Archived: Angels @ Home C.I.C.

About the service:

Angels @ Home C.I.C is a domiciliary care agency, which provides personal care and support to people in their own home. At the time of the inspection, there were 32 people using the service.

People’s experience of using this service:

The culture at the service was poor. Carers were not meeting people’s care needs. Staff were late to care visits and didn’t stay with people for the required duration of time. Staff had remained for two minutes of a 30-minute call and were not completing care tasks as detailed in people’s care plans.

The registered manager who was also the sole director of Angels @ Home C.I.C lacked oversight and was implicit in what was occurring at the service. They were implicated in falsifying documentation to indicate they had completed a care visit when another carer had attended.

The registered manager and sole director was responsible for devising the staff Rota’s which had the same staff member scheduled to visit four different people at the same time.

Angels @ Home C.I.C recruitment policy had not been adhered to and safe recruitment procedures were not followed. Staff were identified as working independently with people in their own home prior to their DBS check being received.

People had been placed at risk of harm because risk assessments and care plans were not representative of people’s assessed needs.

Staff had not received appropriate up to date training to meet people’s needs safely. There were staff working at the service that had not completed a care qualification and no identified timeframe to do so.

Systems and processes were ineffective to manage the service which had resulted in breaches of the regulations.

Rating at last inspection:

The service was last inspected 27 and 28 February 2018 and was rated as requires improvement. The report was published 03 May 2018. Following the last inspection, we met with the registered manager and sole director of Angels @ Home C.I.C in July 2018 and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least ‘Good’. They had failed to achieve this and the quality of care people received had significantly deteriorated.

Why we inspected:

The inspection was brought forward because we had received information indicating that staff were attending to people singularly when the person required two carers. Staff were alleged to be falsifying documentation and recording that two carers had attended the visit and people were being charged as if two carers had attended.

It was substantiated during a safeguarding strategy meeting 20 November 2018 that staff had attended two carer calls alone. It was also substantiated that a staff member had falsified documentation by pre-entering in the home report log a care visit that had not yet occurred.

Enforcement

We undertook enforcement action to cancel the registration of the provider and registered manager. Action to cancel the service and registered manager's registration was completed on 24 April 2019.

Follow up:

Following the inspection, we made safeguarding referrals to the Local Authority to look in to our immediate concerns regarding people’s safety.

On 14 March 2019, everybody that was still receiving a service from Angels @ Home C.I.C was supported by the local authority to move to an alternative care provider to receive their care and support.

The service was rated ‘Inadequate’ and the service placed in ‘special measures’. The Care Quality Commission (CQC) has now completed the enforcement action taken following our November 2018 inspection to cancel the provider and the registered managers registration. This concluded and the CQC register was updated on 24 April 2019.

Angels @ Home had been inspected in February 2017 when seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been identified. These were in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing and fit and proper person’s deployed. 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.

We inspected the service again in September 2017 when we found the provider had addressed all the regulatory breaches identified during the February 2017 inspection. However, we made a recommendation the provider seek advice and guidance from a reputable source, about person -centred care planning.

This inspection was carried out to determine if the improvements observed at our September 2017 inspection had been sustained. At this inspection we identified four breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, receiving and acting on complaints, good governance and fit and proper person’s deployed. We also made a recommendation regarding induction and training. We are currently considering our enforcement options regarding the regulatory breaches identified.

Angels @ Home is a domiciliary care agency, which provides personal care to people in their own home, who require support in order to maintain their independence.

This service is a domiciliary care agency. It provides personal care to people living in their own home in the community. The agency provides a service to: older people; people living with dementia; people living with Learning disabilities, people living with a Mental Health need, people living with a physical disability, sensory impairment and younger adults.

Not everyone using Angels @ Home received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; which includes help with tasks related to personal hygiene and eating. Where people do receive personal care we also take into account any wider social care provided to that person.

The provider was also the registered manager. This meant there was no other individual registered to provide oversight of the carrying out of the regulated activity. 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 told us they felt safe. However, we found the service was not consistently safe. We found accidents and incidents were not effectively investigated and managed to reduce the risk of people being exposed to further harm.

We found the provider had not adhered to the recruitment procedure and found gaps in the process to determine people employed were of suitable character to work with vulnerable people.

