About the service: Angelcare uk is a family run domiciliary care service, who were providing personal care to 105 people at the time of our inspection.

People’s experience of using this service:

People told us they felt safe They said staff were good. Relatives told us they thought staff were friendly and caring. However, people and their relatives said they had received late calls and staff did not always stay for the allocated time. We discussed this with the registered manager.

We found medication records were unclear.

The care plans included risk assessments, which identified any risks associated with people’s care and had been devised to help minimise and monitor the risks without placing undue restrictions on people. However, there was little information about people’s likes, dislikes and life histories. End of life information was not always discussed or thought of during the care planning process.

People spoke fondly of the registered manager. There were not always effective systems in place to monitor and improve the quality of the service provided. The registered manager was working on these areas.

There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. Support workers had a clear understanding of safeguarding people and they knew how to act appropriately to safeguard people from abuse.

There was a programme of training, supervision and appraisal for staff to support people using the service with their assessed needs.

People were encouraged to make decisions about their activities and meals.

There was a clear complaints process in place and copies of this were available in people’s homes.

Rating at last inspection: Good (published 16 September 2016). The rating at this inspection has gone down to Requires Improvement.

Why we inspected: This was a planned inspection based on the rating awarded at the last inspection.

Follow up: We will continue to monitor this service. We plan to compete a further inspection in line with our re-inspection schedule for those services rated requires improvement.

We made recommendations to the service.

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

We inspected Angelcare UK Limited on 9, 10, 12 and 15 August 2016. The provider was given 48 hours’ notice of our intention to inspect the service. This is in line with our current methodology for inspecting domiciliary care agencies to make sure the registered manager can be available.

The last full inspection took place on 5 March 2014, when we found the service was meeting the regulations we looked at.

There was 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.

Angelcare UK Limited is a domiciliary care agency which provides care services to people in their own homes. On the day of our visit 82 people were receiving a personal care service. The agency can provide a service to adults, older people, people living with dementia, people with physical disabilities, learning disabilities and people living with mental health issues.

Staff recruitment processes were through with appropriate checks being undertaken prior to staff working at the service. These included obtaining references from the person’s previous employer as well as checks to show staff were safe to work in the care sector. Staff recruitment was on-going to make sure there were enough staff to provide people with care and support.

Staff received induction and on-going training to make sure they had the right skills and knowledge to provide people with care in their own homes. The registered manager acknowledged more ‘spot checks’ needed to be made to make sure staff were applying their training to their practice.

People who used the services and relatives told us staff were kind and helpful.

Safeguarding procedures were in place and staff understood how to report any concerns in order to keep people safe in their own homes.

The care plans we looked at were detailed and staff we spoke with were able to describe how individual people preferred their care and support delivered and the importance of treating people with respect in their own homes. Where any risks to people were identified we saw action had been taken to mitigate those risks to keep people safe.

Medicines management systems were in place to ensure people received their medicines at the right times. When necessary staff involved district nurses, GPs or the emergency services to make sure people’s health care needs were met. Care plans were in place for people who needed support with meals to make sure they were having enough to eat and drink.

People had information about how to make a complaint and we saw complaints had been dealt with by the registered manager.

We found there were some effective auditing systems in place. However, the registered manager recognised more work needed to be done on the scheduling and monitoring of calls to ensure people were receiving a reliable and consistent service.

People were asked for their views every annually through satisfaction surveys and from telephone contact. Where people had raised issues the registered manager had responded to them individually.

We received information of concern about calls to people using the service being missed, staff not being checked properly before they started work and staff not being properly trained.

We visited the service to look at these issues and found no evidence to support those claims.

We spoke with four people using the service, three relatives and four members of staff. These were some of the things they told us:

“Generally they (care workers) are very good and know what they are doing.”

”They are pretty fair and seem nice enough.”

“Some staff are better than others and we would like regular staff rather than different ones all the time.”

“It’s a good company to work for. My training is kept up to date.”

We found that people had received calls as scheduled, staff had been properly checked before they stated work and had received appropriate training.

We spoke with three people who were using the service, nine relatives and six members of staff. These were some of the things they told us:

“The staff are kind and helpful and know what they are doing.”

“I am very satisfied with the service I get. I have regular carers that all know what they are doing.”

“The agency have been superb and I have peace of mind that my relative is being cared for.”

“The staff are very good and are always polite and courteous.”

“When I have had any issues I have contacted the office and things have been sorted out quickly.”

“My relative gets on very well with the staff and finds them very considerate.”

People were fully involved in designing and reviewing their care packages.

There were systems in place to make sure that people were kept safe and procedures for reporting any suspected abuse.

Before stating work staff were being properly checked to make sure they were suitable and safe to work with vulnerable people.

Our conversations with people and staff indicated staff were well trained and felt supported in their role.

There was a complaints procedure in place and people told us they would feel able to raise any concerns. We saw complaints that had been made had been fully investigated.

During and after our inspection we spoke with the Registered Manager, two people who used the service, two relatives and three care staff.

The three care staff we spoke with told us Angelcare was a good company to work for and they felt confident the service they provided was good. Care staff received appropriate training for their role and told us they felt well-supported by their managers.

Comments from the care staff included: - “I love working there”; “My service users are happy”; “I love what I’m doing”.

People using the service and their relatives were all complimentary about the care provided by the agency. They told us care staff usually arrived on time, stayed for the allocated time and they did not feel rushed when receiving care. They felt safe when the care staff visited them in their homes, and they knew whom to contact if they had any concerns.

They also told us the same care staff usually provided their care and they liked having this continuity. Comments included The staff are kind and courteous”; “We get on well with them all”; “My care on the whole has been really good” and “The staff are more like friends”.

We spoke with three people who use the service and they told us they were happy with the care they receive and staff were very helpful and always explained what they were doing.

The people we spoke with told us they had been involved in a review of the care plans at least once within the last 12 months. They also told us that the care they receive is based on their needs and preferences.

The people we spoke with told us that staff were friendly and that they had no issues or concerns relating to staff.

One person told us that they had an issue in the past where their care was being provided by lots of different carers. They told us that they had a meeting with the Manager and now receive care from a regular carer.