The Angels on Call

The Angels on Call is a care service providing personal care to people in their own homes. At the time of the inspection 16 people were being supported.

People’s experience of using this service and what we found

People were not always supported safely when staff administered medicines. For one person, the processes in place for medicine administration were not robust and did not allow staff to effectively check the medicines they were administering. This was addressed by the provider following our inspection.

There had been improvements in the way the majority of people’s medicines were managed since our last inspection.

The risks to people’s safety had been assessed and measures were in place to safely support them. There were improved processes to ensure people were protected from possible financial abuse and staff had received safeguarding adults training.

There were enough adequately trained staff to support people and the recruitment processes had improved, so people were supported by suitable people.

People were protected from the risks of infection as the provider had followed national guidance about the management of COVID - 19, ensuring staff were following best infection prevention and control practices.

There had been improved oversight of the service and the provider had over the last six months introduced a more robust quality monitoring process. They had employed an administrator to support them with the quality monitoring processes. These processes need time to embed in the service, to ensure the care people receive remains at a good standard.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 18 May 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 18 May 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced focused inspection of this service previously on 30 March and 7 April 2021. Breaches of legal requirements were found. This included safe care and treatment, governance, safe recruitment of staff and reliability and trustworthiness of the registered person (provider). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion however were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Angels on call on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe care and treatment related to safe medicines administration.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Angels on Call is a domiciliary care service. It is registered to provide personal care to people living in their own homes in the community. The service operates in and around Boston, Lincolnshire.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, 13 people were receiving a personal care service.

People’s experience of using this service and what we found:

The provider was still failing to effectively assess, monitor and improve the quality of the service and to assess and manage a range of potential risks to people’s safety and welfare.

The provider’s response to the COVID-19 pandemic was inconsistent and increased risks to people's health. There were continuing shortfalls in staff training, recruitment and the management of people’s medicines.

We identified further concerns about the registered person's honesty, trustworthiness and reliability and her fitness to carry on the regulated activity. Some invoicing systems were ineffective and unsafe.

More positively, action had been taken to improve the deployment of staffing resources and the scheduling of people’s care calls. Staff now received regular supervision and systems to promote organisational learning had been strengthened. Care plans and individual risk assessments were now reviewed on a monthly basis.

Everyone we spoke with was satisfied with the care and support they received and told us they liked and respected the registered person. Staff were happy in their work and spoke positively of the leadership provided by the registered person.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection:

The last rating for this service was Inadequate (published 16 December 2020) and there were multiple breaches of regulation. The provider told us after the last inspection what they would do to improve. At this inspection we found insufficient improvement had been made and the provider was still in breach of regulations.

Why we inspected:

This was a planned inspection to follow up the findings of our last inspection. The inspection was focused on the key questions of Safe and Well-led. Ratings from previous comprehensive inspections for the key questions of Effective, Caring and Responsive were used in calculating the overall rating at this inspection.

The overall rating for the service remains Inadequate. This is based on the findings at this inspection.

Enforcement:

At this inspection we have identified continued breaches of regulations in relation to the assessment and management of potential risks to people’s safety; recruitment; organisational governance and the character of the registered person.

In response to these breaches we have retained the additional conditions of registration imposed after our last inspection. Please see the end of this report for further details.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the registered person's registration, we will re-inspect within 6 months to check for significant improvements.

If the registered person has not made enough improvement within this timeframe and there is still a rating of Inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the registered person from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of 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 re-inspect it and is no longer rated as Inadequate for any of the five key questions, it will no longer be in special measures.

The Angels on Call is a domiciliary care service. It is registered to provide personal care to people living in their own homes in the community. The service operates in and around Boston, Lincolnshire.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, 19 people were receiving a personal care service.

People’s experience of using this service and what we found:

• There were significant shortfalls in organisational governance which increased the risk to people's safety and welfare. By her own admission, the registered person had failed to effectively audit and monitor the quality of service provision.

• The registered person had failed to schedule care calls effectively and ensure there were sufficient staff deployed to meet people's needs. The registered person had also failed to take proper steps to ensure staff employed were suitable to work in the service.

