Archived: A New Angle Ltd (Beverley)

About the service

A New Angle Ltd (Beverley) is a domiciliary care service providing care and support to people with a range of support needs living in their own homes. There were 20 people being supported with personal care at the time of our inspection.

Not everyone who used the service received personal care. Care Quality Commission (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.

At the last inspection we identified concerns with the management of medicines. There had been no improvements made to ensure medicines were being safely administered as prescribed due to various system failures such as gaps in recording and missing information.

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.

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. The provider failed to respond to requests from the inspection team and had taken no action to address the concerns we found at the last 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.

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 18 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.

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 of 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 (Beverley) is a domiciliary care service providing care and support to people with a range of support needs living in their own homes. There were 48 people being supported by the service 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 to assess risks associated with the COVID-19 virus were generic, and did not contain personalised information for people or staff. We have made a recommendation about the management of risk reduction in relation to COVID-19.

Quality assurance systems in place were not consistently completed and did not identify the shortfalls we found during the inspection. A lack of oversight from the provider could not guarantee people were being effectively or safely supported.

Staff had lost faith in the provider and were frustrated with persistent concerns about operational issues. A number of staff had recently left the service and a further 11 staff were due to leave within the next month, this included the area director.

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 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 and their relative were happy with the care and support provided. The area director and care coordinators worked hard to ensure people received their required support. Following the inspection the area director completed lessons learnt for the shortfalls found at the inspection in order to prevent reoccurrences.

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 18 September 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 two breaches in relation to medicines safety and 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 as 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.

Systems and processes were in place to support people to stay safe. Staff were trained in safeguarding and knew how to recognise and report abuse. Medications were managed in line with company policy. The service provided information to people to support them to remain safe within their homes.

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

Staff received a thorough induction which included classroom training, shadowing shifts and competency checks. Staff understood the importance of promoting independence to maintain people’s wellbeing.

Staff were observed to be kind and caring. Staff understood what was important to people; this was evident throughout the inspection. Staff spent time with people during calls and had meaningful conversations with them; staff treated people with dignity and respect. Care plans were detailed and clearly informed staff of the support people required.

People told us the service was responsive to their changing needs. People and their relatives knew how to raise concerns and were confident these would be dealt with in the appropriate way. We found staffing levels were appropriate to meet people’s needs.

Care plans held information of people’s wishes for end of life care. Detailed records instructed staff on how to support people in a dignified way, in line with their wishes.

People were confident the service was managed well. There was a clear management structure and staff spoke positively about the management team. The registered manager informed us they were currently recruiting a member of staff to focus on quality assurance and auditing . Feedback was sought from staff, people and their relatives to continuously monitor and improve the service.

Further information is in the detailed findings below

Independent Home Living Beverley is a domiciliary care agency which is registered to provide personal care to people in their own homes. The service supports people living in Beverley and the surrounding villages and provides assistance with personal care, domestic help and companionship. At the time of our inspection the service supported approximately 100 people with approximately 70 people receiving support with a regulated activity.

The service was last inspected in April 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 staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes.

We found that people’s needs were assessed and risk assessments put in place to keep people using the service and staff safe from avoidable harm. We found that the administration of medicines was being audited appropriately. However we found that some medications were not always accurately recorded.

People were happy with the service they received and told us that the staff usually arrived on time. They told us that they generally received support from the same member of staff or group of staff.

We saw that staff completed an induction process and they had received a wide range of training, which covered topics including safeguarding, moving and handling and infection control and also more specific training such as dementia awareness and pressure area care. Staff told us they felt well supported; they received regular supervision and attended team meetings. Staff were also encouraged to complete an NVQ Level 2 or higher.

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 on behalf of a person who used the service.

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 and were generally satisfied with the meals prepared. People were supported to access healthcare support where necessary.

People told us that staff were caring and that their privacy and dignity was respected by the agencies staff. People told us that they received the support they required from staff and that their care packages were reviewed and updated as required.

We saw that people’s needs were assessed and care plans put in place to enable staff to provide responsive care and support. People had been involved in the planning of their care and relevant people were included in reviews.

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.

People using the service and agencies staff told us the service was well-led. We could see there were systems in place to monitor the quality of care and support provided and evidence that action was taken to address any concerns.

We received positive comments from the carers of people who received a service from the agency. One person said, 'I cannot fault the carers' and another said, 'We can choose which agency to use and we would change to another agency if we were not satisfied, but we have been'.

People told us that they received a service from a small number of care workers and did not express any concerns about inconsistency, missed calls or lateness. They said that they were consulted about the care they received and were satisfied with the support they received with the administration of medication.

Care workers told us that they received appropriate training that equipped them to carry out their role effectively.

There were quality monitoring systems in place that gave people who used the service, their carers and care workers the opportunity to express their views and affect the way in which the agency was operated. Care plans were audited and complaints were responded to appropriately. More robust recording of complaints and accidents/incidents would allow areas for improvement to be identified and acted on.