Archived: Angel Care Tamworth Limited

Updated 15 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection visit took place on the 18 19 and 24 July 2018 and was announced. We gave the provider five days' notice of the inspection site visits. This was because the manager and staff are often out of the office providing care and we needed to be sure that they would be available. The inspection visit was carried out by two inspectors and an expert by experience. The expert by experience had knowledge of care services including domiciliary services. The Inspection site visit activity started on 18 July and ended on 24 July 2018. It included making telephone calls to people and staff. We visited the office location on 24 July 2018 to see the manager and office staff; and to review care records and policies and procedures.

We checked the information we held about the service and the provider. This included notifications that the provider had sent to us about incidents at the service and information that we had received from the public. A notification is information about events that by law the registered persons should tell us about. We brought forward our planned comprehensive inspection of this service due to the concerns we were receiving. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information to formulate our inspection plan.

At the inspection we gave the provider the opportunity to send us further information including risk assessments for people and staff and updated care plans. We asked for this information to be provided on Monday 30 July 2018. We did not receive this information on this date however we did receive some blank copies of documentation.

We used a range of different methods to help us understand people's experiences. We made telephone calls to ten people who used the service and five relatives. We spoke with seven members of care staff, the registered manager and three office staff. During the office visit we looked at the care records for twelve people. We checked that the care they received matched the information in their records. We also looked at records relating to the management of the service, including, rotas complaints and policies.

Updated 15 September 2018

This comprehensive inspection took place on the 18 19 and 24 July 2018 and was announced. This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to adults. At the time of our inspection the provider was supporting approximately 90 people.

At our last inspection the provider was rated as Requires Improvement and were in breach of regulations.

There is 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.

At this inspection people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. We found when needed there were no capacity or best interest decisions in place. Relatives were consenting on behalf of people without the legal power to so. Individual risks to people were not considered or managed in a safe way and when needed action was not always taken to ensure people were safe.

Medicines were not managed in a safe way and an accurate record of medicines administered was not in place. When people had as required medicines there was no guidance in place for staff to follow to ensure people receive their medicines as prescribed.

We found that people did not always receive calls at the allocated time or for the correct amount of time. There were not enough staff available to offer support to people and they had to wait for support. Some people received calls before their times. The provider's recruitment process did not ensure staffs suitability to work within people's homes.

Staffs training and induction did not ensure they had the skills and knowledge to support people.

There were no systems in place to assess and monitor the quality of the service so this information could not be used to drive improvements. Staff did not have access to the guidance they needed to keep people safe. We could not be assured we received all notifications as required as documentation within the service was limited.

As guidance for staff to follow was not available people did not receive support that was individualised. People did not receive a consistent approach to care due to the turnover of staff. People's support needs were not understood and people's cultural needs had not been considered. Information was not made available to people in a format they could always understand. Complaints were not always recorded or responded to in line with the provider’s procedure.

There were concerns with the culture of this service and when we asked the provider for reassurances this was not provided to us.

People were happy with the staff that supported them. When people required support with meals they were offered a choice and people were referred to health professionals accordingly. There were infection control procedures in place and people's privacy and dignity were maintained.

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. If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

We found breaches 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.

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.