Archived: Angel Care Tamworth Limited

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.

We inspected this service on 14 August 2017. This inspection was announced. This meant the provider and staff knew we would be visiting the service’s office before we arrived. The service provides domiciliary support for people who live in their own home in Staffordshire and Warwickshire. There were 76 people in receipt of personal care support at the time of this inspection visit. This was the first inspection since the provider’s registration at their current office on the 27 April 2016.

The service had 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.

The provider had systems and processes in place to protect people from the risk of harm but these had not always been followed to ensure people’s welfare was protected. People were supported to take their medicine but improvements were needed to ensure errors were identified in a timely way.

People did not always receive their call at the agreed times which they told us impacted on their plans for the day. Where people were unable to consent their records did not clearly demonstrate that assessments had been undertaken to show that their capacity had been assessed. This meant we could not be confident that people’s rights were protected and that they were supported in their best interests.

The majority of people confirmed they received their calls from a consistent staff team, although some people told us they received support from several different staff which did not provide continuity in the support they received.

Some people did not feel their complaints were listened to or addressed. Improvements were needed to how complaints were managed and documented to demonstrate that people’s concerns were investigated and actions taken as needed. People were supported to express their views about the service; however the provider’s auditing system did not enable them to identify where improvements were needed so that the required action could be taken.

Staff understood what constituted abuse or poor practice and their role in reporting concerns. Staff supported people to make their own decisions. People’s individual needs and preferences were met and risks were managed to support people’s welfare. People were supported with their dietary and health care needs were this was required. People told us staff the staff were caring towards them and supported them to maintain their dignity and independence.

Checks on staff were done before they started work to ensure they were suitable to support people. Staff confirmed they felt supported by the registered manager and received the training needed to support people effectively.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.