Archived: Angel Home Care

Angel Home Care is a domiciliary care agency that provides personal care to people living in their own homes in the community. When we inspected they were providing the regulated activity, personal care, to 59 people in Bovey Tracey and surrounding rural areas in Devon. 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 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 were supported by staff that were caring, compassionate and treated them with dignity and respect. Any concerns or worries were responded to and used as an opportunity to improve the service. Overall what people liked specifically about the service was the professionalism. People described the service as, “Courteous”, “Wonderful”, [Care workers] have time for a chat” and one person said staff always asked, “Is there anything else I can do before I go?”.

People received person-centred care and support based on their individual needs and preferences. Staff were aware of people's life history, and their communication needs. They used this information to develop positive, meaningful relationships with people. One person said they loved seeing the care workers and showing them photos of their family.

People told us they felt well cared for by staff who encouraged them to maintain relationships and keep their independence for as long as possible.

The provider ensured, as much as possible, people had consistent staff visiting them.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. One care worker said they had good training, especially in topics related to individuals such as advanced epilepsy. Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

Staff spoke positively about working for the provider. One care worker said there was good, supportive, approachable management. They felt supported and could talk to management at any time, feeling confident any concerns would be acted on promptly. They felt happy in their work.

Audits and an overarching service improvement plan (SIP) had been completed to check the quality and safety of the service. The provider was very passionate about providing good care and they and the staff team had worked closely with the local council quality and improvement team to ensure they were embedding effective systems. The staff team worked well together with the provider in their roles and ensure people received a good service.

Rating at the last inspection and update

The last rating for this service was Requires Improvement overall with Well-Led rated as Inadequate (last report published 20 May 2019). We issued two warning notices in relation to breaches of good governance and safe care and treatment regulations.

The provider completed an action plan after the last inspection to show what they would do and by when they expected to have improved and were meeting the regulations.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

•People described they were happy with the service and the carers who gave them their care

•Relatives described they were happy with the service and how care was given to their relatives.

•People’s medicines and infection control were not safe.

•People did not have the required risk assessments and care plans in place to ensure staff had the information required.

•Staff were not always recruited safely.

•Staff did not receive the appropriate training, professional development, supervision and appraisal as necessary to carry out their duties they were employed to perform.

•Systems of leadership and governance were not ensuring checks of the quality of the service were taking place.

Rating at last inspection: The service was rated Good at the last inspection. The report was published on 8 October 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, the service was rated as Requires Improvement overall.

Enforcement: We found breaches of the Regulations. We have asked the provider to send us an action plan in respect of Regulation 11, 18 and 19 on how they are going to address these. In respect of the breach of Regulation 12 and 17, 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 return and inspect the service in line with our inspection methodology.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

One of the service’s two directors held the role of registered manager and managed the service on a day to day basis. 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.

This announced inspection took place on 24 and 25 August 2016 and included visits to the office, staff interviews and visits to people in their own homes. At the time of this inspection 96 people were using the service, of which 69 were receiving support with their personal care needs. Domestic help is not regulated by us, and therefore this inspection looked at the care and support of those people who received assistance with their personal care. The service was previously inspected in January 2014 when it was found to be meeting the regulations at that time.

People, their relatives and staff told us the service was well-led. One person said, “The office is very efficient and you get a prompt response from the out of hours’ team”, and another said, “They’re excellent, I’m very confident with them”. Both of the service’s directors worked at the service, one in the capacity of registered manger and one with the responsibility to oversee staff training and also to work alongside staff providing care, and as such both directors knew the people receiving a service well.

People said they felt safe with the staff when receiving care. They said they had a regular staff team whom they had come to trust and know well. Staff had received training in safeguarding adults and knew how to report any concerns in line with the service’s safeguarding policy.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks, however we found that some plans held more detail than others. The service used a number of documents to record people’s care needs and to guide staff about how to minimise risks to people’s health, safety and well-being. We found the information from these various documents had for most people been incorporated in to their care plans, and provided staff with clear guidance not only about the person’s care needs and how they wished to be supported, but also how to reduce any identified risks. However, one person’s care plan identified the risks to their well-being but did not describe how staff should support the person to minimise these risks and to provide care in a safe manner. Through meeting this person and discussing their care needs with staff, we found no evidence staff did not know and understand how to care for this person safely. The register manager confirmed they would arrange for this person’s care plan to be reviewed and rewritten to provide more detailed information.

