Angel Carers (UK) Limited

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

The provider had systems in place to keep people safe from abuse and avoidable harm. Everyone we spoke with said they felt safe using the service. Comments included, “I am very happy with the carers, they are lovely” and “The carers are very good. I am very safe in their care”.

Risks to people’s health, safety and well-being were assessed, and measures were in place to reduce the risks. People’s medicines were safely managed. Staff were deployed effectively to ensure people received the care and support they required. People said the service was flexible to meet their needs. Recruitment procedures in place helped to ensure only staff suitable were employed.

Infection prevention and control policies kept people safe and had been updated to reflect the latest guidance for the COVID-19 pandemic. Comments included, “I feel safe. They are well trained and observe all COVID regulations”.

People and their relatives contributed to the initial assessment process to ensure needs, preferences and expectations could be met. People were supported to manage their health and medical conditions. People’s records contained information for staff to help them work safely and effectively with people.

The provider's induction procedures, ongoing training and spot checks ensured staff had the skills and competencies to carry out their role effectively.

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.

Everyone we contacted spoke highly of staff, describing them as respectful, caring and friendly. Comments included, “The carers are lovely, treat me well, kind and respectful. They are very jolly, and we chat about all sorts of things. I am quite deaf, and they are very patient, making sure I understand”. People received support, wherever possible, from the same staff who knew them well so the care they received was consistent.

People told us staff had time to socialise and chat with them. Comments included, “They (staff) chat with me about my interests. In fact, we swap recipes as we are both interested in cooking. They have helped me access my laptop”.

The provider had a complaints procedure in place and people told us they knew how to raise a complaint or concern. People said when they had any issues, these had been swiftly resolved by the registered manager and staff. However, one relative felt improvements could be made in this area.

People had been given the opportunity to discuss their wishes in relation to end of life care and their preferences and advanced decisions had been recorded, where appropriate for the person.

The service had an experienced registered manager, who was also a director of the company. There was a clear management structure and accountability within the service. An experienced senior management team supported the provider and registered manager. There were systems in place to monitor and assess the service provided, which helped the provider and registered manager to identify and address any shortfalls.

People had regular opportunities to feedback their experience of the service. For example, through care reviews, regular phone calls from the senior management team; spot check visits and satisfaction surveys. People and they relatives confirmed there was good communication with the service.

The provider and senior management team worked in partnership with other health and social care professionals, such as GPs, nurses and social workers, to ensure people's health and wellbeing was maintained.

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

Rating at last inspection (and update) The last rating for this service was good (published 19 December 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Angel Carers is a domiciliary care service registered to provide personal care to people in their own homes. The service provided domiciliary care and 24-hour live-in care. At the time of the inspection the service was supporting 43 people with the regulated activity of personal care. People receiving support from the service were adults or older people. Some people were living with dementia. Not everyone who used the service received personal care. The 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

People were positive about the service they received. People, their relatives and professionals expressed their complete trust and confidence in the staff and the management team. Comments included, “Staff really care and make such a difference”; “I couldn't find anything better; they are excellent. I couldn’t manage without them now” and “We have been blown away by Angel Carers and how they have handled everything. They are part of our family now…”

The service was caring. People received support from committed and compassionate staff. A strong caring ethos was promoted by the management team and company directors, which ensured the staff team kept people at the heart of the service. The management team and staff had created caring and meaningful relationships with people, which resulted in positive outcomes for them. Staff were proactive in promoting people’s independence and we heard from several people how their general condition had improved with the help and support from staff. One relative said, “We have been blessed with the staff; it makes a significant difference. They enabled (the person) with her rehabilitation and promote her independence. What they do with (the person) is phenomenal”.

People received care and support that was personalised to meet their individual needs. People and their relatives were at the centre of planning their care and support. The management team carefully matched people’s needs, preferences and interests to care staff to ensure the best possible care and support was delivered. One person said, “I would give them 100%. We were in a very difficult situation and the whole process has been amazing. They have gone above and beyond”. There was a strong focus on promoting social inclusion and enabling people to lead active lives. People were supported to access the local community and take part in their hobbies and preferred activities.

People who used the service, and their relatives, described a service they could rely on. They confirmed visits were not missed and staff arrived when expected. They said the service was safe. There were sufficient staff employed to ensure all planned visits were undertaken.

People were safe and protected from avoidable harm. Staff knew how to identify and report any concerns relating to the risk of abuse. Risks to people’s health, safety and well-being were assessed, and measures were in place to reduce the risks. People’s medicines were managed safely. People were supported by staff who had been safely recruited.

Staff had received appropriate training and had their competency assessed to help ensure they were sufficiently skilled and knowledgeable.

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.

The management team was especially effective when working with other professionals to ensure the best possible outcomes for people. Professionals held the service in high esteem. Comments included, “I work with different care agencies in Dorset. They are the best; without reservation I say that” and “This is the type of service we want to encourage”.

A complaints procedure was in place, which people confirmed they were aware of. People’s concerns and complaints were listened to, addressed in a timely manner and resolved quickly.

People said the service was very well managed. There were effective systems in place to monitor the safety and quality of the service. Regular feedback about the quality of the service people received had been sought. Where improvements had been identified there were on-going plans for improving people’s experience of the service. The management team continually looked for ways to

Improve the service.

