Little Angels Home Care Services

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During this assessment we looked at all 8 quality statements in the key question of safe. Recruitment checks were not being safely completed because references were not always sought before commencement of employment and gaps in employment were not explored. This was a breach of Regulation 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was lack of evidence of staff completing required training to complete their jobs safely, in particular moving and handling and having their competency to administer medication assessed. This was a breach of Regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found concerns with medicines records. Risks to people’s care were well managed but improvements were needed in documenting these. Staff arrived on time and stayed for the required duration of the care calls.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt safe and well supported.

Leaders were not able to evidence how accidents and incidents were reviewed and learning taken from these. However, staff knew people well and how to support people in case of accident.

Accidents and incidents were not being recorded, however in our review of the evidence available, we were assured staff knew how to support people if an incident happened.

People and relatives felt well supported at the start of their care package and told us other professionals were involved in their care, when required.

The nominated individual and manager were in contact with relevant healthcare professionals and partners to ensure people's needs were met.

Stakeholders did not share concerns about the service.

The service worked well with relevant healthcare professionals and partners to ensure people's needs were met. This included completing initial assessments before start of a care package and liaising with relevant healthcare professionals.

People and relatives told us they felt safe with the care provided. Their comments included, "I have never felt unsafe with any of the carers, they are all very competent at all they do" and "100% good care by everyone who comes to look after me."

Staff demonstrated a good knowledge of the safeguarding procedures and who to inform if they had any concerns. Staff knew how to report abuse. Their comments included, " I would make a note on my notes, let my manager know these are my concerns." The nominated individual and manager were clear on their responsibilities and duties to identify and report any safeguarding concerns, however the required statutory notifications to CQC had not always been submitted.

There were policies and procedures in place covering safeguarding adults and whistleblowing concerns. These were being followed. However, we found examples where the provider identified safeguarding concerns with medicines management, appropriately reported these to the local authority safeguarding team, however did not submit a statutory notification to CQC. We asked the nominated individual to submit this without delay. We did not see evidence that all staff had received safeguarding training before our inspection visit. After our visit, we discussed with the management team how they were ensuring all staff had their training up to date. The management team also told us staff who worked at the service were experienced staff who had worked in care before and knew their responsibilities under safeguarding. In our conversations with staff we confirmed this.

People and relatives told us risks to people's care were well managed. Comments included, "[Person] uses a hoist, and the carers have all been trained on how to move him safely, [name of nominated individual] came and watched the staff" and "[Person] has had a pressure ulcer for a long time now but since [name of nominated individual] and her team took over it has finally started to heal; this is because [person] is getting good care”.

Staff told us how they managed risks to people's care, such as managing risk of falls or how they safely supported people with their equipment. Comments from staff included, "We make sure [people] are using their safety alarms, to prevent falls." In our conversations with the nominated individual and manager, they were able to describe to us the main risks linked to people's care and how these were managed. However, during this inspection, we found examples of risk assessments not being detailed. There was also no documentary evidence that all staff had received face to face training in moving and handling and was competent to administer medication. There was a lack of evidence that the management team were recording accidents and incidents and analysing these to prevent reoccurrence.

During this inspection, we found risk assessments were not always detailed. For example, one person required support with moving by an electric hoist. This person's moving and handling risk assessment did not detail which sling loops to be used. In our conversations with the nominated individual and staff, we were reassured that staff knew how to safely support this person in line with their requirements. However, risk assessments need to be detailed and person centred to ensure these guide staff consistently.

People and relative told us staff kept a safe environment.

Staff acted on risks in the environment and protected people from risks of infections.

There were policies and procedures in place to control and prevent the spread of infections. These were being followed. People and relatives did not share concerns in this area. Environmental risk assessments were completed at the beginning of the care being provided to ensure any risks were identified and managed well.

People told us staff arrived on time and stayed for the full duration of the calls. Comments included, "The carers have plenty of time to do what they have to for me;" "The carers have never let me down, whatever the weather the carers come and they have never been late" and "Because [person] has to leave early in a morning for [day activities] the carers come early about 6am and this has never been a problem to Little Angels."

In our review of documentation and conversations with managers, we found staff were not safely recruited and there was a lack of evidence that staff had received the required training to do their jobs safely. We found breaches in regulations in these areas.

There was a lack of evidence that staff had received all the required training. We found a lack of evidence that all staff had been through a face to face training session in how to carry out safe moving and handling of people. The nominated individual told us one of their staff members was certified to train other staff in moving and handling procedures and they had trained all staff, however the nominated individual was not able to provide documentary evidence of this for all staff. No concerns were shared by people, relatives or stakeholders in relation to moving and handling or any other areas of staff's training. There was a lack of documentary evidence that staff had been provided with regular supervision and spot checks. Not all staff who were administering medication had completed a medication competency assessment. We feed this back to the provider and after our inspection, the nominated individual sent us a list showing most of the staff had received a medication competency assessment. No concerns were raised by people, relatives or stakeholders in relation to medication. This shows there was a lack of documentary evidence that staff had been provided with the appropriate training and support to carry on their jobs safely. This constitutes a breach in regulation 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Recruitment was not always managed safely. There was a recruitment policy in place but we found this was not always being followed. Job applications were not always completed, references not sought before commencement of employment and gaps in employment not explored. This show safe employment checks were not always completed. This constitutes a breach in regulation 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had an electronic monitoring system in place to ensure staff arrived on time for the care calls and stayed for the allocated duration of the care visit.

People and relative told us staff kept a safe environment.

Staff acted on risks in the environment and protected people from risks of infections.

There were policies and procedures in place to control and prevent the spread of infections. These were being followed.

People told us their medication was safely managed. Comments included, "My tablets are boxed weekly, so the carers always check I have had them and if I have forgotten they make sure I do take them."

During this inspection we found medication was not always managed safely. We found concerns with medicine records and a lack of evidence of staff receiving their medication competency assessments. We did not find these issues had a negative impact on people receiving services, but it showed a lack of robust governance and management systems in relation to medicines management.

Medication was not always safely managed. There was a medication policy in place but we found examples of this not being followed. We found gaps in medicine administration records; these had not been identified or investigated before our inspection. We asked the provider to investigate, and they confirmed medication had been administered and gaps were recording issues. Staff had not received a medication competency assessment. People's allergy status was not recorded. This showed the medicine records were not always complete and forms part of the breach in regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.