Archived: Angel Heart Home Care Limited

We inspected Angel Heart Home Care on the 29 September and 2 October 2015 and it was an announced inspection.

At our last inspection on 2 April 2015, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to person centred care and good governance. Requirement actions were served in relation to staffing and safe care and treatment. The provider wrote to us to say what they would do to meet legal requirements in relation to safe care and treatment, person centred care, good governance and staffing.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found the provider had made pockets of improvements however, sufficient improvements had not been made to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014. Some of these breaches were repeated because the provider had failed to take proper action after the last inspection.

The overall rating for Angel Heart Home Care is ‘Inadequate’ and the service therefore remains in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Angel Heart Home Care is a domiciliary care agency providing personal care for a range of people living in their own homes. These included people living with dementia, older people and people with a physical disability. The support hours varied from one to four calls per day, with some people requiring two members of care workers at each care call. The agency’s office was based in

Camberley and the agency offered support and care to people in Camberley, Frimley, Blackwater and the surrounding area. At the time of our inspection, the agency was supporting up to 17 people and employed six care workers.

People and their relatives felt there had been improvements with the running of the agency in the past two weeks. One person told us, “My care has been better these past two weeks after the office staff have been out doing the work.” One relative told us, “They seem to have some new care workers and trying to improve over past two weeks but am exhausted chasing things up.” Although people felt some improvements had been made, the provider had not fully addressed the issues we found at our last inspection.

Risks to people’s safety continued to be poorly managed. Risk assessments lacked sufficient guidance and information to enable care workers to provide safe care. Moving and handling risk assessments failed to document specific information required to safely move and transfer people. Where restrictive practice was used, robust risk assessments were not in place and did not provide detailed information about reducing the risks or what was in people’s best interest.

Care plans lacked detailed information on how to effectively meet people’s nutritional needs. For people who required a soft or puree diet, guidance was not in place on how to minimise any potential risks of choking. Where people required support to maintain a healthy diet or support with dietary requirements, such as diabetes, guidance and information was not in place.

The provider had not followed best practice guidance when they had recruited new care workers. New care workers had not been fully vetted before they worked with people.

The provider had not been able to respond fully to the inadequacies we raised with them at our last inspection. They had a lack of understanding about prioritising people’s safety which was demonstrated by the continued lack of proper risks management, medicines management and safe staff recruitment practices. Audits were being carried out by the management team but they had failed to understand how they needed to follow relevant legislation and best practice. The provider was unaware of their legal requirement to display their Care Quality Commission (CQC) rating. Incidents and accidents were not monitored for any emerging trends, themes or patterns.

People and their relatives raised concerns over the timekeeping of care workers, not being informed if the care worker was running late and calls times being inflexible and not personalised to them. One person told us, “We never know who is coming sometimes no one comes and sometimes have duplicated calls.” Relatives also raised concerns regarding poor management of complaints. One relative told us, “They are not diplomatic when we raise concerns.”

A database management system was now in place which provided a centralised system of recording everyone’s details and frequency of care calls. The provider had also implemented a telephone monitoring system whereby care workers logged in and out care calls. This provided a clear audit trial of when care workers were late to a care call and provided a system for monitoring for any missed calls.

The provider had taken action to ensure care workers received the training and support required to effectively undertake their job role. Care workers now received regular supervision, team meetings were taking place. Face to face training was implemented and spot checks were being undertaken. Mechanisms were now in place to assess care worker’s competency with the training provided and ensure it is embedded into practice.

Care workers spoke with compassion for the people they supported. Individual reviews had been taking place which considered what was working for people and what was not working. However, further work was required to ensure care plans and risk assessments were updated following any review. Work was still being undertaken to ensure care plans were personalised.

Overall, we found shortfalls in the care provided to people. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. We will publish what action we have taken at a later date.