Angels Care At Home Ltd

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 remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to need for consent.

This service scored 59 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

At our last inspection we identified processes to record accidents and incidents had not been followed. At this inspection we identified these were still not followed. For example, we identified 1 person who had experienced a fall while a staff member was present. Although this was recorded in the daily notes, an incident form had not been completed and no investigation had taken place to establish contributing factors or support staff learning. This was raised with the provider, who subsequently completed an incident form.

Team meetings were now taking place; however, staff attendance was inconsistent, and records of discussions did not always provide sufficient detail to ensure that learning was shared with all staff. The registered manager told us they would improve the quality of meeting records to support effective communication and learning going forward.

However, people and staff told us the communication with the service had now improved and they felt listened to when they raised concerns.

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.

There had been no instances of people moving between service since the last assessment of the service. The service had not taken on any new packages of care as the focus had been on the service making improvements identified with the current packages of care.

At the last inspection we saw hospital passport were not available for transitions into hospital for people with a learning disability or autistic people. We now saw hospital passports were now available for people. The provider had reassessed most people’s needs through a care plan review although this had not been consistently applied for everyone at the time of the assessment. The registered manager told us since they started at the service they had reassessed most people’s needs, however there were still a few outstanding which they were focussing on.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

At the last inspection we identified consent processes not aligned with the requirements of the Mental Capacity Act (MCA) 2005. We identified similar shortfalls during this inspection. For example, there were no decision-specific capacity assessments in place in accordance with the MCA for 1 person. This was raised with the provider, who acknowledged the issue and advised that MCA documentation would be updated. Subsequent evidence submitted included reference to decisions made by professionals; however, there were still no specific MCA assessments in place relating to decisions about medication or personal care. This meant the provider could not demonstrate that care and treatment were being delivered with consent, or in line with MCA principles.

Although staff could demonstrate their understanding of how to identify and escalate abuse, we found some staff lacked knowledge on how to support people who did not have capacity. This meant care might not always be delivered in line with the legal requirements of the MCA. Leaders told us they would focus on improving staff knowledge in this area but souring additional training.

However, staff had received training on MCA and safeguarding which was up to date. The safeguarding policy had now been updated to include the relevant information about the services’ safeguarding lead and contact details for the local authority safeguarding team. People told us they liked staff and they felt safe with them.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We continued to identify shortfalls in some care plans and risk assessments. For example, there was a lack of detailed guidance relating to diagnosed conditions, allergies, early warning signs, and clear escalation procedures for staff to follow. Some staff were not always able to explain how they would recognise early warning signs linked to people’s specific conditions. However, they told us they would contact the office or emergency services if they were concerned. This meant there was a risk that changes in people's health or wellbeing may not be identified or responded to promptly and appropriately.There was no evidence to suggest people had experienced any harm. When we raised this with the provider, they updated the care plans and risk assessments and submitted evidence of the improvements made.

Some people told us that not all staff fully understood their or their relatives’ needs, which at times caused them worry and anxiety. Most people said they had not seen a copy of their care plan. While some felt this was not necessary due to their trust in the provider, others said they would find it beneficial to review and be involved in their care planning. This meant people were not always fully involved in or aware of how their care and associated risks were documented and managed.

The registered manager and nominated individual told us they were in the process of reviewing care plans and risk assessments. Although most reviews had been completed, some were still outstanding.

However, we saw some improvements since the previous assessment in how risks were managed. For example, 1 person told us they felt staff were now much better trained to manage their needs. Feedback showed that people felt more reassured about risk management following the appointment of the new registered manager.

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

The provider had made improvements in this area since the last assessment. Lone working risk assessments were now available for live-in staff. There was now clear guidance for staff to follow in the event of emergency evacuation from people’s properties. Fire-related risks had been reviewed and updated, and there was evidence the provider was carrying out checks on fire monitoring equipment to ensure they were working. This meant staff who worked in a live-in care setting were protected from the risk of harm.

Staff were able to describe what they would do in an emergency. The business continuity plan identified what actions should be taken in the event of an emergency.

People told us they had access to the equipment they needed, and staff demonstrated an understanding of how to manage risks associated with the equipment being used.

There were trained staff in place to ensure peoples care visits were completed and people did not report any missed visits. However, the provider had still not fully addressed concerns identified at the previous assessment regarding visit times. Whilst some people were happy with their visit times, 3 people we spoke with continued to express concerns about the timing of their visits. We identified records showing people’s visits occurred outside of their scheduled times, in some cases by up to 1 hour. This meant people did not always receive care at the planned times, which could impact their routines and overall experience of care. Leaders said that these issues were related to staffing availability and confirmed that recruitment activity had recently increased.

We also found that a newly recruited staff member had a gap in their employment history that had not been explored and formally documented. This meant recruitment processes were not consistently followed, and the required information was not always recorded to evidence safe recruitment practices. The provider said they had discussed the gap with the staff member and were able to explain the reasons to us. They also acknowledged this had not been documented and would ensure they did this in the future.

However, overall recruitment practices had improved, and the provider was no longer in breach of regulations relating to fit and proper persons employed and staffing. Staff confirmed they were receiving regular supervision, and we saw evidence that team meetings were now taking place. This provided opportunities for shared learning and good practice discussions. Live-in staff reported they were now receiving regular breaks to support their wellbeing.

Training records were now clear and up to date, and the provider was in the process of enrolling staff onto the Care Certificate to further support their competence in their roles. All staff had completed tier 1 training in line with the Oliver McGowan code of practice. This is the governments preferred and recommended training for health and social care staff when working with people with learning disabilities, or autistic people. The provider was in the process of sourcing the next level of training for staff.

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.

People told us that staff used personal protective equipment (PPE) when supporting them with personal care. Staff confirmed they had access to sufficient PPE and were able to demonstrate a clear understanding of how to use and dispose of it safely.

The provider had updated care documentation to reflect where individuals had potential transmissible infections. This ensured staff were aware of risks and able to take appropriate precautions to protect both staff and people receiving care receiving care. The infection prevention and control policy had also been reviewed and updated to include relevant and current guidance.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

We identified shortfalls in staff medicines competencies, which is a tool used by providers to ensure staff have the skills, knowledge and understanding required to manage and administer medicines safely and effectively. Medicines competencies did not adequately assess staff knowledge regarding how to respond if an individual lacking capacity refused medication. We also identified that some competencies had been completed by a staff member who did not have health and social care knowledge and skills. This issue had also been identified during the previous inspection. This meant staff competencies could not be fully assured, increasing the risk of inconsistent or inappropriate practice. There was no evidence to suggest people had come to any harm because of this. Following our feedback, the registered manager took action to reassess staff competencies, and evidence of this was provided.

We found that risks associated with ‘as and when required’ (PRN) medicines were not always clearly documented. For example, 1 person’s care plan referred to them as having fluctuating capacity and requiring full support with their medication, as they would otherwise not take it. However, there was no decision-specific Mental Capacity Act (MCA) assessment in place to determine whether the person had capacity to make decisions about their medicines. This person had been prescribed pain relief medication, but there was no clear guidance outlining how they would present signs of pain to inform staff when administration was required. This meant it was unclear how staff should determine whether the person was able to request or consent to these medicines. There was also a risk that medicines may not be administered in line with the person's needs and best interests.

However, people told us staff supported them with their medicines safely. Medicine Administration Records (MARs) were completed accurately by staff. Clear protocols were now in available for the use of paraffin-based emollient creams, and body maps were available to guide staff on application of use.