Archived: Angels Domiciliary Care Services

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, falls risk assessments and moving and handling risk assessments. However individual risk was not well managed and concerns around people's safety were not always identified. Accidents and incidents were not always being documented.

There were significant shortfalls in the way the service was led. The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement.

There was a lack of statutory notifications being sent to CQC and a lack of monitoring and auditing of the service.

The provider was working within the requirements of the Mental Capacity Act (2005) and we saw evidence of capacity assessments in place.

People had access to healthcare professionals. Assessments and care plans in place included people’s personal histories and social interests, which enabled staff to build relationships.

People were complimentary about the staff who looked after them. They told us the staff were caring and they felt confident in them. They liked the continuity of staffing that they received from the small team and felt in particular that a senior member of the care team was efficient.

The overall rating for this service is 'inadequate' and the service has been 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 providers registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If insufficient improvement is made within this timeframe so that there is still a rating of 'inadequate' for any key question or overall, we will take action 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 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.

The Registered Manager was present during the visit to the registered premises and was cooperative throughout the inspection process. 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.

The service was registered with the Care Quality Commission in July 2013. We last inspected Angels Domiciliary Care Services on 18 & 24 September 2015. At the inspection in September 2015 we found the service was not meeting three of the regulations that we assessed and we asked the provider to take action to make improvements. The three breaches of regulation were in relation to gaining valid consent from people prior to their care and support being delivered; the lack of established systems and processes in place to prevent adult abuse and staff not receiving appropriate support via robust training, supervision and appraisals.

We issued three requirement notices and asked the registered provider to tell us how they were going to make the improvements required. At this inspection we found that the registered provider and registered manager had made the changes and improvements needed to meet the three requirement notices issued from the previous inspection. However we found the service to be in breach of one further regulation at this inspection.

People told us that they felt safe when receiving care and support from staff employed by Angels Domiciliary Care Services. However we found an issue with one person who was receiving care and support that presented as a safeguarding issue, which had not been recorded as being reported through to the local authority safeguarding team. We have made a recommendation about this.

The service had up to date safeguarding and whistleblowing policies in place which meant that staff had clear guidance to enable them to recognise different types of abuse and who to report it to if suspected.

We found evidence to show that staff received appropriate training and formal supervisions and appraisals took place. Staff also received a good level of training across a range of areas.

The service was working within the principles of the Mental Capacity Act 2005 (MCA) and staff received training in this area. Staff understanding of the principles of the MCA act was limited however they were able to talk around the area of consent well.

People, and relatives we spoke with, told us they were happy with the care and support they received and that staff were caring and compassionate.

People we spoke with and their relatives told us they knew how to raise issues or make a complaint and that communication with the service was good. We saw that the service kept records of complaints, concerns and compliments and responded to complaints in line with their own policy.

All care plans contained an initial assessment of the person's needs prior to their care beginning. We saw that care plans were reviewed regularly although some elements of care plans needed to contain additional information and guidance for staff.

We saw evidence of some quality audits taking place. We discussed the need to expand this are as and when the business grew, although it was evident that the registered manager knew the people the service cared for well.

Angels Domiciliary Care Services is a small family run domiciliary care provider, which cover the Chorley area. At the time of our inspection, the service supported 10 people who had a variety of needs, ranging between personal care and domestic tasks.

The service had 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 spoke with people who used the service, some relatives and staff during the inspection. The feedback we received from people was positive. People expressed satisfaction with all aspects of the service provided and spoke highly of staff and managers. People who used the service told us they were treated with compassion and kindness and that their privacy and dignity were respected.

Staff were not fully aware of their responsibilities to safeguard people they supported from abuse. Staff were not able to speak confidently about their role in safeguarding people. We found the service's policy around safeguarding had not been updated since 2012. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the provider had not established systems and processes to prevent abuse of service users.

We found staff had not received adequate training, appraisal and supervision in order to carry out their role safely and effectively. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as persons employed by the service provider in the provision of the regulated activity had not received such appropriate support, training, supervision and appraisal to carry out the duties they were employed to perform.

The provider had not ensured that staff understood their responsibilities in line with the Mental Capacity Act 2005. The service did not routinely record people's consent to care and support. Where people's capacity to make a decision may be affected, for example, because they were living with dementia, the service had not assessed their capacity to consent. This was in breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service supported some people who were living with dementia and had not gained valid consent in accordance with the MCA, where people's capacity to consent had been called into question.

There were effective systems in place to assess and manage risks to people’s health and wellbeing. Staff were fully aware of personal risks people’s faced for instance, in relation to their health or mobility, and the measures they should take to support people safely. However, we found that assessments and plans of care were not dated and review dates were not scheduled. We have made a recommendation about this.

Accidents and incidents were recorded in care records in people's homes. However, we found there was no centralised system for recording and analysing such events. We have made a recommendation about this.

The service worked well to help ensure people received effective health care support from other agencies. People who required assistance to take their medicines were provided with safe support.

Staff at the service were carefully recruited and were required to undergo a number of background checks prior to starting their employment. This helped to ensure only people with the correct skills and of suitable character were employed.

The registered manager took a very hands-on approach to delivering the service to people. Due to the small number of clients the service supported, they were able to monitor and assess the quality of the service in terms of people's experiences. However they realised that as the service grew, they would need to implement more formal monitoring systems.

We have found 3 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations, you can see what action we have told the provider to take at the back of the full version of the report.