Angel carers is a domiciliary care service registered to provide personal care to people in their own homes. .

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.

The service provided domiciliary care ranging from housekeeping to daily / nightly help with personal care or live-in care. At the time of inspection the service was being delivered to around 50 people, all of whom were older people. We visited three people in their homes and spoke to one relative. We spoke to the manager and staff.

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'.

Summary

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.”