Background to this inspection
Updated
19 May 2016
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 took place on 11and 23 March 2016 and was announced. Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available.
The inspection team consisted of three inspectors. We spoke to one person and four relatives to gain their views of the service on the 10 March 2016. During the inspection we spoke to the provider, two office staff and one staff member.
Prior to this inspection we reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law.
We had not asked the provider to complete a Provider Information Return (PIR) on this occasion. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was because we were conducting the inspection in response to enforcement action being taken.
During the inspection we looked at a range of records about people’s care and how the service was managed. For example, we looked at six care files, risk assessments, three staff files, training records, complaints logs and quality assurance monitoring records.
Updated
19 May 2016
The inspection took place on 11 and 23 March 2016. The inspection was announced.
Angel Heart Home Care Limited is a domiciliary care agency providing care to people living in their own homes. Since the last inspection of the service in September 2015 the local authority stopped commissioning services with Angel Heart Homecare Limited. This meant that the number of people receiving care has reduced significantly. At the time of this inspection the service provided care to eight people, seven of whom lived with relatives or carers.
At our inspection on 2 April 2015, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to person centred care and good governance. Requirement actions were served in relation to staffing and safe care and treatment. The provider wrote to us to say what they would do to meet legal requirements in relation to safe care and treatment, person centred care, good governance and staffing.
We undertook a further inspection on 29 September 2015 and 2 October 2015 to check that they had followed their plan and to confirm that they were meeting legal requirements. We found the provider had made some of improvements however sufficient improvements had not been made to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014. Some of these breaches were repeated because the provider had failed to take proper action. As a result of this we put Angel Heart Home Care Ltd in Special Measures.
This comprehensive inspection was conducted to check that the actions taken by the provider meant they were now meeting their legal requirements. We found that the provider had made improvements in some areas which had made a positive difference to people they support. The improvements made meant the overall rating is now Requires Improvement and we have taken Angel Heart Home Care Ltd out of Special Measures.
However, we found the provider continued to breach a number of requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014.
The provider was also the registered manager for the service. 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 did not always operate safe recruitment practices. Risk assessments for staff with past convictions were not always completed and reference checks were not satisfactory.
Risks to people’s safety and well-being were not always adequately assessed and guidance for staff was not always provided. The service did not support anyone who required assistance with oral medication. Where topical creams were prescribed there was insufficient guidance for staff to follow in how and where to apply the creams.
Information relating to people’s care was not always recorded in an accessible manner. Although actions were taken to address changing needs these were recorded in a number of different places which meant that care staff did not always have the most up to date information.
The service had electronic monitoring systems in place to reduce the risk of people’s care calls being missed and feedback from people was they had not experienced any missed calls since our last inspection. People’s rights were protected and they were safeguarded from the risk of abuse because staff understood their roles and responsibilities in protecting them.
Improvements had been made in the monitoring of staff training. However, one staff member had not completed all of the appropriate training to support them in their role. Staff received regular supervision and spot checks were completed to monitor the quality of their work. Where issues with staff performance were identified these were not consistently monitored.
The majority of people receiving care from the service lived with family members or carers and did not require support with food preparation. Where people required support with food preparation people told us they received this.
People had signed to show they consented to the care and treatment being provided to them. People liked the care staff and felt they knew their needs well. People and their relatives were involved in the development and review of care plans and these were updated when changes occurred.
People were provided with schedules detailing the times of their care calls each week. People and relatives told us that staff arrived on time and would contact them if they were running late. They felt the service was responsive and flexible to people’s changing needs. Records showed that care plans were person centred and people’s likes, dislikes and personal histories were recorded.
Complaints were recorded, investigated and responded to in a timely manner. Systems were in place to monitor complaints to minimise the risk of concerns reoccurring.
The provider had implemented a quality assurance monitoring system to monitor the standard of care provided. People and their relatives were regularly asked for feedback on the service which was monitored as part of the quality assurance process.
Accidents and incidents were recorded and monitored to minimise the risk of reoccurrence.
We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also made some recommendations to the provider. You can see what action we told the provider to take at the back of the full version of the report.