Home Angels Healthcare Services Ltd

Home Angels Healthcare Service Ltd is a domiciliary care agency providing personal care to people. The service provides support to children, younger adults, older people and people who may have dementia, a physical disability or sensory impairment. At the time of our inspection there were 13 people using the service.

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

People’s risk assessments were not always person centred and did not include information for staff on how to safely mobilise people. Although incidents had been identified, lessons learned were not always documented.

Although we recognised some changes implemented by the new management team and additional improvements were planned, we found the provider’s governance required further improvement. We took this into consideration when making our judgement to ensure the most proportionate regulatory response to the concerns identified. Notifications had not always been sent to CQC when required.

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 4 May 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last 5 consecutive inspections. 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 the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection, and remains requires improvement. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement and recommendation

We have identified breaches in relation to safe care and treatment, notification of incidents to CQC and good governance at this inspection.

We have recommended the provider reviews training in relation to learning disability and autism.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Home Angels Healthcare Service Ltd is a domiciliary care agency providing personal care to people. The service provides support to children, younger adults, older people and people who may have dementia, a physical disability or sensory impairment. At the time of our inspection there were 14 people using the service.

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

People’s risk assessments were not always up to date or included enough information in order to keep people safe and mitigate those risks. The visits were scheduled using an online system and this was overseen by the registered manager. People were not always happy with the way staff provided care and support. We have made a recommendation regarding the providers recruitment records of new staff.

Staff had received training in topics the registered manager considered mandatory. However, the training was not in line with best practice guidance. The registered person had not followed up on the recommendation made at the last inspection relating to referring to best practice guidance regarding staff training. 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.

The provider did not ensure systems were in place to oversee the service and ensure compliance with the fundamental standards. They did not ensure the Care Quality Commission (CQC) was informed of notifiable incidents in a timely manner.

The staff team followed procedures and practices to control the spread of infection using personal protective equipment.

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 10 January 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 4 consecutive inspections. 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider ensures staff training is up to date and seek advice and guidance to ensure training is in line with best practice. At this inspection we found the provider had not made enough improvement.

Why we inspected

We carried out an announced focused inspection of this service on 1 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve recruitment records and good governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Home Angels Healthcare Services Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk assessments, staff training and notifications of incidents to CQC.

We have made a recommendation regarding recruitment records.

We issued a Warning Notice to the provider regarding relating to good governance. The provider is working with us to address the issues raised.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Home Angels Healthcare Services Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. Not everyone using Home Angels Healthcare Services Ltd receives 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.

It provides a service to older people, younger adults who may also have dementia, a physical disability or a sensory impairment. The provider has detailed in their statement of purpose they can provide a personal care service to children aged up to 18 years, however, at the time of this inspection, the 10 people using the service were all adults.

People’s experience of using this service and what we found

The provider did not ensure systems were in place to effectively oversee the service and ensure compliance with the fundamental standards. The registered person did not always ensure staff recruitment records included all information as required. We have made a recommendation regarding staff training.

People told us they felt safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. The provider ensured their safeguarding systems were operated effectively to investigate allegations of abuse or neglect. Individual risk assessments were in place meaning staff knew how to provide safe care to people.

There was positive feedback about how staff felt regarding the new registered manager. Staff felt they could ask the management for help when needed. Staff felt the registered manager was open and transparent with them.

Care plans were person centred; however, sometimes further detail was required. Care plans included the input of the people’s relatives and legally appointed representatives where appropriate. People received care and support that was personalised to meet their individual needs. People's diverse needs were identified and met and their right to confidentiality was protected. There were contingency plans in place to respond to emergencies. The provider had sought feedback from people and families, which they used to make improvements to the service and protect people against the risks of receiving unsafe and inappropriate care and treatment.

Systems were in place for people to raise concerns and they felt they would be listened to. People felt that staff were caring.

The service had an open and transparent way of working to ensure the safety of the people living at the service. Staff knew people they supported well and cared about their wellbeing. People and their relatives said people were treated with care, respect, and kindness by the staff visiting them.

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 16 December 2020) and there were breaches of regulation. 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 improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 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 recruitment of staff, good governance and training at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Home Angels Healthcare Services Ltd is a care agency which provides staff to support people in their own homes. People with various care needs can use this service including people with physical disabilities and older people. At the time of this inspection 10 people received personal care from this service.

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.

People’s experience of using this service and what we found

The provider did not ensure systems were in place to oversee the service and ensure compliance with the fundamental standards. The registered person did not always ensure they maintained clear and consistent records. They did not ensure the Care Quality Commission (CQC) was informed of notifiable incidents in a timely manner.

Medicines were not always handled and recorded correctly and safely. Complaints were not managed effectively and not according to the provider’s policy. The prover ensured their safeguarding systems were operated effectively to investigate and follow the provider's policy and procedure after becoming aware of allegations of abuse, neglect or acts of omission. They did not have evidence to support the effective process. The provider did not ensure risks to people’s personal safety had been assessed and that care plans were in place to minimise those risks.

There was a mixture of feedback about how staff felt regarding the provider support, accessibility, and the management of the service. Staff did not feel they could ask the management for help when needed at times. Staff felt the management was not always open with them and did not communicate what was happening in the service.

People received care and support that was personalised to meet their individual needs. People's diverse needs were identified and met and their right to confidentiality was protected.

