Angels Care Home Limited

At our last inspection in June 2016 we rated the service good. The inspection was brought slightly forward due to information of concern about the service being conveyed to us. This information included suggestions of poor recruitment processes and lack of staff training and support. However, we found the service was upholding standards in all areas. 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.

The service had a registered manager 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.

The service helped people to stay safe. Staff knew about abuse and how to report it and other incidents or accidents which took place. Risks to people were regularly assessed and updated and there were systems in place to ensure there was enough staff to meet people's needs. The registered manager was actively recruiting new staff and the service was not taking on any new care packages until staff had been safely recruited.

People were supported to take their medicines safely and in accordance with the prescribed instructions. Staff members received the training, support and development opportunities they needed to be able to meet people's needs.

People had a care plan that provided staff with direction and guidance about how to meet their individual needs and wishes. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people's homes and any risks in relation to the care and support needs of the person. People told us they were involved in decisions about their care and were aware of their care plans.

Staff had been recruited safely, received on-going training relevant to their role and supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed.

Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals.

People confirmed there was a stable staff team and that care was provided by familiar faces.

People's feedback about their experience of the service was positive. People said staff treated them respectfully and asked them how they wanted their care and support to be provided. People told us they had their care visits as planned. Staff mostly arrived on time and stayed for the allotted time. Nobody reported any recent missed visits.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s views on the service were regularly sought and acted on.

Staff were respectful of people’s privacy and maintained their dignity.

There were processes in place to monitor quality and understand the experiences of people who used the service. We saw that people were visited on a regular basis in order to obtain feedback about the staff and the care provided.

The service worked in co-operation with other organisations such as healthcare services to deliver effective care and support

The service listened and responded to people’s concerns and complaints, and used this to improve the quality of care. The service learnt lessons and made improvements when things went wrong.

This inspection took place on the 21st June and was announced. The provider was given 48 hours’ notice because the location provided a domiciliary care service and we needed to be sure that the manager would be available. At our last inspection in June 2014 the service was meeting the regulations inspected.

Angels Home Care Limited provides personal care in people’s homes. The majority of people are on end of Life Care and are funded from the NHS continuing care budget. On the day of our inspection there were 11 people using this service.

The service had a registered manager who had been in post since the service opened in 2013. 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.

People’s needs were assessed and care plans were developed to identify what care and support people required. People said they were involved in their care planning and were happy to express their views or raise concerns. When people’s needs changed, this was quickly identified and prompt, appropriate action was taken to ensure people’s well-being was protected. People had a copy of their care plan in their home.

People felt safe. Staff understood how to recognise the signs and symptoms of potential abuse and told us they would report any concerns they may have to their manager. Assessments were undertaken to assess any risks to the people using the service and the staff supporting them. This included environmental risks and any risks due to people’s health and support needs. The risk assessments we viewed included information about action to be taken to minimise these risks.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

We found that the service was working within the principles of the MCA.

Our discussions with staff found they were highly motivated and proud of the service.

Staff were very complimentary about the management team and described them as approachable and supportive.

Staff were respectful of people’s privacy and maintained their dignity. Staff told us they gave people privacy whilst they undertook aspects of personal care, asking people how they would like things done and making enquiries as to their well-being to ensure people were comfortable.

Care staff received regular supervision and appraisal from their manager. These processes gave staff an opportunity to discuss their performance and identify any further training they required. Care workers we spoke with placed a high value on their supervision.

We saw that regular visits had been made by the office staff to people using the service and their relatives in order to obtain feedback about the staff and the care provided.

People were supported to eat and drink. Staff supported people to take their medicines when required and attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

The service had a complaints policy. People who used the service and their relatives told us they knew how to make a complaint if needed.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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If you want to see the evidence supporting our summary please read the full report

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe.

There were effective recruitment and selection processes in place, and staff had been through induction training and shadowing before starting work. This ensured that the staff were of good character and were competent enough to meet the care and welfare needs of people.

Is the service effective?

People's health and care needs were assessed.Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in the care planning process and that they were happy with the care that was provided.

Is the service caring?

People were supported by kind and attentive staff. People told us that care workers showed patience and gave encouragement when supporting people. One person told us, 'staff are very friendly, flexible and patient.' People using the service, and their relatives, were contacted regularly to check if they were satisfied with their care. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The provider had a robust complaints procedure that was accessible to people who use the service.

There had been one complaint since our last inspection and we saw that this was investigated in line with their procedure.

Is the service well-led?

Staff told us that the manager was ''always routing' for people who used the service and "responded very quickly.'

Staff told us they were very happy with the manager, and 'she is good at providing support whenever you need it.'

A healthcare professional told us 'she is very involved and I have a lot of confidence in her.'

Staff were clear about their roles and responsibilities, and had a good understanding of the ethos of the agency, quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We were not able to talk directly with people using the service. The service was small and people were unwell or unable to communicate with us. We spoke with people's relatives. They told us that, in the main, a professional, caring service was provided. One relative described the care as 'extremely reliable'. A second relative said, 'the staff are kind and courteous.' We spoke with other professionals involved in people's care. One described the care provided as, 'reasonably efficient with no major problems'. Another said that care provision had been, 'good in difficult circumstances.'

There were detailed care plans for people using the service which were supplemented by risk assessments and other records such as medication and fluid charts. Staff told us that they felt supported, liked working for the agency and had received relevant training. There were records confirming that staff had received training and that staff supervision and appraisals were carried out. Staff recruitment records showed that the required checks including criminal record checks and references had been made.

There were a range of methods for assessing and monitoring the quality of the service. These included regular visits to people using the service to carry out spot checks. The records included adequate information for people using the service, staff and for the management of the service.

The provider was not notifying the Care Quality Commission of important events that affected people's welfare, health and safety. As a result, people using the service could not be confident that they would be protected from risks and safeguarded when needed.