Angel Home Care Service Private Limited

Angel Home Care Service Private Limited is a domiciliary care agency. It provides personal care to people living in their own homes in the community. The service provides care to a range of people with different needs including older people, people living with dementia, learning disabilities, physical disabilities, mental health and sensory impairment. When we inspected the service, there were 51 people receiving domiciliary care. Calls to people’s properties ranged from 30 to 60 minutes per visit. Not everyone receives the regulated activity of ‘personal care’; The Care Quality Commission (CQC) only inspects the ‘personal care’ ; element of care. That is tasks related to personal hygiene and eating. We also take into account any wider social care provided.

Our last inspection of this service was on the 1 and 6 September 2016 and we found concerns relating to regulations 9, 11, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider was not carrying out adequate assessments of the needs and preferences of people using services. The provider was not acting in accordance with the Mental Capacity Act 2005. There were insufficient systems in place to assess, monitor and improve the quality of the service. Staff were not receiving appropriate training to enable them to carry out their duties and the provider had allowed two care workers to work before they had received a valid disclosure and barring certificate. The overall rating for the service was Requires Improvement. At this inspection, we found significant improvements had been made to the service and found the service to be ‘Good’ in all of our key questions; safe, effective, caring, responsive and well led.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and the timescale they needed to improve the key questions in safe, effective, responsive and well led. At this inspection, we found that the provider was completing comprehensive assessments of needs of people and documenting preferences in the care plan. The service was working in accordance with the Mental Capacity Act 2015 and assessing people’s capacity and making referrals to the local authority, when required. Audits and quality assurance systems were in place to assist in monitoring and improving the service. All new staff members had the required pre-employment checks in place before starting to work for the service. Staff members were receiving training appropriate to their job roles.

The service had a registered manager in post since February 2017. A registered manager is a person who has registered with the CQC 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 protected from abuse. Staff followed the provider's and the local authorities safeguarding procedures to identify and report concerns about people's well-being and safety. Accidents and incidents were recorded, reviewed and analysed to determine patterns and take preventative measures.

Comprehensive assessments were carried out to identify any risks or potential risks to the person using the service. This included any environmental risks in people's homes, risks in the community and any risks in relation to the care and support needs of the person.

Staff were recruited safely and trained to meet people's individual needs. Wherever possible people were only supported by staff known to them.

There were enough staff assigned to provide support and ensure that people's needs were met.

Medicines was well managed and staff were fully trained in the safe administration of medicines.

Legible daily records were kept which documented what care and support each person had been given.

Care plans were regularly reviewed and were individual to the person.

People we spoke with told us that staff members were kind and caring.

Staff received support, regular supervision and attended training to enable them to undertake their roles effectively.

Staff were aware of the requirements of the Mental Capacity Act [2005] and the Deprivation of Liberty Safeguards [DoLS] which meant they were working within the law to support people who may lack capacity and who may need to be referred, under the court of protection scheme, through the local authority.

People were aware of how to raise concerns about the service provided and felt the registered manager was approachable.

There were quality assurance systems in place to make sure any areas for improvement were identified and addressed. This meant the service was working to improve the service for the benefit of people using it.

The registered manager and care coordinators were present in the office and we observed them interacting with staff in person and by telephone. They regularly visited people in their own homes and each person we spoke with knew who they were.

The previous inspection took place in June 2013, when we found the service was compliant in the areas we looked at.

The service registered as Wythenshawe refers to itself and is generally known as Angel Home Care. We have raised this with the provider as they need to register in the name of the service that people recognise. It is a small domiciliary care company, providing personal care and support to people living in their own homes. At the date of this inspection there were 22 people receiving the service. All the people it supported lived in Stockport, which is a few miles away from the office in Wythenshawe, south Manchester. Stockport Council funded all but two of the people supported by the service; those two were privately funded.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 person who was registered manager at the date of this inspection had resigned about ten days earlier, and the provider was in the process of finding a replacement. An acting manager was in post on the first day of our inspection but submitted their resignation four days later. The ‘nominated individual’ or representative of the provider was actively involved in the management of the business and was present throughout the inspection.

