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Angel Human Resources Limited (London Bridge) Requires improvement

Reports


Inspection carried out on 14 April 2021

During an inspection looking at part of the service

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

Inspection carried out on 5 June 2019

During a routine inspection

About the service

Angel Human Resources Limited (London Bridge) is a domiciliary care service providing personal care to 75 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

Some people did not have enough information recorded on their medicines care plans despite care workers prompting them to take their medicines. Accident and incident records did not contain full details about whether risks had been mitigated and lessons learned as a result of accidents. The provider assessed and mitigated known risks involved in people’s care. The provider had clear processes to safeguard people from abuse. There were a suitable number of appropriately vetted staff to work at the service. Staff had a good understanding about how to provide hygienically safe care.

People’s care plans did not always contain enough information about their healthcare needs. The provider told us and care workers confirmed they received regular training and supervisions, however, there was no documentary evidence to support this. 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. However, we found that where people could not sign their care plans due to being physically unable to do so, there was no written explanation on the care record to confirm this. People’s care was given in line with current standards as the provider worked well with other professionals to provide timely care. People were supported appropriately with their nutritional needs.

People gave good feedback about their care workers and they demonstrated they knew people well. People’s care records contained very little information about their religious or cultural needs, but care workers had a good level of knowledge about this. Care workers respected people’s privacy and dignity and supported people to be as independent as they wanted.

At the time of our inspection, the provider was not supporting anyone with their end of life care needs. However, the provider did not keep a record of people’s needs in the event that someone did need this support. People’s care record contained limited information about the support they needed to maintain their interests, but care workers had a good understanding about people’s needs. People were given choices in relation to their care and their preferences were followed. People were supported with their communication needs. The provider had a clear complaints policy and procedure in place.

Care workers gave good feedback about the registered manager who had a good understanding of her duty responsibilities to be open and honest when things went wrong. The provider worked well with other professionals but could not demonstrate clear auditing processes of the quality of the service. As a result, the issues we found had not been identified or addressed by the provider.

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 good (published 8 December 2016).

Why we inspected- This was a planned inspection based on the previous rating.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have identified breaches of regulations in relation to medicines management, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safet

Inspection carried out on 1 November 2016

During a routine inspection

This inspection took place on 1 November 2016. This was an announced inspection and the provider was given 48 hours' notice. This was to ensure that someone would be available at the office to provide us with the necessary information to carry out an inspection. When we last visited the service on 22 August 2013, we found the service was meeting all the regulations we looked at.

Angel Human Resources Limited provides care and support to people in their own homes who have physical and mental health care needs. At the time of the inspection the provider had 87 people who used their service.

The service had a registered manager. 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.

People told us they were safe. Medicines were managed safely. Risk assessments identified the risks to people and how these could be minimised. Staff were available to meet people's needs.

People were involved in decisions about their care and how their needs would be met. Managers and staff had received training on the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005.

Staff had access to ongoing training. They were knowledgeable about their roles and responsibilities. They had the skills and knowledge to meet people’s support needs.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People received individualised support that met their needs. Staff knew how to respond to people's needs in a way that promoted their individual preferences and choices regarding their care.

People were treated with dignity and respect. Staff understood people’s preferences, likes and dislikes regarding their care and support needs. Care was planned and delivered in ways that enhanced people’s safety and welfare according to their needs and preferences.

People were supported to maintain good health and had access to healthcare services.

The service regularly requested feedback from people who use the service. People, relatives and staff said the management were approachable and supportive. Systems were in place to monitor the quality of the service. People felt confident to express any concerns and these were addressed by the registered manager.

Inspection carried out on 22 August 2013

During an inspection looking at part of the service

We spoke with two staff members who had completed safeguarding training and were aware of the local authority's safeguarding processes. The provider had safeguarding policies and procedures in place, and staff were made aware of these and were provided with a copy. Staff told us that they were able to identify signs of abuse and associated actions to take. We saw evidence that the provider had contact details of the local authority safeguarding adults team. This meant that people who use the service were protected from the risk of harm or abuse.

Inspection carried out on 11 April 2013

During a routine inspection

We found that the provider respected people who used the services. One person said, "my support worker always supports my decisions". The provider involved people in the development and review of their care plans. We saw evidence that risk assessments and risk management plans were in place to protect people who use the service.

Staff did not follow their safeguarding policy of reporting and escalating an allegation of abuse.

There was a complaints procedure and policy in place and people who used the service were made aware of this and were encouraged to make a complaint if required.