At this inspection we found safeguarding processes remained effective and staff were able to identify safeguarding concerns and the procedure in place to report concerns.

Medicines continued to be managed safely and no concerns were raised by people regarding the administration of medicines.

Oversight regarding the monitoring of scheduled visits required strengthening but there was an identified timeframe for this and people told us missed visits were not a concern with Angels @ Home.

We made a recommendation regarding induction and training. Although training had significantly improved, the agency was supporting people with specific needs that staff were not trained in. The provider had also not achieved staff completing the care certificate in the identified time frame at the last inspection and did not have a time frame identified at this inspection.

People and one relative we spoke with were complimentary about the staff, support received and gave examples of staff maintaining their dignity and promoting their independence.

We saw the provider had addressed our recommendation following the September 2017 inspection and the care files contained person-centred information and care plans sat alongside identified tasks.

The complaints process required strengthening to respond to complaints in identified time frames.

The quality auditing process was not being undertaken consistently. We found the provider and care coordinator could not demonstrate effective oversight of the service, which had resulted in regulatory breaches being identified.

This announced inspection took place on Wednesday 06 September 2017. We gave the provider 48 hours’ notice because we needed to ensure someone would be in the office to facilitate our inspection.

At our inspection in February 2017, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person centred care, safe care and treatment, safeguarding, complaints, good governance, staffing and fit and proper person's deployed. The service was rated as ‘Inadequate’ overall and for the key questions: ‘safe’ and ‘well-led’. We rated ‘effective’, ‘caring’ and ‘responsive’ as ‘requires improvement’. This meant the service was placed in to special measures.

Following the February 2017 inspection, we issued a Notice of Decision (NoD) which imposed additional conditions for the regulated activity personal care at Angels @ Home which required the provider to seek CQC authorisation to increase or commence new packages of care. The provider has done this alongside the local authority and has appropriately planned how new packages will be staged proceeding forward to ensure that the quality of care delivered to people is not compromised.

The provider was also required to appoint a new registered manager to oversee the regulated activity. 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.

Following receipt of the NoD, the provider had recruited a manager who registered with the Care Quality Commission (CQC) but they subsequently left in July 2017. At the time of this inspection, another manager had been recruited and they confirmed that they had commenced the application process to register with CQC.

At this inspection, we found the provider had taken all the required action and had addressed all the breaches identified at our February 2017 inspection.

The people we spoke with told us they felt safe. Relatives also confirmed they felt their family members were safe with the staff going into their family member’s home.

At our last inspection appropriate recruitment checks had not been undertaken prior to staff working in isolation with people in their own homes. At this inspection, we found recruitment checks had been promptly undertaken following our February 2017 visit for those staff without the required safeguards in place. We checked seven recruitment files for staff appointed following our last inspection which confirmed robust recruitment procedures were now being followed prior to staff being appointed to work at the service.

At the previous inspection we found medicines had not been handled safely and staff supporting people with medicines had not been sufficiently trained to do so. At this inspection we found medicines were handled safely. The medicines documentation had been redesigned and now supported the accurate recording of medicines to enable staff to ensure sufficient time was maintained between doses. ‘Prescribed when needed’ (PRN) protocols were now in place in addition to medicines risk assessments. All staff supporting people’s medicines had received the required training to do so.

Safeguarding policies and procedures were in place and the staff spoken with demonstrated a good understanding of safeguarding concerns and the process to follow if they suspected abuse. We saw safeguarding concerns had been identified and appropriately reported to the local authority and CQC.

The provider had appropriate assessments in place which were reflective of people’s needs and provided guidance for staff on the measures needed to reduce risks. There was an effective system in place to manage accidents and incidents, and to reduce the likelihood of re-occurrence.

The provider had policies and procedures in place to respond to emergencies and there was an on-call procedure in place to support staff.

Since our previous inspection, staff had received a comprehensive training programme and were working towards the care certificate with an identified timeframe for completion. Staff had received monthly supervision following our February 2017 inspection to support staff through the required service changes.

The provider and staff knew the requirements of the Mental Capacity Act 2005 and acted in accordance with this legislation.

People told us that the staff respected their privacy and dignity and promoted their independence where possible.