• There were shortfalls in the registered person's approach to assessing and managing risks to people's safety and there was little evidence of a proactive approach to organisational learning.

• Staff had not received some of the induction and refresher training the registered person had identified as mandatory. The registered person had also failed to ensure staff received regular supervision.

• Notifications about events that had happened in the service had not been submitted to CQC, as required in law.

• We identified concerns about aspects of the conduct and character of the registered person.

• More positively, current staff were generally satisfied with their experience of working in the service. Most people and their relatives also provided positive feedback on the caring, friendly nature of staff.

• The registered person had taken action to strengthen infection prevention and control measures in response to the COVID-19 pandemic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was Good (published 26 July 2019).

Why we inspected:

We received concerns about a number of issues including the management of people’s medicines; the safety of staff recruitment; the scheduling of people’s care calls and the management and administration of the service overall. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No significant issues of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

Enforcement:

At this inspection we have identified breaches of regulations in relation to the assessment and management of potential risks to people’s safety; the organisation of staffing resources; recruitment; organisational governance; the character of the registered person and notification of significant events.

In response to these breaches we took enforcement action against the registered person. Please see the action we have told the registered to take at the end of this report.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the registered person's registration, we will re-inspect within 6 months to check for significant improvements.

If the registered person has not made enough improvement within this timeframe and there is still a rating of Inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the registered person from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of 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 re-inspect it and is no longer rated as Inadequate for any of the five key questions, it will no longer be in special measures.

The Angels on Call is a domiciliary care service. It is registered to provide personal care to people living in their own homes in the community, including older people and people living with dementia. The service operates in Boston and surrounding villages. At the time of our inspection, 16 people were receiving a personal care service.

Rating at last inspection:

Good (Published June 2018)

Why we inspected:

We conducted this inspection in response to information we had received which alleged people were at risk of receiving unsafe care; that the personal safety of staff was at risk and that there were shortfalls in the management of the service. Reflecting the information received, we inspected the service against elements of two of the five questions we ask about services: is the service Safe and is the service Well-led. None of the information we had received related to the remaining key questions so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At this inspection we found no evidence to support the allegations we had received. As a result, the rating of the service remains Good overall.

People’s experience of using this service:

Everyone we spoke with said they felt safe using the service and that the owner and her staff team were committed to promoting their safety and welfare. Similarly, staff told us they enjoyed their work and had no concerns about their personal safety.

Almost everyone we spoke with told us how highly they thought of the service and the way it was managed.

Safeguards implemented by the owner following our last inspection remained in place and were effective in mitigating a very specific potential risk to service users and staff.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We inspected the service on 17 May 2018. The inspection was announced. At the time of our inspection 14 people were receiving a personal care service.

The service was managed on a full-time basis by the owner who worked in the service on a daily basis, both in the office and delivering care. The owner was the registered provider (‘the provider’) with legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Almost everyone we spoke with told us that they were highly satisfied with every aspect of the service they received. In particular, the provider’s careful approach to managing staffing resources which meant staff were rarely late for the start of their care calls. Staff had established warm, friendly relationships with people and went out of their way to help them in any way they could. Staff worked together in a supportive way. They were proud to work for the service and felt appreciated by the provider.

People were involved in agreeing the type and amount of care they received and their needs and wishes were understood and followed by staff. Staff treated people with dignity and respect and encouraged them to maintain their independence. Staff had the knowledge and skills required to meet people’s individual needs effectively and supported them to prepare food and drink of their choice.

People’s medicines were managed safely and staff worked closely with local healthcare services to support people to access any specialist support they needed. The provider assessed any potential risks to people’s safety and welfare and put preventive measures in place where required. Staff knew how to recognise and report any concerns to keep people safe from harm. Significant incidents were reviewed by the provider to identify opportunities for organisational learning.

CQC is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff understood the principles of the MCA and how to support people who lacked the capacity to make some decisions for themselves.

The provider was committed to the continuous improvement of the service and monitored service quality closely. The provider sought people’s opinions through customer surveys and people were confident any complaints would be handled properly.