There were contingency plans in place to respond to emergencies. The provider had started seeking feedback from people and families, which they would use to make improvements to the service and protected people against the risks of receiving unsafe and inappropriate care and treatment.

Staff recruitment has been improved and we saw changes made to the recruitment and selection process.

At the last inspection we made a recommendation that future ongoing staff training and monitoring of practice is updated in line with the latest best practice guidelines for social care staff. We saw training has been improved. However, we noted to the provider there was no effective system in place to oversee it and ensure staff remained knowledgeable and competent to support people who use the service.

Staff felt they could visit people on time and stay the right time. The visits were scheduled using online system and overseen by the care coordinator. People and relatives felt the staff supported them well however some improvements could be made such as timings and consistencies of the visits.

People reported they felt safe with the staff providing their support and care. Relatives agreed they had no issues with people’s safety. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. The staff team followed procedures and practices to control the spread of infection using personal protective equipment. People and their relatives who provided feedback said people were treated with care, respect, and kindness by the staff visiting them.

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 10 January 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and sustained, and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 20 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, receiving and acting on complaints, good governance, and informing CQC of any provider changes and when notifiable safety incidents happened.

We undertook this focused inspection on 6 November 2020 to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions in Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Home Angels Healthcare Services (Wokingham location) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Regulations 12, 16, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 12 and 18 of the Care Quality Commission (Registration) Regulations 2009 at this inspection.

You can see what action we have asked the provider to take at the end of this full 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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Home Angels Healthcare Services Ltd is a care agency which provides staff to support people in their own homes. People with various care needs can use this service including people with physical disabilities and older people. At the time of this inspection 25 people received care from this service.

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

The registered person did not ensure systems were in place to oversee the service and ensure compliance with the fundamental standards. The registered person did not always ensure they maintained clear and consistent records. They did not ensure Care Quality Commission was informed of notifiable incidents in a timely manner.

Staff recruitment and staff deployment did not always support people to remain safe in their own homes. The way visits were scheduled, the staff felt they were not always able to support people appropriately and in good time. People were not always informed about the changes to their visits or staff, as necessary. Medicines were not always handled and recorded correctly and safely.

We made a recommendation that future ongoing staff training and monitoring of practice is updated in line with the latest best practice guidelines for social care staff. Staff said they did not always feel supported to do their job or ask the management for help when needed.

There had been management changes since the last inspection, which affected the service and staff team. The new registered person had reviewed paperwork, systems and processes to ensure they could assess and monitor the quality of care in a more consistent way. There was some progress in making various improvements but not sufficient at the time of the inspection for us to judge this would be sustained.

There was a mixture of feedback about how staff felt in regard to the management support, accessibility, and the management of the service. Staff felt the management was not always open with them and did not communicate what was happening in the service. People and relatives also felt the service was not managed consistently and some improvements could be made.

People and their relatives who provided feedback said people were treated with care, respect, kindness and their dignity were upheld by most of the staff visiting them. People were involved in review of their care and support and could change how things were done if they wanted to. People received care and support that was personalised to meet their individual needs. People's diverse needs were identified and met and their right to confidentiality was protected.

People were protected from the risks of abuse and said they felt safe with the staff providing their support and care. Relatives agreed they had no issues with people’s safety. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. The staff team followed procedures and practices to control the spread of infection using personal protective equipment. There were contingency plans in place to respond to emergencies. The registered person had the knowledge to identify safeguarding concerns and acted on these appropriately. Risks to people’s personal safety had been assessed and care plans were in place to minimise those risks.

People were supported to access healthcare professionals such as their GP. The service worked with other health and social care professionals to provide support and care for people. People were supported to eat and drink to meet their nutrition and hydration needs according to their care plan.

People's rights to make their own decisions were protected. 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.

The registered person had started seeking feedback from people and families, which they would use to make improvements to the service and protected people against the risks of receiving unsafe and inappropriate care and treatment.

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 5 January 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to Regulations 12, 16, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 15 and 18 of the Care Quality Commission (Registration) Regulations 2009 at this inspection.

Please see the action we have told the provider to take 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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Home Angels Healthcare Ltd is a care agency which provides staff to support people in their own homes. People with various care needs can use this service including people with physical disabilities and older people. At the time of this inspection 39 people received care from this 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 and their relatives told us that they felt safe with staff and would be confident to raise any concerns they had. The provider’s recruitment procedures were thorough and medicines were managed safely. There were sufficient staff to provide safe, effective care at the times agreed by the people who were using the service.

There were procedures in place to manage risks to people and staff. Staff were aware of how to deal with emergency situations and knew how to keep people safe by reporting concerns promptly through processes that they understood well.

Staff received an induction and spent time working with experienced members of staff before working alone with people. Staff were supported to receive the training and development they needed to care for and support people’s individual needs.

People and their families were mostly complementary of the services provided. An improvement in the timings of calls was reported by people and their relatives. The comments we received demonstrated that the majority of people felt valued and listened to. People were treated with kindness and respect whilst their independence was promoted within their homes and the community. People received care and support from familiar and regular staff most of the time and some would recommend the service to other people.

People’s needs were reviewed and their care and support plans promoted person-centred care. Up to date information was communicated to the majority staff to ensure they could provide the appropriate care and support for each individual. Staff knew how to contact healthcare professionals in a timely manner if there were concerns about a person’s wellbeing.

The provider had a system to regularly assess and monitor the quality of service that people received and identified areas for improvement.