We carried out a review of the data available to us about Angel Care Support Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Angel Care Support Limited, you can give feedback on this service.
About the service
Angel Care is a domiciliary care service providing care to people in their own homes. 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. At the time of our inspection, there were ten people receiving support with personal care.
People’s experience of using this service and what we found
People and their relatives were very happy with the service provided. It was evident from their feedback they appreciated seeing regular staff and as a result of this were able to build strong positive relationships. Comments included, “I’m very pleased, she’s (the care worker) is very, very good”, “they’ve been brilliant”, and “I know he’s in safe hands”.
The registered manager had taken action since the last inspection to improve recruitment. This had been a breach at our last inspection. We saw that checks were undertaken to ensure that newly recruited staff were safe. This included gathering references from previous employers and undertaking a disclosure and barring service check (DBS). A DBS check identifies people who are barred from working with vulnerable adults and any convictions they have. People all told us they felt safe with staff and had good relationships with the registered manager. This meant people felt able to report any issues or concerns if they had them.
The registered manager had taken action in relation to staff supervision and training. This had been a breach of regulation at our last inspection. Staff told us they were very happy with the support and training they received. They told us they felt able to ask for specific training if they needed it and this was supported. Where a person had specific clinical needs, suitable specialist training was provided for staff. Staff told us they received regular supervision and the registered manager came to observe their practice in people’s home as a means of checking on their performance and development needs.
The service was well led, though we have recommended further improvements to the systems in place for checking quality and safety. This was a breach of regulation at our inspection. People all reported having a positive relationship with the registered manager and told us communication was good. There was a strong person centred culture within the service and people were very happy with the service they received.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 27 March 2020)
Three breaches of regulation were found at our last inspection. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service and what we found
People using the service told us they felt safe. However, there were several areas of concern we identified which meant we could not be assured that people received care in a safe manner. Safe recruitment procedures were not being followed, this was because some staff were working without the necessary employment checks taking place.
Staff did not receive ongoing training relevant to the needs of people using the service or that was required of them to do their job safely. Staff did not receive supervisions or appraisals in line with the provider’s policy. However, staff said they were supported in their role. There was a comprehensive induction in place for new staff and staff were supported to gain a recognised qualification in care.
Systems to monitor the quality of the service such as spot checks and regular courtesy calls to people who use the service had lapsed since the last inspection.
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.
People confirmed they had care and support from a small consistent team. They knew who would be supporting them and had built positive relationships with staff. Staff were knowledgeable about the people they supported. Care was delivered in a person centred way. People were involved decisions about how they wanted to be supported. Staff sought consent from people. Relatives said they were involved and kept informed of any changes.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was good (published 18 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
At this inspection we identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around fit and proper persons employed, staff training and supervision and good governance. Details of action we have asked the provider to take can be found at the end of this report.
Follow up
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avon Care Support Ltd on our website at www.cqc.org.uk.
.
Angel Care Support Limited is a domiciliary care agency registered to provide personal care to people in their own homes. There were eight people being supported with the regulated activity of personal care at the time of our inspection.
At our last visit we found that the induction training for new staff who had been employed did not meet the requirements of the Care Certificate standards. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the inspection, the provider wrote to us to say what they would do to improve in this area. At this inspection we found that this regulation had been met.
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 were supported by staff in a respectful and caring way. Individualised support and care plans were in place which recorded people’s care and support needs. These plans enabled staff to provide any assistance a person may have required.
People, when needed, were assisted to access a range of external health care professionals and were assisted to maintain their health and well-being. Where required, staff supported people to maintain their links with the local community to promote social inclusion. People’s health and nutritional needs were met.
People were able to raise any concerns or suggestions they had with the registered manager and staff and they felt listened to. Communication between people and the office staff and management was good.
Staff demonstrated that they respected people’s choices about how they would like to be supported. All staff were able to demonstrate a sufficient understanding of Mental Capacity Act (MCA).
Plans were put in place to reduce people’s identified risks, to enable people to live as safe and independent a life as possible. Arrangements were in place to ensure that people were supported with their prescribed medication when needed. Accurate records of staff supporting people with their prescribed medication were kept.
There were pre-employment safety checks in place to ensure that all new staff were deemed suitable to work with the people they supported. There were enough staff available to meet people’s care and support needs. Staff understood their responsibility to report any concerns about poor care practice.
