or people in the service. The quality of care the service provided was assessed, reviewed and improved, as necessary.

Inspection carried out on 10 February 2016

During a routine inspection

Angels Care at home limited is a small domiciliary care agency supporting people in their own homes with a range of individual needs. At the time of our inspection six people were using the service.

The service had a registered manager in place at the time of our inspection. 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 reported feeling safe with the service offered. There were systems in place to protect people from the risk of abuse and potential harm. Staff were aware of their responsibility to report any concerns they had about people’s safety and welfare.

There were enough staff deployed to fully meet people’s health and social care needs. The registered manager had systems in place to ensure safe recruitment practices were followed. However we saw for one person only personal references had been requested and not one from a previous employer. The registered manager has agreed to address this.

People’s relatives spoke positively of the care their loved ones received and praised the staff for their kindness and patience. One person commented “Staff are so nice and helpful” and a relative said “They are living up to their name, they are caring, all I see is care”.

Where challenging behaviour was displayed there was no guidance in the care plans for staff to follow on how to support them through this and alleviate their distress. For people needing assistance with applying prescribed creams there was no protocols in place on how and where to administer this. We have raised this with the registered manager who is going to ensure the information is clear and available to staff.

People’s needs were regularly assessed and reviews held on meeting these needs. Relatives said they were involved in planning their family member’s care and were happy to express their views or raise concerns.

The registered manager did not have a duty of candour policy in place for the service and was not aware of this regulation. We made this a recommendation to the registered manager.

The registered manager had systems in place to monitor the quality of service provided and people, their relatives and staff told us they had confidence in the manager’s leadership skills.