Archived: A New Angle Ltd (York)

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.

Independent Home Living (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 nine 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

Risks assessments in place to assess risks associated with COVID-19 virus were generic and did not contain personalised information for people or staff. Staff had not received training for COVID-19 to support their understanding of safe practice. We have made a recommendation about the management of COVID-19 at the service.

There was no provider oversight of the service. Quality assurance systems in place did not monitor the service fully and did not identify the shortfalls we found during the inspection.

Staff, relatives and stakeholders had lost faith in the provider due to persistent concerns about operational issues.

People received person centred care. Care plans and risk assessments for people’s health needs contained detailed person-centred information and informed staff how to manage and mitigate potential risks to people. Staff demonstrated a good understanding of how to keep people safe from abuse. People received their medicines as prescribed.

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 Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 August 2018).

Why we inspected

We received concerns in relation to provider operational issues which resulted in a high turnover of staff. This included staff not being paid on time. 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 good to requires improvement. 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 a breach in relation to governance. Please see the action we have told the provider to take at the end of this report.

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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. People and staff spoke positively about the management of the service.

Risks to people were assessed and action taken to reduce them. Staff were able to explain different types of abuse and were aware of action they should take if they had any concerns. A safeguarding referral had been made appropriately. There were safe systems in place to support people with their medicines.

Appropriate recruitment checks were undertaken before staff started their employment, to ensure they were suitable to work with vulnerable people. There was a system in place to plan care visits and most people told us staff usually arrived on time. Staff received an induction, training and supervision to give them the skills and knowledge they needed to care for people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received support with their nutritional needs where required and people were satisfied with the support they received to prepare meals. Staff sought advice from healthcare professionals when they had any concerns about people’s health.

Staff treated people with dignity and respect and supported people to maintain their independence. We observed caring interactions between staff and people who used the service. It was evident staff knew people well.

Care plans were in place to give staff the information they needed to support people in line with their preferences and needs. The provider had a policy for responding to any concerns and complaints. People told us they would feel comfortable reporting any concerns and were confident these would be addressed.

There was a quality assurance system in place to monitor the quality of care provided. Feedback from staff indicated there was a positive, person-centred culture within the service.

Further information is in the detailed findings below.

Independent Home Living Yok is a domiciliary care agency which is registered to provide personal care to people in their own homes. The service supports people living in York and the surrounding villages and provides assistance with personal care, domestic help and companionship. At the time of our inspection the service supported approximately 60 people although only 31 were receiving support with a regulated activity.

The service was last inspected in June 2013 at which time it was compliant with all the regulations we assessed.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

We found that people supported by Independent Home Living (York) were safe. All staff received training in safeguarding adults from abuse and they were clear of the process and policies to follow should an allegation or any concerns be raised.

People were supported to take risks and, where any restrictions were in place to support people’s safety, these had been appropriately documented and agreed.

People spoke highly of the staff and said that they generally arrived on time, although they recognised that there were occasions where staff may be running late. The agency had systems so that this could be monitored and people contacted where necessary. Recruitment checks were completed before staff commenced work so that only suitable people were employed.

People received their medication as prescribed and we saw that medication reviews were undertaken to ensure that people were receiving the medication they required.

Staff received induction and training to support them in their roles. They had access to a range of training and staff we spoke with confirmed that this supported them in carrying out their roles effectively. Staff received regular supervision and all confirmed that they received good support from the registered manager.

People were supported to make decisions and choices. Staff received training on the Mental Capacity Act 2005 and were aware of the importance of using this legislation should any decisions need to be made.

Some people told us they received support from staff with shopping, cooking and domestic tasks. They were involved in choosing what items they wanted staff to buy or what they wanted making.

People’s health needs were kept under review and professional advice was sought where necessary. Staff knew and understood the people they supported, which meant that any changes in health were quickly identified and responded to.

We observed a positive warm and friendly relationship between staff and people being supported. People we spoke with provided positive feedback regarding the care they received. People were involved in discussions regarding their care and signed their agreement to their care records.

Equality and Diversity issues were considered and supported. People were provided with information about the agency when they started to use the service. People had access to external advocacy support where this was required.

Records were stored securely at the office and copies also held in people’s individual homes. Staff were aware of the importance of maintaining confidentiality.

Staff demonstrated a clear understanding and gave examples of how privacy and dignity was promoted and maintained. The agency responded to people’s changing needs and we saw detailed care records, which recorded how people’s care should be delivered. People were involved in discussions regarding their care and signed their agreement to their care records.

People were supported to make choices and decisions and to feedback any concerns. There were appropriate complaints procedures in place should people need to raise any issues.

The agency had management systems to review and develop the service they provided. However, these systems did not reflect the changes made or record the action taken in response to people’s feedback. The area manager agreed that these systems could be further developed.

The provider was carrying out appropriate checks when recruiting new staff and levels of staffing were closely monitored to ensure that calls were covered. However, some people we spoke with did comment on late arrival of carers.

There were robust processes for assessing the quality of service in place and people who used the service were able to feedback and felt confident that action was taken. People were informed of the complaints system which was followed appropriately by the service. Records were found to be accurate, detailed and regularly reviewed.

This was a follow up visit so we did not speak to people who use the service again, as we had spoken to them during our previous inspection. The action taken by the provider since our last visit was positive, and matched what they had told us they would do in the action plan they had submitted following our last inspection.