Archived: Angels Domiciliary Care Services

Updated 20 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

We carried out a comprehensive inspection of Angels Domiciliary Care Services on 10, 11 12 and 18 January 2019. The inspection was undertaken by one adult social care inspector. The provider was given 48 hours' notice because the location provides a domiciliary care service to vulnerable adults. We needed to be sure people who used the service, staff and the registered manager would be available to speak with us. We used the 48-hour notice period to speak by telephone with service users and relatives of people who used the service. This was to gather their views and opinions of the support people and their family members received.

Prior to our inspection of the service, we were provided with a copy of a completed provider information return (PIR); this is a document that asked the provider to give us some key information about the service, what the service does well and any improvements they are planning to make. This provided us with information and numerical data about the operation of the service.

In preparation for the inspection, we reviewed the information we held about the service such as the PIR, notifications, complaints and safeguarding information. This included statutory notifications sent to us by the service about incidents that affected the health, safety and welfare of people supported by the service. A notification is information about important events, which the service is required to send us by law.

We contacted the Local Authority safeguarding team, the local commissioning teams and the local Healthwatch organisation to ask them about their opinion of the service. This helped us to gain a balanced overview of what people experienced accessing the service.

We contacted three people who used the service and five relatives via telephone interviews. We also visited and spoke with two people within their own homes. We spoke with the registered manager, the administrative director of the service, the deputy manager and four support workers to ascertain their views on the service.

During the inspection we looked at care records of three people who were supported at the service. We looked at three staff personnel files and reviewed a range of records relating to how the service was managed. This included recruitment records, staff training records, medication administration records, quality assurance systems and policies and procedures.

Updated 20 February 2019

We carried out an announced inspection at Angels Domiciliary Service Limited on 11, 12, 13 and 18 January 2019.

Angels Domiciliary Service Limited is a small domiciliary care agency in Chorley. It is a family run business running from the family home which covers the Chorley and South Ribble area. The service is registered for dementia, learning disability and autism, older people, physical disability, sensory impairment and younger adults. The service provides personal care to people living within their own homes. At the time of the inspection fourteen people were using the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission 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.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2008 and once breach of the Care Quality Commission (Registration) Regulations 2009) We found shortfalls in the management of medicines, the staff recruitment process, staffing levels and safeguarding people from abuse. We also identified further shortfalls in dealing with complaints, the governance arrangements and as well as failure to provide statutory notifications.

We are considering what action we will take in relation to these breaches. Full information about the CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

At the last inspection carried out in May 2017, the service was rated as good, however we found that at this inspection there had been significant deterioration in the quality and safety of the service being provided. At this inspection, the rating of the service had deteriorated to inadequate.

Safeguarding adult’s procedures were in place and staff were aware when to raise concerns. However safeguarding incidents were not always being documented or reported to the local authority safeguarding team. A recent safeguarding investigation regarding an individual not receiving commissioned support through the agency was substantiated.

Complaints were not being managed, recorded and responded to appropriately. People using the service, relatives and staff did not always feel listened to. One person’s care package was cancelled when they raised a concern about the registered manager.

We found shortfalls in the management of medicines. There had been several incidents around medication and not all staff had received medication training.

There was a lack of training for staff within the service. Neither management or the staff team had received any training in moving and handling, fire safety, health and safety or food hygiene. Supervisions were not being undertaken as frequently as they should have been.

Staffing levels were low and there had been a high turnover of staffing within the service. Rotas were constantly changing and people were not always receiving the hours they have been commissioned for.

We found shortfalls in the recruitment of new staff. Recruitment was unsafe. Of the three files we looked at, only one reference was received out of six. There was also a lack of understanding of the risks posed by the employing inappropriate people to work in the service.

There was a lack of confidentiality within the service. Service users, relatives and staff were aware the registered manager crossed professional boundaries.

Complaints were not being managed, recorded and responded to appropriately. People using the service, relatives and staff did not always feel listened to. One person’s care package was cancelled when they raised a concern about the registered manager.

We saw people’s care files contained environmental risk assessments, falls risk assessments and moving and handling risk assessments. However individual risk was not well managed and concerns around people's safety were not always identified. Accidents and incidents were not always being documented.

There were significant shortfalls in the way the service was led. The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement.

There was a lack of statutory notifications being sent to CQC and a lack of monitoring and auditing of the service.

The provider was working within the requirements of the Mental Capacity Act (2005) and we saw evidence of capacity assessments in place.

People had access to healthcare professionals. Assessments and care plans in place included people’s personal histories and social interests, which enabled staff to build relationships.

People were complimentary about the staff who looked after them. They told us the staff were caring and they felt confident in them. They liked the continuity of staffing that they received from the small team and felt in particular that a senior member of the care team was efficient.

The overall rating for this service is 'inadequate' and the service has been placed 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 providers 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 insufficient 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.

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.