The service employed sufficient numbers of safely recruited and well trained staff to meet people’s needs. Staff told us they had received training in topics including safeguarding, dementia awareness, infection control, catheter care, moving and handling, the Mental Capacity Act, first aid and respecting privacy and dignity. Should a person have very specific care needs, such as the care of a feeding tube, this was undertaken directly with the person and their staff team. People told us the staff were knowledgeable and skilled. One person told us “The carers are considerate and competent in the tasks they undertake.”

People told us they had never had a missed call, and if the staff were going to be late they always received a phone call to notify them. Staff told us they had no concerns over the planning of visits and they were provided with sufficient paid travel time. They said they had enough time to ensure they delivered care safely and visits were not compromised by having to leave early to get to their next person on time.

People and their relatives were very positive about the way staff supported them. Each person we spoke with told us their care staff were kind and compassionate. One person said, “My carers are caring, conscientious, efficient and thoughtful.” Other comments included, “they are all so lovely, so friendly” and “super, excellent, couldn’t get anybody better”. A relative told us their relation’s carer was “a nice person to have around the home.”

Staff performance was monitored through direct observation, spot checks and appraisals to ensure they were meeting people’s needs and following the guidance in people’s care plans.

Care plans were developed with each person and people told us they had received a copy. These plans described the support the person needed to manage their day to day needs and to remain as independent as possible. Staff knew people well and were able to tell us how they supported them. The service was flexible and responsive to changes in people’s needs. For example, one person told us the service had provided extra visits during a time their relation was away from home.

Some of the people receiving a service were living with dementia which affected their ability to make decisions about their care and support. The registered manager and the staff had a good awareness of the Mental Capacity Act 2005. Records showed staff had been involved in a best interest decision about a person living with dementia continuing to receive assistance with their personal care. Staff said they asked people everyday about whether they were happy to receive care and to allow them to make what decisions they could.

People and their relatives had no concerns over the care and support they received and they felt able to make a complaint if something was not right. One person told us, “If there was anything wrong I know they [the registered manager] would put it right. They help me in any way they can.” The service had not received any complaints this year.

Regular staff meetings provided opportunities to review the development and continued improvement of the service. Staff told us the registered manager was very approachable, they were invited to share their views about the service.

Audits were carried out periodically to monitor the quality of the service. Unannounced checks to observe staffs’ competency and interaction with people were carried out on a regular basis. The service sought regular feedback from people who used the service and the results of the most recent surveys sent to people in May 2016 were very favourable. The registered manager kept up to date with current issues in the care profession by accessing care related websites, attending external training events, meeting regularly with other care providers, as well as the local authority’s commissioning groups.

Everyone we spoke with told us that staff were thoughtful and kind. One person said "they fetch my milk and bread in their own time, they are a big help".

One person told us "I would rather do things for myself, but I can't and they are the next best thing. They are respectful and understanding".

One person told us "I have a laugh with (carer's name), she really cheers me up. I look forward to her coming".

We spoke with staff members about their work and asked if they would be able to recognise abuse. Each person was able to tell us what that understood by the term and the procedure that they would follow should they feel that a person they were caring for was at risk of abuse. From the answers given we were able to ascertain that staff understood what forms abuse took and how to properly alert the authorities.

We were shown the results of the annual user surveys which had been recently returned to the service. Very few contained negative comments. Of the ones that did, the service owners investigated each comment and where necessary took steps to change things to better suit the person's needs.

We found the office staff welcoming and friendly, easily approachable and professional.

Everyone we spoke with thought that staff were polite and respectful and said that staff provided care and support in a respectful way.

People told us that they were happy with the care staff they had. The people we spoke with said care staff knew what to do and how to provide the care and support they needed.

People told us they felt safe and comfortable in the presence of staff and said staff respected them. Staff were aware of the different types of abuse and knew how to recognise and report it appropriately.

Staff told us they had enough information given to them to know how to care for people's needs. Staff were complimentary about the support they received from the organisation. We saw evidence that appropriate background checks were carried out prior to employing staff.

The agency conducted user surveys and records showed they responded when issues were raised. A trained assessor conducted regular spot checks to monitor the quality of care delivered in people's homes.

We saw that various checks were performed to ensure the service ran efficiently and to ensure that people were happy with the care they received.