Archived: Archangel Home Care - Staffordshire Branch

Archangel Home Care – Staffordshire Branch is a domiciliary care agency. It is registered to provide personal care to people living in their own homes. CQC only inspects where people receive personal care. This is related to help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, 42 people were receiving personal care.

People’s experience of using this service and what we found

People felt safe using the service because they were supported by staff who knew their needs well and knew how to manage their risks.

People were protected from abuse and avoidable harm because suitable systems were in place to keep them safe. Staff understood their responsibilities. People were protected from the spread of infection and the provider had ensured practices were updated during the COVID-19 pandemic.

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's needs and choices were assessed and planned for, and their preferences had been considered.

Staff were safely recruited and inducted. They had access to training and supervision to ensure they had the skills to support people effectively.

There were systems in place that worked to ensure areas of improvements were identified and actions were taken to make changes when needed so that people had good quality care.

The manager was approachable and supportive and had a very clear direction to continue to make and sustain improvements. Staff enjoyed working at the service and were listened to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 17 December 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to medicines, missed calls, breaches of personal protective equipment (PPE) and poor care records. As a result, we undertook a focused inspection to review the key questions of safe, effective, 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 good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Archangel Home Care – Staffordshire Branch on our website at www.cqc.org.uk.

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.

Archangel Home Care – Staffordshire Branch is a domiciliary care agency. It is registered to provide personal care to people living in their own homes. CQC only inspects where people receive personal care. This is related to help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, 110 people were receiving personal care.

People’s experience of using this service and what we found

There were not enough staff to cover calls, this meant the registered manager, deputy manager and care coordinators had to support, which impacted on the overall governance of the service.

Quality assurance systems were not always effective at identifying areas for improvement and people’s care records were not always updated. People did not have individual ‘as required’ medicine protocols in place to guide staff when they were needed.

People felt safe. Staff knew how to protect people from abuse and they understood people’s risks and how to support them safely.

People were protected from the risk of cross infection as staff followed the additional guidance in place due to the COVID-19 pandemic.

People felt able to contact the office to raise concerns and were confident these were acted on. People were given the opportunity to feedback about the care they received.

The registered manager understood their responsibilities and were open and reflective during the inspection.

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 September 2019) and there was a breach of regulation. We asked the provider to complete an action plan after the last inspection, however, we did not receive this. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

Our intelligence and monitoring systems highlighted to us that the service was high risk. 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 remained as 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 report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement overall. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Archangel Home Care - Staffordshire Branch on our website at www.cqc.org.uk.

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 monitor the service.

We have identified breaches in relation to governance at this inspection. You can see the action we told provider to take at the end of the full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress and will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Archangel Home Care – Staffordshire Branch is a domiciliary care agency that was providing personal care and support to people living in their own home. It provides a service to older adults some of whom are living with dementia, people that have mental health, learning disabilities, physical disabilities, people with sensory impairments and younger adults. At this inspection they were providing a regulated activity for 106 people.

People’s experience of using this service and what we found

The management team did not have effective systems in place to monitor people’s medication administration records or action plans, which detailed the improvements the service was working towards.

Staff members did not always follow effective infection prevention and control procedures when supporting people in their own homes.

The provider had systems in place to respond to any complaints or compliments from people.

People were protected from the risks of harm and abuse as staff members had been trained to recognise and respond to concerns. The management team made appropriate referrals to keep people safe. The provider had assessed risks to people associated with their care and support.

The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision.

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 received help and support from a kind and compassionate staff team with whom they had developed positive relationships.

People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability.

People were supported to develop their independence whilst living in their own homes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 06 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

Enforcement

We have identified breaches in relation to and systems not being effective.

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.

Archangel Home care – Staffordshire Branch provides personal care and support for people in their own homes. At the time of our inspection 75 people were receiving personal care and support.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People felt safe with the support offered from staff. Staff understood their responsibilities to protect them from avoidable harm and abuse. Risks to people’s health and well-being were assessed which gave staff guidance about how to support people to reduce the likelihood of harm. Where an accident or incident did occur, the registered manager took action to prevent reoccurrences wherever possible. The provider had plans in place to support people to remain safe during emergencies such as a shortage of staff.

People and their relatives were satisfied with the number of staff available to offer them care and support. The number of staff the provider employed was enough to provide the care that was planned for each person. Prospective staff were checked before they worked for the provider for their suitability.

Where people required support to take their prescribed medicines, this was undertaken in a safe way by staff who had received guidance. Staff knew their responsibilities when handling people’s medicines including what to do should a mistake occur.

Some staff felt that improvements could be made to the training offered to them so that they could practice the skills they required. The provider told us they would make improvements to offer staff training that was undertaken by a trainer rather than on a computer. The registered manager told us they would make improvements to the records of the induction staff received as these were not in place.

People’s food and drink was monitored where this was required to make sure they had enough. People received support to monitor their health where this was required.

The provider followed the requirements of the Mental Capacity Act 2005. Staff understood their responsibilities under the Act including what might constitute restrictions to people’s freedom. People were asked for their consent when care and support was offered.

People received support from staff who were kind and offered compassionate care. Their privacy and dignity was protected when receiving care and support. People’s privacy was not always protected as their care records were not always stored carefully. The registered manager took action on the day of our visit to improve this.

Staff knew the people they offered care and support to as people’s care plans contained information on their life histories which staff could describe. People were supported to be as independent as they wanted to be. For example, staff encouraged people to do tasks with them where this was important to them.

People were involved and contributed to the planning and review of their support so that this was centred on them as individuals. People had care plans that contained information for staff to follow on their likes, dislikes and routines that were important to them.

People were mainly satisfied with the regularity and punctuality of the staff that offered them care and support. The provider was improving on the punctuality of care calls people received and was working with the local authority to make sure that this occurred.

People and their relatives knew how to make a complaint. This was because the provider had a complaints procedure in place which was included in a service user’s guide that had been given to people when they started to use the service. The provider took action when a complaint had been made.

People, their relatives and staff had opportunities to give feedback to the provider about the quality of the service. Staff felt supported and received good support from the registered manager.

Staff knew their responsibilities when offering people care and support. For example, they knew to report their concerns should they have needed to about poor working practices of their colleagues. The provider had aims and objectives for the service that were known by staff. These included supporting people to remain independent.

The registered manager was aware of their registration responsibilities including notifying CQC of significant incidents that occurred. The provider checked the quality of the service. For example, checks of people’s care records took place to make sure they contained the information that staff required to offer good quality care and support to people. The provider took action where improvements were required.

Most people told us they were satisfied with the care they received. People were more satisfied when they had regular care workers. They told us that regular care staff provided the care they wanted. Comments included: "On the whole good" and "I have four visits a day and nothing is too much trouble".

Assessments of people's needs were completed and a plan of care was available to staff. This made sure that care workers had the information to provide appropriate care.

Records of care generally showed that people received the care as it was outlined in their plan of care. There were a few gaps in some medication and food charts. This meant that the provider could not be sure appropriate care had always been provided.

People did not always receive their care at the time agreed when their care was planned. Times of care were changed and this was not always reflected in the rosters. This meant that care may not be provided at the time the person expected and could affect adversely their wellbeing.

We found and people told us that their care and welfare needs were being met. One person said: 'Carers are very reliable, a good group of staff'.

We saw records that confirmed staff knew what constituted abuse and what to do if they suspected abuse had taken place.

We found the service followed the correct procedures when recruiting new staff and they were supported to fulfil their role effectively.

We saw that the service had implemented quality monitoring systems but not all systems were effective in maintaining the service delivery.