Archived: Angel Solutions Community Care

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.

Angel Solutions Community Care is a domiciliary care agency providing personal care to eight people at the time of the inspection.

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

At our last inspection we found the registered manager had worked hard to turn the service around following an inadequate rating, to ensure people received safe care. Shortly after the inspection, the registered manager resigned their position and the service was managed by a former registered manager from another branch of the organisation.

During this period there was a marked decline in the quality of care. The people we spoke to were overwhelmingly negative about the support they received. One person said, “I do not feel they are kind and caring but I am afraid to make a fuss.” We were concerned the provider had not acted promptly to prevent the deterioration in care.

Staff did not have access to care plans that sufficiently detailed how they should manage peoples individual risks. Some of the systems in place at the last inspection, such as complaints management, had been poorly maintained. Regular quality checks took place. However, continued negative feedback from people indicated actions taken as a result of feedback had not resulted in improved care.

People raised concerns around staff arriving on time and staying for the allocated time. Action had not been taken by the provider to address this. The new manager told us they were setting up a new system to ensure staff visited at the agreed times. This was not yet in place at the time of inspection.

People told us they received their medicines as required. However, we were concerned poor timekeeping meant they did not always receive medicines at the right time.

There were systems in place to support people to have choice and control of their lives, such as regular reviews of care. However, because the systems were not working well, support was not always provided in people’s best interests. Further improvements were needed to ensure people had greater control over the service their received.

The provider had processes in place to prevent the spread of infection. People told us they felt staff took the necessary precautions to minimise the spread of COVID-19.

A few weeks before our recent inspection a new manager was appointed and had started to address poor practice. However, further time was needed to ensure these positive changes were fully embedded and sustained.

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 requires improvement (published 7 January 2020). The service remains rated requires improvement. This service has been rated requires improvement or inadequate over the last three consecutive inspections.

Why we inspected

The inspection was prompted in part because we had received serious concerns about the provider’s quality of care and oversight at their other service. A decision was made for us to inspect and examine the risks at the service in Southend-on-Sea. 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. Although we found concerns in other areas, these related specifically to the lack of effective management. We have therefore recorded these concerns under the well-led section of the report. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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 found the quality of care people received had deteriorated since our last inspection. At this inspection we have identified three breaches in relation to the provider’s failure to ensure people received safe care and care which was dignified and respectful. The rating for well-led has deteriorated to inadequate.

At a previous inspection we had placed conditions on the service. We did not find there had been enough improvement to remove all these conditions. We therefore required the provider to continue sending us monthly information reports about the actions they were taking at the service. We also kept a restriction on the service providing personal care to any new people without the written permission from the Care Quality Commission.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor progress and will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

Angel Solutions Community Care is a domiciliary care agency providing personal care to twelve people at the time of the inspection. Not everyone who used the service received personal care. 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.

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

The registered manager demonstrated a commitment to improving outcomes for people and responding to the concerns raised at the last inspection. Key to the improvements at the service was the support the registered manager had received from an external consultant. Change had been significant and had made a difference to people’s lives. A family member told us, “Especially over the last few months, things have definitely improved.”

There was a new, improved complaints process. The registered manager was committed to using feedback from complaints to improve the service. The quality of their complaint responses did not reflect the positive investigations and actions taken when concerns were raised.

We made a recommendation about improving complaint responses.

Despite these improvements, feedback about the service remained mixed. People were largely positive, especially where they had developed positive relationships with named staff. Families gave us more negative feedback and told us the service still needed to get better at communicating with them and ensuring staff provided consistent good quality care.

The registered manager had improved the processes to safeguard people from abuse. They communicated more openly with external organisations and supported investigations when concerns were raised.

Senior staff had updated all risk assessments, which now contained better information about how to support people safely. There were improved systems in place to help staff minimised the risk of infection.

Organisation and recruitment of staff had improved so people received safe support when they needed it. Measures to check visit times had improved, though this was an ongoing process.

The administration of medicine was safer than at our last inspection. Staff had been re-trained and there were more effective checks on their competence. The recording and monitoring where staff prompted with medicines required improvement.

The registered manager had worked with staff to ensure people’s needs were assessed in line with good practice. There was a greater awareness of what good care looked like. Staff had received intensive support to ensure they had the skills to meet people’s needs. Senior staff dealt with poor practice well.

There was an improved coordination to promote people’s wellbeing. People were supported to eat and drink in line with their preferences. Joint working with external professionals had improved.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People developed close positive relationships with named staff. People and families told us staff who covered for the named staff were not consistently caring. Staff had spoken to people to gather their views for new care plans, which were written in a more dignified manner.

Support was more personalised than at our last inspection, however further time was needed to ensure the quality of care was consistent across the service.

Communication had improved across the service, particularly with people and staff. Office staff contacted people regularly for feedback.

The registered manager had introduced improved checks on safety and on the quality of the service. They were committed to making sure lessons were learnt and information from concerns, feedback and checks was used to make things better. Provider checks were not always effective at picking up concerns at the service.

The service had worked with professionals to improve the quality of the service. Local authority representatives confirmed the registered manager had started to make improvements and this process was ongoing.

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 14 May 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 14 May 2019. 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

This was a planned inspection based on the previous rating.

Follow up

After the inspection we were told the registered manager was leaving the service. We will meet with the provider to discuss how they will continue to drive improvements and improve their rating to at least good. We will communicate with the local authority and other stakeholders to monitor progress.

We will return to visit as per our re-inspection programme. If we receive any concerning information to indicate the improvement programme is not being sustained, we may inspect sooner.

People’s experience of using this service:

People told us that care workers were kind and caring and they felt safe using the service. We found significant shortfalls in the way the service was managed, these posed risks that people might not always receive safe or effective care. We requested further information from the provider following the inspection but this did not significantly reduce the concerns found. We have found eight breaches of the regulations and the service is now rated Inadequate in three key questions and overall.

¿ The management of risk was not always effective and placed people at risk of unsafe care or harm.

¿ The registered manager did not fully understand their responsibilities and this had not been identified by the provider. The service was not well led and there was a lack of robust and effective processes in place to monitor the quality and safety of the service.

¿ Accurate records of people’s care and records related to the service management were not always kept.

¿ We had mixed feedback from people about the timing of their calls. The registered manager and office staff could not demonstrate an effective and clear system to manage the timing and frequency of calls to people. This meant there was a risk people may not receive their care when needed.

¿ We were not provided with enough evidence to be certain that all staff received sufficient training or were assessed as competent to carry out their roles and meet people’s needs.

¿ There was no effective system for the deployment of staff to ensure people received their care as required and planned.

¿ Medicines were not always safely managed as guidance and the provider’s policies were not always followed.

¿ Safe recruitment processes were not always followed to ensure all staff were suitable for work in social care.

¿ People's human rights were not always upheld as the registered manager did not always follow the principles of the Mental Capacity Act 2005.

¿ People were not always provided with support that was personalised to them or identified their diverse needs.

¿ People did not always have access to information in a way that meant they could read or understand it.

¿ The registered manager had failed to notify of us about a notifiable event as they were required to do.

Rating at last inspection: The service was first registered with the Care Quality Commission on 19 February 2018. This was their first inspection since they registered.

Why we inspected: This was a planned comprehensive inspection.

Enforcement: Action we told provider to take:

The service met the characteristics of Inadequate in three key questions of safe, effective and well-led. We are taking enforcement action and will report on this when it is completed. Full information about the Care Quality Commission's (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Follow up:

We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for the service is inadequate, the service will be placed 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 to check on improvements.

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 act 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.

For adult social care services, the longest 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.

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