We found that the service had procedures to ensure that potential new staff had background checks done. However, in two cases they had allowed staff to start work before criminal record checks had been completed. This meant that not all necessary precautions had been taken, and was a breach of the regulation relating to safe recruitment of staff.

People receiving a service from Wythenshawe told us they felt safe. They said they had not had any missed calls, and when care workers were going to be late they usually received a message. People told us it was important to them to see the same regular care workers, and they believed Wythenshawe tried to achieve this where possible.

Staff received rotas each week and were notified of any changes. The rotas occasionally included clashes or required care workers to be in two places at the same time. The service used an electronic call monitoring system which provided some assurance that calls would not be missed. No call was shorter than 30 minutes but travelling time was not allocated between calls.

Staff had a variable understanding of safeguarding and the forms of abuse they needed to watch out for. Medicines were recorded when the care workers were involved in administering them.

The service had not carried out any mental capacity assessments to determine people’s ability to consent to the care they were receiving. This was a breach of the regulation relating to obtaining consent in accordance with the Mental Capacity Act 2005. The service did sometimes record that people gave consent to the care when they had capacity to do so.

When a new recruit joined they watched four DVDs, spent two days shadowing and then started work. There was a one day training course which both new recruits and existing staff attended. There had been some additional training within the past year. We found there was a breach of the regulation relating to training staff.

Staff had also received supervisions although these were not recorded on staff files.

Some people received support with their meals as part of their care provision. Staff had received basic training in food hygiene. Records of food and drink consumption were kept when needed.

People and their relatives gave examples of how staff were caring and sometimes went beyond what was expected of them. Two people expressed concerns that their care worker did not speak good English, and they could not understand each other. But this did not appear to be a widespread problem.

When people expressed preferences for which care workers would visit, the service tried to accommodate them, except in one case when the then registered manager had told the person they could not meet their wishes.

Confidential documents were kept securely within the office.

Assessments and care plans were sparse and the service tended to rely on the documents provided by Stockport Council. Some parts of the care plans did not assist staff to know what care to deliver. The service relied on verbal instruction. The care plans did not sufficiently record people’s preferences. Reviews of care plans had not been done by the dates scheduled on the plans. These deficiencies were a breach of the regulation relating to person-centred care.

Information was given to people about how to make a complaint. We saw that complaints received in the past year had been handled effectively, with one exception. The service sought feedback from people about the quality of the care provided.

The service had experienced significant management changes in the preceding year, including two registered managers and an acting manager. Stockport Council had imposed a limit on how many hours of care the service could provide. The provider was seeking to appoint a new registered manager.

There was insufficient monitoring of the quality of the service. Spot checks were done to observe staff performance and ask people’s views, but none had been done since June 2016. There were no audits of care plans. This was a breach of the regulation relating to assessing and improving the quality of the service.

The service had not reported to the CQC two safeguarding incidents which had been reported to Stockport Council. This was a breach of the regulation about reporting events to the CQC.

There was a set of policies and procedures but it was clear staff did not access these very often. However, we saw that important policies were discussed at a recent staff meeting. Staff views had been sought in a recent questionnaire.

Staff in the main enjoyed working with Wythenshawe, but the rate of turnover was high, which affected the continuity of care for people using the service.

The provider used appropriate disciplinary processes and monitored the performance of staff.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the end of the full version of the report.

An individual plan of care was in place along with a daily record of the work staff had completed. A range of basic risk assessments had been completed to identify any areas of care where people may be vulnerable to the risk of harm.

The manager was aware of their responsibilities with regard to keeping people safe. Staff had completed training on how to safeguard people from abuse and harm and a policy around this issue was available for reference when necessary. The people who used the service said they had never been treated badly by any of the staff. They described the staff as 'very good'.

Staff said they enjoyed their work and received good support from the registered manager. A staff member confirmed they had enough time to carry out their work and meet the needs of the person they supported. This meant the person who used the service received the care and support they needed.

The people who used the service said they were not aware of the agency's complaint procedure but said they would contact another support agency if they wanted to raise a concern. They said they were happy with the service they received and had no complaints to make.