People confirmed they were supported by the same staff and the provider had introduced an electronic system that enabled them to monitor the continuity of staff visits when scheduling the rotas.

People or their relatives where appropriate, were involved in the initial assessment and we saw care reviews had been undertaken. However, we found care plans were not person-centred and did not identify people’s individual goals. The care plans were prescriptive detailing how care was to be delivered and did not incorporate individualized, measurable and achievable goals based on people’s preferences and wishes. The provider did indicate they would be changing the care plans during our inspection and sent us a new care planning document following our visit. In recognition of the provider’s prompt response to address this, we have made a recommendation about person-centred care planning.

The provider had a complaints process in place and we saw complaints had been logged and responded to. However, we received mixed feedback from people spoken to in regards to their confidence in the complaints system and whether a satisfactory resolution had been brought to their complaint.

The provider sought the views of people who used the service through reviews and quality questionnaires, to help drive improvements. Regular team meetings were conducted and the minutes of meetings circulated to ensure staff were kept up to date with developments at the service.

The provider had introduced effective systems to assess and monitor the quality of services people received and had addressed all our previous concerns. The provider was continuing to monitor progress and make improvements where required.

The inspection took place on 06 and 07 February 2017 and was announced. We gave the provider of the service 48 hours' notice of the inspection. This was because the location provides a domiciliary care service. We needed to be sure that the manager would be available to speak with us. Prior to our visit we had received information of concern about the quality and safety of the service provided. This information prompted our visit.

During the inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person centred care, safe care and treatment, safeguarding, complaints, good governance, staffing and fit and proper person’s deployed.

We made a decision under Section 31 of the Health and Social Care Act 2008, to impose additional conditions to the registration as a service provider in respect of the regulated activity. We imposed the following additional conditions for the regulated activity personal care at Angels @ Home:

1. The registered provider must not commence any new packages of personal care for service users, or increase the provision of packages of personal care to existing service users without the prior written agreement of the Care Quality Commission to do so.

2. The registered provider must appoint an individual, who is not Staff Member A, with the relevant qualification, skills and experience (NVQ Level 4 or equivalent) to provide additional oversight and governance, by their primary role being quality assurance and safety. They must assist Angels @ Home CIC with their assessing, monitoring and improving the quality of the service provided. In addition, assisting Angels @ Home CIC, with the monitoring and mitigation of risks in relation to health and safety and welfare of service users and in turn assisting with evaluating and improving practices at Angels @ Home CIC. The individual must be appointed within 21 days of service of this Notice of Decision.

The Notice of Decision was served on 16 February 2017. We are still considering further enforcement options in relation to this service.

At the time of the inspection, the provider was also the registered manager. This meant there was no other individual providing oversight of the service and the carrying on of the regulated activity. 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.

The provider had increased the number of packages of care they were providing and this had not been planned effectively. The provider did not have plans in place to manage the transition. Resources in the service were not adequate to increase at this rate and provide a high quality service to people.

People told us they felt safe but we found they were receiving care from staff that had not undergone appropriate pre-employment checks. Staff had been appointed and commenced working unaccompanied in people’s home prior to the Disclosure and Barring service (DBS) check and references having been received. This exposed people to the risk of being supported by unsuitable staff.

Medicines were not handled safely as sufficient gaps between doses could not be demonstrated. We also found staff were handling medicines without having received medicines training.

People did not always have risk assessments that reflected their current needs or care plans to mitigate these risks. Staff did not have detailed guidance about the care people required.

Staff had not received an induction or appropriate training and support to enable them to fulfil their roles.

People were complimentary about the staff and support they received. People told us they were treated with dignity and respect and felt able to contribute to the care they received.

We found people did not receive care at regular times from staff that knew them. The staff rotas showed that staff were allocated for the convenience of the service and did not always take into account people's needs or preferences.

We found there was a complaints procedure in place but this had not always been followed by the

provider, which meant the concerns a relative had raised had not been responded to in a robust and adequate way.

We found there were no robust procedures in place to monitor the quality of the service. We found checks being made on the overall operation and quality of the service were not in place to identify the areas of concern which meant the provider was not meeting their regulatory requirements.

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

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.