About the service:

• Angel Care Solutions (UK) Ltd is a domiciliary care agency that provides personal care to people in their own homes. At the time of our inspection the service was delivering support to eight people.

• The service supports people with a range of needs including physical and mental health needs.

People’s experience of using this service:

• The quality of care people received had significantly deteriorated since the last inspection.

• People were not safe as the provider had recruited and deployed unsafe and unsuitable staff to deliver care and support in people’s homes.

• People who presented with behavioural support needs were not protected from avoidable harm because risk assessments were inadequate and did not provide staff with the guidance they required.

• People’s medicines were poorly managed. Audits were not carried out of one person’s medicines and the medicines administration records for another person contained unexplained gaps.

• Staff were not adequately trained and staff training records were inaccurate.

• The service was poorly managed. Weak systems and inadequate management meant the provider failed to identify and act upon the shortfalls we found.

• Notwithstanding our findings, people were positive in their comments about the service they received.

• The service met the characteristics of ‘inadequate’ in two of the key areas we inspected and therefore ‘inadequate’ overall.

• We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around people’s safety, staffing and the management of the service. You can see what action we told the provider to take at the back of the full version of this report.

Rating at last inspection:

• The service received an overall rating of ‘requires improvement’ at our last inspection which was published on 12 March 2018.

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Enforcement:

In respect of this inspection full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

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

This inspection took place on 24 January 2018. The last inspection of this service was carried out on 10 and 17 February 2016. At that inspection the service was meeting the regulations we looked at and was rated Good overall and in all five key questions. At this inspection we found the service Requires Improvement within the domains of effective and well-led and as a result has received an overall rating of Requires Improvement.

Angel Solutions Limited is a domiciliary care service which is registered to provide personal care to adults in their own home. At the time of our inspection there were seven people receiving personal care from the service. An additional number of people received services from the provider including support with housework and companionship. The Care Quality Commission does not regulate these activities.

The service had 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’s needs were not always assessed adequately or recorded appropriately. Staff were not in receipt of a programme of training to keep their skills and knowledge up to date. Staff did not always receive supervision in line with the provider’s policy and none of the staff had received an appraisal.

There was a lack of good governance at Angel Solutions (UK) Ltd. Quality assurance processes failed to detect and remedy poor quality needs assessments, low training levels and infrequent supervision. However, the new manager operated an open culture and people and staff were positive in their comments about him. The provider collaborated with other services and kept the CQC informed of significant developments.

People receiving a service from Angel Solutions (UK) Ltd told us they felt safe. Staff knew people well and how to mitigate presenting risks. The provider had assured itself that staff were safe and suitable to work with people and that there were enough staff to deliver care and support as planned. Staff followed the appropriate hygiene practices when supporting people with their personal care and people received their medicines as prescribed.

Staff supported people to access healthcare services and where required to meet with healthcare professionals. People’s nutritional and hydration needs were met by staff and people gave consent to the care they received.

People considered the staff who supported them to be caring and kind. The provider ensured that people were supported by the same staff and this consistency resulted in positive relationships developing. Staff promoted people’s dignity, maintained their privacy and encouraged people to continue to be independent.

During this inspection we found breaches relating to staffing and good governance. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 10 and 17 February 2016 and our first visit was unannounced. At our last inspection in September 2014 the provider met the regulations we inspected.

Angel Solutions (UK) Ltd provides domiciliary care to people living in their own homes. The agency was providing the regulated activity of personal care to six people at the time of this inspection.

The agency had a registered manager who was also the registered provider. 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 using the service told us that care staff spoke to them politely and treated them with dignity and respect. They were positive about the care and support being provided to them.

Staff felt supported to carry out their roles effectively and were in regular contact with the registered manager. They received training relevant to the care and support they provided.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 (MCA). Staff were aware of the need to obtain people’s consent prior to them providing any care and support.

There was a system for dealing with concerns and complaints. People felt comfortable in speaking to the registered manager if they had any issues.

Effective systems were in place to assess and monitor the quality of the service. These included obtaining the views of people who used the service and monitoring the quality of service provided through spot checks, surveys and telephone contact.