2 February
During a routine inspection
Angelic Homecare is a domiciliary care service based in the Swinton area of Salford, Greater Manchester. The head office is located close to the A580, East Lancashire Road, which provides good access to facilities in the local area and the city centre.
We carried out this inspection of Angelic Homecare on 2 February 2015. Our previous inspection was in May 2013 where the service was meeting the regulations in the areas we looked at.
There is a registered manager in post. 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.
We found that the registered person had not protected people from the risks associated with care and welfare, monitoring the quality of service and supporting workers effectively. These were breaches of regulation 9, 10 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulation 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, governance and staffing.
We looked at how the service managed risk. We found individual risk assessments had been completed for each person and recorded in their care plan. The risk assessments used covered areas such as manual handling, medication and the environment in people’s homes. We looked at six peoples risk assessments during the inspection and found four of them had not been reviewed in line with required timescales, which the manager told us was every six months. Additionally, where risks been identified, there was no record of what action or prevention measures were in place to keep people safe. This meant there had been a breach of regulation 9 of the Health and Social Care Act 2008 which relates to regulation 12 of the fundamental standards with regards to safe care and treatment.
We saw no evidence of any formal staff supervision or appraisal. The manager told us she saw and spoke with staff at regular intervals but that none of these discussions were recorded. This meant staff may not be able to discuss any concerns, training opportunities or speak with their manager confidentially. The manager told us she would introduce a formal supervision and appraisal system for staff following our inspection. This meant there had been a breach of regulation 22 of the Health and Social Care Act 2008 with regards to supporting staff effectively. This relates to regulation 18 of the fundamental standards with regards to staffing.
Each member of staff had their own personal training record which captured any training courses they had completed. For three members of staff, we saw the only training that had been completed included moving and handling, medication, health and safety and food hygiene. We saw no evidence of staff having undertaken training in key topics such as safeguarding or infection control. We discussed this with the manager who told us they would look to book staff onto these courses when they became available.
We looked at the staff induction programme which enabled staff to gain a thorough understanding of working in care and for the company in general. Two members of staff, who commenced employment with the service in December 2014 were yet to complete the formal induction programme. We raised this with the registered manager who told us they aimed to do this within three months and would do this following our inspection.
We found there was no formal system in place to gain feedback from people who used service, as things such as surveys had not been sent out for some time. The manager told us they would re-introduce these following our inspection. Additionally, when people’s care plans were reviewed they did not capture any comments from people about thing that were going well or anything they may like to change.
We looked at how the quality of service provided to people was monitored and found the systems were limited. For example there were no audits being undertaken, no spot checks of staff and no medication competency assessments. We discussed these concerns with the manager who told us she would introduce these systems following our inspection. This meant there had been a breach of regulation 10 of the Health and Social Care Act 2008 with regards to monitoring the quality of service provision. This relates to regulation 17 of the fundamental standards with regards to Governance
The people we spoke with and their relatives were happy with the care provided by the service. One person said; “I get the best of everything. The staff are marvellous”. Another person added; “They are lovely girls. They are always regular and on time. They will do anything you ask of them”.
The staff we spoke with spoke positively about how the service was run. One member of staff said; “Yes I am happy with how the service is run. One of the good things is that the manager delivers care herself so we see her often and can go to her with anything”. Another member of staff said; “This is the best place I have worked for”.
People told us they felt safe and trusted staff to come into their house to look after them. One person said, “Yes I feel safe. I’m not frightened of anybody. The staff are very good to me”.
People were protected against the risks of abuse because the service had a robust recruitment procedure in place. Appropriate checks were carried out before staff began work at the service to ensure they were fit to work with vulnerable adults. During the inspection we looked at four staff personnel files. Each file contained a job application form, interview notes, a minimum of two references and evidence of either a CRB or DBS (Criminal Records Bureau or Disclosure Barring Service) check being undertaken. This evidenced to us that that staff had been recruited safely.
We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. At the time of our inspection the service employed four members of staff and provided care to six people, some of whom required assistance from two members of staff with certain aspects of their care. The staff we spoke with told us they were happy with the staffing levels and that there were enough to meet people’s needs. In addition, the registered manager also worked closely alongside staff delivering care to people.
We saw of evidence of where the service worked closely with other professionals. For example, where people had pressure sores, we saw the manager worked closely with the district nursing team. Additionally, care plans captured any involvement with either social workers, doctors and dentists.
Although the people we spoke with told us that staff asked for their consent before providing care, this had not been clearly recorded in people’s care plans. For instance, the care plan just stated ‘Yes’, that consent had been given, but did not provide a written signature from people who used the service or their relative. This made it difficult to establish if people or their relatives had given their consent to the care they received. We discussed this with the manager who said they would ensure signatures were provided following the inspection.
The people we spoke with told us they were treated with dignity and respect by staff and were allowed privacy when they required it. However one person said to us; “The staff assist me to the toilet but then stay in the room at the same time and clean things in the sink. That is basic. I would prefer it if they went out”.
One person told us about how they felt staff did not allow them to be as independent as they would like. This person told us; “Staff don’t always let me have a go first. I would like to do my personal care myself but sometimes they don’t offer me the choice and start doing it anyway. I would like to me more independent”.
People who used the service had care plans in place with copies held at the both the head office and in their house. This provided staff with guidance around how peoples care should be provided. Additionally, care plans captured information of importance to people about their likes, dislikes and personal preferences. Of the six care plans we looked at, four had been reviewed in the past month, whilst two had not been reviewed for some time. The manager told us they were in the process of reviewing care plans and would completed this following our inspection.
There was a complaints policy and procedure in place. The manager told us there had been no complaints made against the service. The people we spoke with told us they would contact the office or speak with their relative if they were concerned about anything.