Background to this inspection
Updated
20 May 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 service was inspected by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
At the time of the inspection the service did not have a manager registered with the Care Quality Commission. This means that 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 24 hours’ notice of the inspection. This was because we needed to be sure that the manager would be in the office to support the inspection.
What we did before the inspection
The provider was not asked to complete the required Provider Information Return. This is information providers are required to send us with key information about the service, what it does well and improvements they plan to make. We took this into account in making our judgements in this report. We reviewed the information we held about the service since the last inspection. This included notifications from the provider, which is information about important events which the provider is required by law to send to us. Our planning also took account of the information provided by the registered manager during an Emergency Support Framework (ESF) call on 2 July 2020. ESF calls helped us to give targeted local advice, guidance and support to providers and care staff using a structured framework to guide conversations and help them to respond to emerging issues, and to deliver safe care which protects people's human rights. We used all of this information to plan our inspection.
During the inspection
We spoke with the manager, care coordinator and Human Resources (HR)manager. We reviewed a range of records. This included five people's care records, six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. Staff were consulted via a questionnaire and we received feedback from 22 staff members.
Updated
20 May 2021
About the service
Angel Human Resources Limited (London Bridge) is a domiciliary care service providing personal care to 61 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
Medicines were not always managed safely as staff were not always completing the records in line with the provider’s policy. Risks were not always effectively managed as there was at times a lack of information provided to staff to help them mitigate risks when providing care. The provider’s processes for recording and investigating incidents and accidents were not always effective.
The provider did not have effective quality assurance systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people.
We made a recommendation to the provider to ensure they had effective recruitment processes in place. There were enough staff deployed to provide care and support. Staff received training and supervision in line with the provider’s policy.
The provider had made some improvements to how the service was managed. These included reviewing all policies and procedures and introducing new processes for recording how care was being delivered.
The manager had only recently started working at the service. They had started to introduce a range of audits as they had identified there were gaps in how the service was being monitored.
Staff understood the provider's safeguarding policies and were familiar with the reporting procedures. Staff had access to appropriate personal protective equipment (PPE) to help prevent the spread of infection.
On the whole people told us they felt safe and gave positive feedback. Relatives also told us they were happy with the care their loved ones received from the service. There was a positive culture amongst the care staff, they told us they felt supported in their roles and enjoyed working for the service. People were able to provide feedback via a survey on the quality of the care and support they received.
Rating at last inspection and update.
The last rating for this service was requires improvement (report published 23 September 2019) and there were multiple breaches of regulation for safe care and treatment, staffing and good governance. 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 improvements had not been made and the provider was still in breach of regulations 12 and 17.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Angel Human Resources (London Bridge) 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 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 safe care and treatment, staff recruitment and good governance. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
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.