Background to this inspection
Updated
28 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of one inspector and one assistant inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses, flats and specialist housing.
The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We asked the provider and manager to send us information relating to their quality assurance arrangements and evidence of staff training. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We conducted the inspection with the manager and administrator. We reviewed a range of records. This included, six people’s care files, three staff personnel files and agency staff profiles. We also looked at the service’s quality assurance arrangements, the management of medication, staff training and supervision, safeguarding and complaints management.
After the inspection
We spoke with two people who used the service and five people’s relatives about their experience of the care provided by the domiciliary care service. We also spoke with two members of staff. We reviewed the service’s staff rosters.
Updated
28 July 2021
About the service
Angel Solutions Community Care provides personal care to people living in their own houses, flats and specialist housing. This is a domiciliary care service and primarily provides a service to older people, older people living with dementia, people who may have a physical and/or learning disability. At the time of inspection there were 15 people using the service.
People’s experience of using this service and what we found
Risks for people were not identified and recorded in relation to how risks to a person’s wellbeing and safety were to be mitigated. Not all people were safeguarded from potential abuse or protected from bullying. Improvements were required relating to the service’s recruitment practices and procedures. People were often not informed about staff changes or who may be visiting and sometimes felt the care and support provided was rushed. We could not be assured all people using the service received their medicine at consistent times and improvements were required where amendments to the quantity of medication administered had occurred. Infection control policies and procedures were not as up to date as they should be or in line with government guidance. Lessons were not learned when things went wrong.
The service was not consistently well led and managed, both at provider and service level. Breaches of regulation previously highlighted remained outstanding. The provider and manager had permitted people to receive a care package with the domiciliary care service but without seeking our permission. This was in breach of their conditions of registration. The provider and manager had not acted in an open and transparent way with people using the service by applying the duty of candour.
People were generally complimentary about the care and support provided by staff.
We have made recommendations about safeguarding and abuse, staffing and staff recruitment.
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 requires improvement (published January 2021).
Why we inspected
We carried out an announced inspection of this service on October 2020. Breaches of legal requirements were found relating to dignity, risk and quality assurance. 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 of ‘Safe’ and ‘Well-Led’ which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Inadequate. 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 Angel Solutions Community Care 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to risk management and quality assurance at this inspection.
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.
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 provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider 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 provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.