The inspection was announced and took place on 25 September 2017.Guardian Angel Carers Ltd is a domiciliary care agency that provides personal care and support to people in their own homes in Chichester and the surrounding areas. People who receive a service include those living with frailty or memory loss due to the progression of age, mobility needs and health conditions. At the time of this inspection the agency was providing personal care to 114 people.
Visits ranged from half an hour up to six hours. The frequency of visits ranged from one visit per week to four visits per day depending on people’s individual needs. The agency also provides live-in carers for people and overnight care.
During our inspection the provider and the registered manager were present. 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 agency was previously inspected in May 2015 however a change in legal entity has resulted in this being the first inspection since then.
The agency had clear vision and values that were person-centred, fully embedded and owned by everyone. This ensured people were at the heart of the service. High quality care was integral to the agency and robust systems were in place to drive continuous improvement. There were a range of quality assurance audits and checks in place that helped ensure the agency ran smoothly. The agency had developed effective partnerships with other organisations to ensure they were following current practice and providing a high quality service. The provider, registered manager and members of the staff team were members of, or worked with, local and national organisations that provided support, guidance, and information about best practice. They attend workshops and meetings with these organisations in addition to receiving regular updates and information. We saw that publications from these organisations were shared with staff and service provision reviewed when needed to ensure continual improvement and best practice. Records and discussions with people and care workers confirmed that this was applied in practice and led to a consistently high service.
Being part of the community was intrinsic to the ethos and culture of the agency. The provider and the registered manager went out of their way to put people at the heart of the service. They constantly looked for ways of improving the service to benefit people they provided a service to. This also extended to older people in the wider community as the provider recognised that older people were at risk of isolation. The provider founded the ‘Golden Angels Lunch Club’ six years ago. The agency has donated Christmas gifts each year, and in January 2017 the agency became sponsors of the club. This is a lunch club for older people who live alone that takes place bi-monthly. The club provides a home cooked meal for a small cost and includes providing transport to and from the venue. It is run by volunteers that include the provider and people who work at agency.
There was a sustained and positive culture at the agency that was open, inclusive and empowering. All the care workers spoke very highly of the provider and the registered manager. The provider and registered manager were excellent role models who placed importance on developing each member of staff's potential and helping them develop a career path, offering promotion to suitable staff where possible. The provider also promoted a strong sense of teamwork, keeping care workers involved, and making sure they felt valued. This ethos won the agency best large business and best overall business 2017 at the Observer and Gazette Business Awards. This is a local newspaper that operates in the areas that the agency covers.
Everyone that we spoke with, without exception told us they were treated with kindness and respect by the care workers who supported them. Positive, caring relationships had been developed with people. Care workers understood the importance of promoting people’s privacy and maintained their dignity. The agency had signed up to the Social Care Institute for Excellence (SCIE) Dignity Challenge and the training manager at the agency was a Dignity Champion and all members of staff dementia friends. Care workers had also been provided with more in-depth dementia training. Care workers were knowledgeable about supporting people who lived with dementia. As a result, people received a care service that was personalised and responsive to their needs.
Everyone that we spoke with said they felt safe with the care workers who visited them. They said that they trusted them and had confidence that they could do a good job. People knew how to contact the head office if they had any concerns and were made aware of the complaints procedure. Care workers that we spoke with confirmed they had received training and were knowledgeable in recognising signs of potential abuse and the relevant reporting procedures. Robust recruitment procedures were followed to ensure care workers were suitable for the job.
People said that care workers arrived on time and stayed to their allocated time. On the few occasions when there has been a delay, care workers or office staff had made contact and kept them updated. The provider recognised on-going challenges around recruitment and retention of staff and had been proactively addressing this. The provider had an electronic care planning system which also incorporated a log-in system that care workers activated from a mobile phone when arriving and leaving a visit. The system flagged up at the agency office if a care worker was late and this was monitored by office staff to ensure people received visits as arranged. The system was monitored outside of office times by on call staff. Both the registered manager and the provider told us they believed punctuality was an important commitment, and they monitored visit times closely.
People received care from care workers who were supported and had access to frequent one to one and group meetings with their supervisor or members of the management team. A training programme was in place that included courses that were relevant to the needs of people who received a service from the agency. The provider had looked at innovative ways to help care workers increase their knowledge in a flexible environment. As well as face to face training and support the training manager at the agency had created a ‘Flipboard’ application that could be accessed by care workers on their phones. The application included films showing how to use equipment such as bath aids and information relevant to care workers roles such as protection of vulnerable adults, the MCA and The Care Act.
Everyone said that they were very happy with the level of support they received, whether it was with personal care, medicine management or supporting with food and hydration. Electronic Medicine Administration Records (eMAR) had been introduced that care workers completed in line with the contents of peoples assessments and care plans. The new system immediately flagged up if all parts of the eMAR had not been completed before a care worker left a visit. This not only helped ensure accurate medicine records were maintained but also helped staff at the agency office monitor that all medicine needs were being managed safely as the system alerted them if a task had not been completed.
People were encouraged to maintain their independence and the agency worked in partnership with them to access services and facilities in their local community. In order to support people to remain independent the provider offered an innovative responsive service. In addition to the traditional domiciliary care service they offer a ‘Peace of Mind’ Service. They worked in partnership with Chichester Careline to provide an early intervention service. This service helped people to remain independent in their own homes but access care as and when required.
The provider, registered manager and care workers were highly motivated and clearly passionate about making a difference to people’s lives. This also extended to people and other agencies in the community. The provider and registered manager supported care workers who had taken part in local fund raising events and also arranged events themselves for organisations including St Wilfred’s Hospice, Alzheimer’s Society and Dementia UK.
Care plans were personalised and covered all aspects of each person's health, personal care needs, risks to their health and safety, and personal preferences. The person's usual daily routines were set out in detail, giving care workers very clear and easy to follow instructions on each task the person required assistance with. Everyone we spoke with confirmed that they had been involved in making decisions about their care package.
The agency also supported people to have dignified deaths by providing compassionate care workers. Care workers were provided with training and support in end of life care and worked with external health professionals to ensure people’s needs were met as they approached the end of their life.