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Archived: Angels Domiciliary Care Services Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 20 February 2019

We carried out an announced inspection at Angels Domiciliary Service Limited on 11, 12, 13 and 18 January 2019.

Angels Domiciliary Service Limited is a small domiciliary care agency in Chorley. It is a family run business running from the family home which covers the Chorley and South Ribble area. The service is registered for dementia, learning disability and autism, older people, physical disability, sensory impairment and younger adults. The service provides personal care to people living within their own homes. At the time of the inspection fourteen people were using the service.

A registered manager was 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.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2008 and once breach of the Care Quality Commission (Registration) Regulations 2009) We found shortfalls in the management of medicines, the staff recruitment process, staffing levels and safeguarding people from abuse. We also identified further shortfalls in dealing with complaints, the governance arrangements and as well as failure to provide statutory notifications.

We are considering what action we will take in relation to these breaches. Full information about the CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

At the last inspection carried out in May 2017, the service was rated as good, however we found that at this inspection there had been significant deterioration in the quality and safety of the service being provided. At this inspection, the rating of the service had deteriorated to inadequate.

Safeguarding adult’s procedures were in place and staff were aware when to raise concerns. However safeguarding incidents were not always being documented or reported to the local authority safeguarding team. A recent safeguarding investigation regarding an individual not receiving commissioned support through the agency was substantiated.

Complaints were not being managed, recorded and responded to appropriately. People using the service, relatives and staff did not always feel listened to. One person’s care package was cancelled when they raised a concern about the registered manager.

We found shortfalls in the management of medicines. There had been several incidents around medication and not all staff had received medication training.

There was a lack of training for staff within the service. Neither management or the staff team had received any training in moving and handling, fire safety, health and safety or food hygiene. Supervisions were not being undertaken as frequently as they should have been.

Staffing levels were low and there had been a high turnover of staffing within the service. Rotas were constantly changing and people were not always receiving the hours they have been commissioned for.

We found shortfalls in the recruitment of new staff. Recruitment was unsafe. Of the three files we looked at, only one reference was received out of six. There was also a lack of understanding of the risks posed by the employing inappropriate people to work in the service.

There was a lack of confidentiality within the service. Service users, relatives and staff were aware the registered manager crossed professional boundaries.

Complaints were not being managed, recorded and responded to appropriately. People using the service, relatives and staff did not always feel listened to. One person’s care package was cancelled when they raised a concern about the registered manager.

We saw people’s care files contained environmental risk assessments, fall

Inspection areas

Safe

Inadequate

Updated 20 February 2019

The service was unsafe

Safeguarding's were not being raised with the local authority

Risks were not being managed appropriately

People requiring 2-1 support were not always receiving this. Commissioned hours were not always been received.

Staffing levels were low

Recruitment was not safe

There were concerns around medication and not all staff had been trained

Effective

Requires improvement

Updated 20 February 2019

The service was not effective.

Capacity assessments were taking place.

People told us they liked the consistency of having regular staff.

Staff had not received appropriate training and supervision to undertake their role effectively.

Caring

Requires improvement

Updated 20 February 2019

The service was not caring.

Not all people felt listened to.

Some people felt disrespected by the management.

People were complimentary about the staff team and a senior member of the team.

People had detailed life histories which helped to build meaningful relationships.

Responsive

Requires improvement

Updated 20 February 2019

The service was not responsive.

Assessments and care plans were in place, although some had incorrect details.

There was evidence of reviews taking place.

People did not always receive appropriate guidance on how to make a complaint.

People who raised concerns felt victimised. Complaints were not handled appropriately.

Well-led

Inadequate

Updated 20 February 2019

The service was not well led.

The culture of the service was not open.

The registered manager had not followed recommendations from a safeguarding investigation.

The registered manager had stated in her statement of purpose that she was a nurse when this was not the case.

Audits were not robust to pick up issues found within the service.

There was a lack of notifications to CQC which meant we could not assess the risk within the service.