This comprehensive inspection took place on the 11 and 12 December 2018 and was an announced inspection. The last inspection took place on the 28 and 29 November 2017. This is the first time the service has been rated requires improvement.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people with a range of needs, including people living with dementia, people who have particular health conditions and people with physical disabilities. At the time of our inspection 34 people were receiving personal care in their home and their care was paid for through either the council, direct payments or people were paying for their own care.

Not everyone using Angels Care At Home Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.

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.

There were some systems in place to ensure people safely received their medicines. However, due to recording errors and a lack of effective regular medicine administration record audits, we could not be confident that people always received their medicines correctly. Audits had not always been recorded and did not always effectively identify where improvements needed to be made.

This was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation for the provider to consider guidance on completing Mental Capacity Act assessments to ensure people who might struggle making decisions about their care were supported appropriately. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Risk assessments were in place, however some risks were not identified to provide sufficient or accurate information to provide direction for staff, or information about how to reduce risks.

People’s care records gave guidance to staff on how to support people to meet their needs. Attention needed to be paid to ensure they were all person centred and not just focused on the agreed tasks that needed to be carried out.

People were supported to maintain good health. People were supported to meet their nutritional needs.

Staff treated people with kindness and compassion. People and relatives spoke positively about the care staff.

Staff received support and training and understood their responsibilities to identify and report concerns related to harm or abuse.

Staff worked with health and social care professionals in order to meet people’s varied needs.

There were sufficient staff deployed to meet people's needs. The provider had recruitment and selection processes in place, these included completing checks to make sure new staff were safe to work with vulnerable people.

This was an announced inspection which took place on 28 and 29 November 2017.

Angels’ Care at Home is a domiciliary care agency. It provides care to people living in their own houses. Not everyone using the service receives a regulated activity. The Care Quality Commission only inspects the service being received by people provided with personal care, help with tasks related to personal hygiene and eating. The agency provides a service to older adults.

At the last inspection, on 10 February 2016, the service was rated as good in all domains and therefore overall good. At this inspection we found the service was still rated as overall good but rated good in four domains. It requires improvement in the safe domain.

People, staff and visitors were generally protected from harm but care staff did not always follow the medication procedure, complete medicine care plans and record medicine administration as safely as they could. The registered manager did not always check the full work history of care staff applicants. We made recommendations around these areas. People benefitted from adequate staffing because the service did not accept a package of care unless they were able to provide staffing to meet the individual’s needs safely.

Safety was maintained by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. Staff understood how to protect the people in their care and knew what action to take if they identified any concerns. General risks and risks to individuals were identified and appropriate action was taken to reduce them, as far as possible.

There was a registered manager running the service. 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 were supported by staff who were appropriately trained and supported to make sure they could meet people’s varied needs. Care staff were effective in meeting people’s needs as described in plans of care. The service worked closely with health and other professionals to ensure they were able to meet people’s needs, as appropriate.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The service was not depriving anyone of their liberty nor ever had. They were fully aware of the action they would need in the unlikely event this became necessary.

People were supported by a staff team who delivered care with kindness, respect and understanding. They built caring relationships with people to enable them to meet their needs more sensitively. The service and care staff were aware of people’s equality and diversity needs and endeavoured to meet them. People were supported to be as independent as they were able to be by well-informed care staff.

The service was person centred and responsive to individual’s needs. It was flexible and adapted their care packages to meet people’s individualised and specific needs. People’s needs were regularly reviewed to ensure the care provided was up-to-date. Care plans included information to ensure people’s communication needs were understood.

The registered manager and the management team ensured the service was well-led. It was described as open, approachable and supportive. The registered manager and her team were committed to ensuring there was no discrimination relating to staff or people in the service. The quality of care the service provided was assessed, reviewed and improved, as necessary.

Angels Care at home limited is a small domiciliary care agency supporting people in their own homes with a range of individual needs. At the time of our inspection six people were using the service.

The service had a registered manager in place at the time of our inspection. 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 reported feeling safe with the service offered. There were systems in place to protect people from the risk of abuse and potential harm. Staff were aware of their responsibility to report any concerns they had about people’s safety and welfare.

There were enough staff deployed to fully meet people’s health and social care needs. The registered manager had systems in place to ensure safe recruitment practices were followed. However we saw for one person only personal references had been requested and not one from a previous employer. The registered manager has agreed to address this.

People’s relatives spoke positively of the care their loved ones received and praised the staff for their kindness and patience. One person commented “Staff are so nice and helpful” and a relative said “They are living up to their name, they are caring, all I see is care”.

Where challenging behaviour was displayed there was no guidance in the care plans for staff to follow on how to support them through this and alleviate their distress. For people needing assistance with applying prescribed creams there was no protocols in place on how and where to administer this. We have raised this with the registered manager who is going to ensure the information is clear and available to staff.

People’s needs were regularly assessed and reviews held on meeting these needs. Relatives said they were involved in planning their family member’s care and were happy to express their views or raise concerns.

The registered manager did not have a duty of candour policy in place for the service and was not aware of this regulation. We made this a recommendation to the registered manager.

The registered manager had systems in place to monitor the quality of service provided and people, their relatives and staff told us they had confidence in the manager’s leadership skills.