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. Report published on 14 February 2017

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

There was no 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. We spoke with the directors of the service during the inspection and an application to register a manager was started before the end of the inspection.

There were systems in place to record people’s needs, risks and the how they should be supported. Their records were kept under review but when a review was recorded it did not consistently mean that the care and support plans were updated. However when we spoke with staff they were able to tell us how people’s needs were being met; this reflected the reviews that had been carried out. We pointed this out to the providers who took immediate action to review these records and make any necessary amendments.

Staff understood the importance of people consenting to the care they provided and encouraged choice making. They understood the importance of enabling people to make their own decisions wherever possible and seeking the involvement of appropriate people when making decisions to provide care in a person’s best interests if they were not able to give consent themselves.

People receiving support felt safe and well cared for. They were protected from harm because staff understood the risks they faced and how to reduce these risks. They also knew how to identify and respond to abuse.

Staff were consistent in their knowledge of the peoples s needs and spoke with confidence about the care they provided to meet these needs. Care and treatment was delivered in a way that met the people’s needs and promoted their independence and dignity.

There were enough safely recruited staff to ensure the care could be provided. Staff told us told us they felt supported in their roles and had received training that provided them with the necessary knowledge and skills to do their job effectively.

Staff were vigilant of peoples health care needs and ensured they had access to health care professionals to maintain their health. Staff understood the need to share information about changes in people’s health.

There were systems in place to monitor the quality of the service and people were encouraged to contribute to the management of the service.

Our inspection set out to answer five questions: is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. It is based on our observations during the inspection, discussions with people living in their own homes, and with the staff supporting them, and on looking at records.

Is the service safe?

People, and their relatives, told us they felt safe. A relative said that staff were 'utterly professional. I completely trust them.'

Staff treated people with respect. Safeguarding procedures were robust, and staff knew how to recognise abuse. Recruitment practice was safe, and staff were not employed until all necessary checks of their qualifications, experience and character were complete. Systems were in place to make sure that the registered manager and staff learnt from incidents and investigations.

Is the service effective?

The service provided care in people's own homes in line with their wishes and personal circumstances. This included support with personal care, cooking and other domestic chores, and full-time live-in care.

People's health and care needs were assessed with them and they were involved in deciding the type of support they needed. One person told us, 'I'm delighted. It all works extremely well.' People told us that the care they received enabled them to stay as independent as possible and to live in their own homes. One person explained how important their independence was to them. They said that they did as much as they could for themselves, and that staff were 'so nice' about helping them in the best way.

Is the service caring?

People were supported by kind and caring staff. The people we talked with spoke highly about their care workers. One person told us, 'If I ask anything of [the staff], nine times out of ten they can help me, and if they can't they'll do as much as they can'. Another person said, 'I am looked after exceptionally well."

Care plans emphasised the importance of treating people in a caring way, in line with their particular preferences. One of the plans we looked at noted that the person took time to complete personal care. It stated, 'Care workers should not make X feel rushed'.

Is the service responsive?

The service responded to people's changing needs. It varied the amount and type of care that was required to keep them safe and well. Relatives described how this happened. One said, 'They match their resources to [my relative's] changing needs, increasing the number of visits and carers as his condition has changed'.

Relatives told us that the service was very good at keeping them informed about changes. A relative told us, 'It's such a relief for us to know that if there is a problem they will contact us'.

Care plans monitored people's needs, and were updated regularly. The service worked closely with external agencies to obtain specialist support and assessment. Risks were identified and monitored to reduce the risk of accidents.

People knew how to make a complaint, and all complaints were fully investigated.

Is the service well-led?

The service had a system of regular quality assurance that showed that care was of a high standard, and where it could be improved. The provider conducted annual satisfaction surveys. The most recent survey showed very high levels of satisfaction with the quality of care.

The registered manager also communicated directly with people receiving care on a regular basis. People told us they would always contact the provider's office if they had a question. They said that it was a system that worked well.

Staff were clear about their responsibilities. They felt well supported by the provider and the registered manager. They told us that senior staff at the provider's office base responded to concerns without delay. One staff member said, 'They are incredibly quick to take action.'

We found evidence that the service made sure it met the needs of individuals safely and effectively and that it was person centred.

One person we spoke with told us ' I get to know them (the carers) and they get to know me, I'm looked after extremely well. If I want something I've only got to mention it and they'll do it'.

We saw that there was a system in place for supervision and appraisal. One member of staff we spoke with told us ' I'm very happy to be their employee; the staff are very easy to talk to - friendly and professional.'

We found staff knew how to identify abuse and that people and staff knew who to contact if they were concerned.

One person told us ' they look after me exceptionally well and I get hot meals. I feel 100 per cent safe with them.'

Another person we spoke with told us ' they always make sure I am washed properly, they do it really well'.

A relative told us 'there's always somebody there. They're quite good at keeping us informed'.

A member of staff we spoke with told us ' it's all about keeping people independent, the client tells me what to do - I always let the client do the leading'.

People's individual needs, risks and preferences were recorded and care was delivered in line with their needs. One person said the care provided was 'absolutely superb' and another said 'They (the staff) really are very good.'

People were protected from harm as there were appropriate safeguarding procedures, and there were effective pre-employment checks and recruitment procedures for staff.

The service had effective systems to monitor the quality of service provided.