Archived: Angels Assisted Living Services

Updated 18 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 7, 9, 12 and 19 June 2017 and was an announced inspection. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be available at the provider’s offices and also to allow the provider to notify people that we were undertaking an inspection.

The inspection team comprised of one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

As part of the inspection we looked at previous inspection reports and checked the information that we held about the service. This included notifications from the provider they are required to send us by law, including safeguarding concerns or incidents involving the police.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Prior to the inspection we received feedback from external agencies and other health and social care professionals who were familiar with the service. Including the local authority commissioners and safeguarding teams and Healthwatch. Healthwatch is an independent consumer champion which gathers and represents the views of the public about health and social care services.

During our inspection we spoke with all five people who received care and support from the provider in the Prudhoe housing complex and also four people’s relatives and two friends. We spoke with seven people who lived in the housing complexes and who were entitled to use the emergency responder element of the service. We also spoke with three care staff from another agency who were visiting the housing complex in Prudhoe during the inspection and provided care to the some of the same people whom the provider's staff supported.

We spoke with the registered provider, the administrator and communicated with seven staff (including those currently employed and those no longer employed by the provider). We also spoke with two care managers from the local authority, one occupational therapist, a specialist in Motor Neurone Disease and a district nurse.

We looked at the care and medicines records of three people and reviewed the records of four members of staff. We also reviewed records in connection with the management of the service, including audits of medicines, training records, surveys and staff meetings.

Updated 18 August 2017

We carried out an announced focussed inspection of this service in November 2016 after the provider had been issued with a warning notice in relation to good governance in December 2015. We found the provider had met the requirements of the warning notice. At the inspection in December 2015 the service was also in breach of a further two regulations in respect of safe care and treatment and staffing.

This announced inspection took place on 7, 9, 12 and 19 June 2017.

Angels Assisted Living Services is a Domiciliary Care Service which is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing care to five people all of whom were living within the housing complex in Prudhoe. The service also provided emergency response cover to all of the people who lived in the housing complex at Prudhoe and also a similar housing complex in Alnwick.

Under its registration with the Care Quality Commission (CQC) this service does not require a registered manager, as the provider of the service is an individual in day to day charge of operations. 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 had recently received a number of safeguarding concerns in relation to the provider and the service offered to people they supported. These are currently being investigated by the local authority safeguarding team and we will continue to liaise with them and take further action if found necessary to ensure the safety of people.

We received mixed views from people and relatives during our inspection. We found that there had been historic blurring of the roles and responsibilities between the management of Angels Assisted Living Services and the previous manager within the housing complex in which the provider worked in Prudhoe. This had caused confusion for people, relatives, staff and visitors as to whom they should refer to when a care issue arose.

There had also been issues in connection with the level of care to be provided, particularly the emergency response element of the service with comments made indicating they thought there was not enough staff. At the time of the inspection the records reviewed and the providers explanation suggested there was sufficient staff.

Staff understood their responsibilities of reporting any allegations of abuse and knew how to raise concerns if needed. People were supported to have their prescribed medication safely.

The provider had not always acted safely, swiftly or appropriately in relation to recruitment procedures, employment checks and investigations completed with staff. This meant staff may have been employed, or employed longer than they should have, who were not suitable to work with vulnerable adults.

People’s safety was protected because risks assessments identified risks that were specific to their needs and care plans were individualised. However, the provider had no pre-assessment information available and told us they destroyed this information once they had drawn up care plans. People and their families told us they had been involved in formulating people’s care plans.

The provider’s business continuity plan needed to be finalised to ensure that if the service had an emergency, they would be able to carry on providing care to people safely.

Staff felt supported and they received supervision sessions and annual appraisals, although they were not always recorded. Training was provided and induction was based around the Care Certificate standards.

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 suitable food and refreshments which met their needs. People had access to healthcare professionals although not all comments received from people or relatives felt this was the case. This is being separately investigated currently by the local authority safeguarding team.

We received mixed views about the caring nature of the service and its staff, including the provider. Surveys had been sent out to gather the views of people and the majority of those returned had been positive. People and their families told us they knew how to complain if they felt they needed to.

Activities were made available to people if this was part of their care plan, including those which were facilitated in the complex in which they lived.

Communication between the provider and other agencies or services was not as good as it should have been. We found that roles had not always been clear and this included who people, relatives or staff should speak with regarding issues arising.

The provider had not always followed their own policies and procedures, including those in connection with gifts.

Quality monitoring systems were in place and when issues had been identified, actions were put in place to rectify these. Although not all the issues we had found during our inspection had been identified.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the good governance and fit and proper person’s employed.

You can see what action we told the provider to take at the back of the full version of this report.