Staff were trained to provide care which met people’s individual care and support needs. Staff were assisted with their training needs by the registered manager to maintain and develop their skills. The standard of staff members’ work performance was reviewed by the registered manager through supervisions, appraisals and spot checks. This was to ensure that staff were competent and confident to deliver the care and support required.
There was a quality assurance system in place to review systems and help to ensure compliance with the regulations and to promote the welfare of the people who used the service. This included audits on care plans, medication and complaints.
At the time of this inspection the service was providing support to 25 people, young adults or children. However, only 13 of them received a personal care service that was within the remit of their Care Quality Commission registration. For the purposes of this report we have referred to all age groups as people, unless there was specific information regarding one such group.
The service was provided to people who lived in the South Gloucestershire, Bristol and Bath and North East Somerset (B&NES) areas. The service did not commission directly with any of the local authorities. The majority of people funded their care and support themselves through the direct payments scheme. The service employed 20 support workers.
There was a registered manager in post, however at the time of the inspection they were on extended leave from the service. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. In the meantime an interim manager had been appointed to manage the service along with the registered provider.
Many of the support workers who worked for the service had done so for a long period and staff turnover was low. However, the induction training for those new staff who had been employed did not meet the requirements of the Care Certificate standards. People received the service they expected and their specific care and support needs were met. Support workers were competent to carry out their jobs and were well supported.
The aim of the service was that people were looked after by the minimum number of care workers. This would ensure they received a consistent service. The provider had purposely made a business decision not to expand their service. They felt this would result in being unable to consistently provide continuity of care to people. All contracted hours at point of care plan inception were covered, however some people had then received further funding for extra hours that the service was unable to fill. This had been a management decision to ensure the service remained reliable and consistent and not ‘overstretched’. The provider and manager continually kept the support workers work schedules under review.
People were safe with the support workers who looked after them. They had a programme of mandatory training to complete and this included safeguarding adults, child protection and health and safety training. New staff were recruited following thorough recruitment procedures which meant that unsuitable staff would not be employed. The support workers knew to report any concerns they had about a person’s welfare to the provider or manager. Any risks to people were well managed and management plans were put in place to reduce or eliminate the risk. Where people were supported with their medicines this was safely managed.
People received the service they had agreed upon and consent was obtained before support workers provided assistance. Support workers talked about the people they supported in a respectful manner and received the appropriate training to enable them to undertake their roles effectively. People received a person centred service and were assisted to have sufficient food and drink where this was an assessed need. People were supported to access health care services and where appropriate, support workers worked in conjunction with other health and social care professionals.
People were supported by staff who were kind and caring and treated them with respect. Their preferences and choices were respected. They were provided with a copy of their care plan and were encouraged to provide feedback on how things were going and any changes they wanted to make.
People and support workers said the service was well managed. The provider and manager had measures in place to monitor the quality and safety of the service. Any feedback that was provided by people using the service, or the support workers was acted upon. Information received was used to make changes where needed.
We found one breach of the regulations during our inspection. You can see what action we told the provider to take at the back of the full version of the report.
People told us that they were supported by a regular team of care staff, staff arrived on time and they were contacted if carers were going to be late. We spoke with people about how staff assisted them and what the care staff were like. Comments were positive about the care and the support they received. One person told us "All the carers are very kind and caring and help to support me.
The provider took account of complaints and comments to improve the service. We saw evidence that there had been one complaint since 2012 which had been investigated with the appropriate action taken. People we spoke with during the inspection told us they felt able to raise any concerns they may have with the manager and felt they would be listened to, and appropriate action taken.
People were given support by the provider to make a comment or complaint where they needed assistance. We asked people what they would do if they were unhappy with the service they received and wanted to make a complaint, people told us "I would ring the office and discuss directly' and 'I would tell the care staff when they arrive that I was unhappy'.
People were supported in promoting their independence and community involvement. We spoke to people who used the service. One person told us, 'My carer supports me to visit family and friends, I always plan where I like to go, they have supported me to go to London on a train recently'.
We spoke with three care workers and they told us that they had received training in child protection and safeguarding vulnerable adults (SOVA) and that safeguarding matters were also discussed in staff meetings and individual supervisions.
We found that people who used the service were allocated a care worker or a small team of care workers, in order to keep the number of staff who visited them, to a minimum so that consistency of care was promoted.
People that we spoke with during our visit told us, "My carer is lovely I could not ask for anything more" and 'If my carer was running late they always phone me to let me know".