Background to this inspection
Updated
16 November 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
One inspector visited the office location on 4 October 2021.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. The provider had recently recruited a new manager who had been in post for one month, however, they left during the inspection.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 4 October 2021 and ended on 19 October 2021. We visited the office location on 04 October 2021. Further inspection activity was completed via telephone and by email, which included speaking with staff and reviewing additional evidence and information sent to us
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three members of staff including the manager and care coordinators. We reviewed a range of records. This included three people’s care records and two people’s medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We requested contact details for care staff, people and their relatives to received feedback about the service. We did not receive the requested information and were unable to gather staff, people and relatives’ views on the service. We contacted the nominated individual to seek further assurances regarding the stability of the service. They did not respond. The nominated individual is responsible for management of the service on behalf of the provider.
Updated
16 November 2021
About the service
A New Angle Ltd (York) is a domiciliary care service providing care and support to people with a range of support needs living in their own homes. There were 14 people being supported with personal care at the time of our inspection.
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 safe running of the service was directly impacted by a lack of financial resources/management. There was no provider oversight and operational issues put people and staff at risk. This included, late payment of staff wages and non-payment of office utilities.
Numerous staff had left the service due to ongoing payment issues with the provider, this included the newly recruited manager. The provider did not respond to requests we made about the management oversight for the service. Staff who continued to work at the service felt unsupported.
Risks to people were not appropriately assessed, mitigated or reviewed. At the last inspection we recommended the provider reviewed the COVID-19 risk assessment, no action had been taken to address this.
We could not be sure that medicines were being safely administered as prescribed due to various system failures such as gaps in recording and missing information.
The provider had taken no action to address the concerns we found at the last inspection. The provider was not open and honest during this inspection and failed to respond to requests from the inspection team.
Quality assurance systems in place had not been updated, reviewed or completed. The provider did not monitor the service fully and systems in place did not identify the shortfalls we found during the 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.
Staff working at the service had a good understanding of how to keep people safe.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 10 June 2021).
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.
Why we inspected
We received further concerns in relation to provider operational and financial issues. This included staff not being paid on time and a lack of working equipment to enable staff to provide safe care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.
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 risk to people, medicines, infection prevention and control, governance, financial position and keeping the statement of purpose for the location up to date. 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 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
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.