Angel Home Care Service Private Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture. Staff did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

There were processes and procedures in place within the organisation intended to promote and support positive learning culture. However, these measures were not consistently effective in practice. Although audits, checks and internal monitoring systems had been completed, they did not identify the concerns highlighted during this assessment. This indicated gaps in the organisation’s quality assurance framework and suggested existing mechanisms for oversight were not sufficiently robust to detect emerging risks or areas requiring improvement.

Safety incidents were investigated timely. However learnings were not always robustly identified or used to improve the outcome for people or to support organisational learning.

The provider worked well with people and healthcare partners to establish and maintain safe systems of care. However, they did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

People were not consistently supported through safe systems, pathways and transitions.

Although staff had good understanding of people’s day to day needs, the provider did not always ensure there were robust arrangements in place to identify, manage and review risks when people’s needs changed.

Care records were often low on detail and lacked detailed information regarding people’s needs and ways of meeting these.

People’s risks were not always identified or reviewed. When risks were identified, there was very little information about how these were minimised, for example, in relation to people’s risk of falls.

There was limited evidence showing how people were involved in managing their own risks.

Staff knew how to raise and communicate any emerging concerns, and people and relatives said staff were responsive when issues were raised. For example, one relative told us, “If I had any problems I would speak to the boss on the telephone and things would get sorted.”

However, the systems used to monitor and oversee this information were not consistently effective, and leaders did not always have the oversight needed to identify where improvements were required.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

There were systems, processes, and policies in place to protect people from avoidable harm. Staff had a good understanding of how to keep people safe. They knew how to raise concerns and felt confident these would be acted upon. One staff member told us, “If I had any issues, I would call and report it to the manager.” Staff received safeguarding training. This was delivered face to face in the provider’s office. One staff member told us, “Safeguarding training was good. I have learnt many things.” People told us they felt safe. One relative told us,” I definitely feel my loved one is safe. There was an occasion when someone came to the door staff didn’t who they were so didn’t let them in.”

During the assessment, the registered manager was reminded of their duty to ensure all statutory notifications were submitted to Care Quality Commission (CQC). This was because we found that a number of safeguarding concerns had been identified by the provider who informed Local Authority but had not been reported to CQC.

The provider did not always work well with people to understand and manage risks. Staff did not always have information about people’s risks available to them to ensure that people were supported and risks mitigated when appropriate.

People’s individual risk assessments were not always completed, and where these were in place, they did not consistently provide the level of detail required to support safe and person-centred care. This meant staff did not always have clear, up-to-date information about the risks relevant to each person. There was very little evidence to demonstrate how people and their relatives were involved in decisions about how their risks were managed. Records did not always show that discussions had taken place, nor did they always reflect how people’s views, preferences, or goals were considered. This limited the extent to which risk management supported people’s independence, choice and control.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider ensured there were enough suitably qualified, skilled and experienced staff in place. Staff received appropriate support, supervision and opportunities for professional development. However, recruitment practices were not always safe.

There were sufficient staff to meet people’s needs. Staff were matched to the people they supported, which meant individuals received care from staff who knew them well. One person told us, “I have two regular carers, and we get on well together.” A staff member said, “We have lots of staff, we have around 50 carers.”

The provider managed rotas effectively, and staff usually arrived on time and stayed for the full duration of their visits. People gave positive feedback about staff punctuality and consistency. One person said, “There wasn’t a time when staff didn’t turn up.” Another person commented, “Staff usually come on time, but traffic builds up in the evening, so it can vary a little.” Staff told us they mostly had sufficient travel time and adequate breaks between visits.

Staff received training delivered both online and face to face. However, not all staff had completed all mandatory training. Although staff had completed Autism Awareness training, there was limited evidence to demonstrate how the provider complied with the Oliver McGowan Code of Practice. This Code sets out the statutory standards for training on learning disability and autism for all CQC‑registered health and social care providers in England.

Staff received regular supervision and appraisal, and there was evidence that their competencies were assessed. One staff member told us, “We receive regular supervision, once every month or something like that.”

Staff were provided with opportunities to attend regular meetings and were encouraged to share their feedback. One staff member said, “Team meetings are regular, every 3 months.”

However, staff were not always recruited safely. We saw evidence that Disclosure and Barring Service (DBS) checks had been completed and that right‑to‑work checks were in place. Despite this, gaps in employment were not always explored, and not all required references had been obtained. Following our feedback we were shown some additional evidence where for example additional character references were obtained when professional references were not provided.

People were placed at avoidable risk of harm because the service did not consistently follow safe recruitment practices.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were appropriate policies and procedures in place regarding infection prevention and control. Staff had a good understanding of infection‑prevention principles and were provided with appropriate PPE (Personal Protective Equipment) when required. One staff member told us, “We have more than enough PPE and can easily collect more from the office.” During our visit to the provider’s office, we observed a good stock of PPE available to staff. There was evidence that checks had been completed to monitor staff compliance with infection‑prevention and control requirements.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Policies and procedures were in place to guide the administration of medicines. However, these were not always implemented effectively. Care plans did not consistently contain sufficient detail regarding the level and type of support individuals required with their medicines.

The provider used an electronic medication administration record (eMAR) system to document when medicines were administered in conjunction with an application available to staff to digitally record care they had provided to people including support with their medicines. However not all of the information included in the app was translated onto individual EMAR.

There was evidence that support people received with their medicines was reviewed. However, this did not always include recorded outcomes or involvement from people receiving support.

Some oversight of medicines management was in place, and there was evidence that the provider had identified areas requiring improvement. However, there was no evidence how this supported improvements within the services and impacted positively on outcomes for people. We noted not all staff had completed the required medicines training.