Angila Care Ltd improved from Inadequate to Requires Improvement following a focused inspection of Safe and Well-led domains, exiting Special Measures, but remained in breach of Regulations 17 and 19 due to ineffective governance oversight and unsafe recruitment practices. Significant strengths were noted in medicines management, risk assessment, safeguarding, infection control, and a positive caring culture reported by people and staff.
Concerns (4)
criticalGovernance — “Systems had not been established to assess, monitor and improve the safety and quality of the service. This was a continued breach of regulation 17(1)”
criticalStaff competency — “Robust recruitment checks were not in place. We found gaps in staff employment histories had not been explored and dates on references were not always consistent”
moderateRecord keeping — “We were assured some checks were in place of care records but they were informal and required more detail.”
minorIncident learning — “The registered manager maintained a log of any falls but there was no system to maintain an overview of accidents and incidents.”
Strengths
· Medicines were managed safely; people received medication as prescribed and on time with competency assessments in place for staff.
· People and relatives reported consistent call times and said staff were kind, caring, and went above and beyond.
· Risks to people's health and safety were clearly monitored and assessed, with detailed individualised risk assessments.
· People felt safe and safeguarding was a standing agenda item in supervisions and team meetings.
· Effective infection prevention and control measures were in place with staff trained and equipped with PPE.
Quality-Statement breakdown (9)
safe: RecruitmentRequires improvement
safe: StaffingGood
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people, promoting a positive person-centred cultureGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
Angila Care Ltd was rated Inadequate overall following a focused inspection of Safe and Well-led, with multiple regulatory breaches covering medicines management, safeguarding, staffing, recruitment, and governance. The service was placed in special measures due to widespread and significant failures that had persisted since the previous requires improvement rating in 2019.
Concerns (10)
criticalMedication management — “Medicine administration records (MARs) indicated medicines had not been given on numerous occasions, with no reasons recorded for the omissions.”
criticalSafeguarding — “The provider failed to identify, investigate and report safeguarding concerns to CQC or the local authority. The deputy manager confirmed there were no safeguarding records.”
criticalMissed or late visits — “[Staff] don't often stay the full time. About 10 minutes instead of 30 minutes. That is regular”
criticalCare planning — “Care records were not accurate, did not reflect people's needs and were not clear about what care was to be provided on each call.”
criticalRecord keeping — “There were no accident or incident reports. However, daily records showed accidents and incidents had occurred.”
criticalGovernance — “There were no effective quality assurance systems in place. Some medicines audits had been completed, however, these were incomplete or undated or unsigned.”
criticalLeadership — “The registered manager resigned with immediate effect the day before the inspection. The registered manager had not been in the service on a full-time basis.”
criticalStaffing levels — “Staff were not effectively deployed to meet people's needs. Regulation 18 (1)”
criticalIncident learning — “Significant shortfalls were identified at this inspection with similar concerns to those found at our previous inspection. These issues had not been identified or addressed.”
moderateComplaints handling — “People and their relatives told us they had raised complaints and said these had been dealt with. However, the provider confirmed there were no complaint records.”
Strengths
· Staff described as polite, lovely and friendly by people and relatives
· Staff said they enjoyed their jobs and felt supported by the office staff
· Staff had received infection control training and were provided with adequate PPE supplies
· Care records showed the service worked in partnership with health and social care professionals
· Six satisfaction surveys completed in September 2022 all expressed satisfaction with the service
safe:Insufficient evidence to rateeffective:Insufficient evidence to ratecaring:Insufficient evidence to rateresponsive:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This was the first inspection of Angila Care Ltd t/a Fisher Healthcare since registration in July 2017; with only one person receiving care, insufficient evidence was available to award quality ratings across all five key questions. Key concerns noted were the absence of a registered manager and limited quality assurance auditing activity.
Concerns (2)
moderateGovernance — “The provider was not completing any of their own audits...audit information was limited.”
moderateLeadership — “There was no registered manager in post. A manager had been recruited and was in the early stages of registering with the Care Quality Commission.”
Strengths
· Safe recruitment procedures in place including DBS checks, application forms, and interviews
· Staff had received appropriate training including safeguarding, infection control, and the Care Certificate
· Care plans in place reflecting individual needs, preferences, and communication requirements
· Person's relative reported staff were respectful, kind and caring and they were very happy with the service
· Provider understood Mental Capacity Act responsibilities and Deprivation of Liberty Safeguards
Angila Care Ltd was rated Requires Improvement overall following inspections in May–July 2019, with breaches of Regulation 12 (safe medicines management) and Regulation 17 (good governance) identified. While staff were caring and people's outcomes were generally positive, unsafe medication practices, absent end-of-life care planning, unlogged complaints, and insufficiently robust audit systems posed ongoing risks to people.
Concerns (9)
criticalMedication management — “Some medicines had been given more frequently than prescribed and some medicines had been given less frequently than prescribed.”
criticalMedication management — “Care staff confirmed no medicines care plans were in place to inform staff what medicines were for or guidance about when any 'as required' medicines may need to be given.”
criticalGovernance — “As there were no robust auditing systems in place the provider was not identifying and rectifying short falls in the service.”
criticalRecord keeping — “Medicine records had not always been completed correctly to show medicines had been given or a reason entered if they had not been given.”
moderateComplaints handling — “Concerns people were raising were not being routinely logged or responded to.”
moderateEnd-of-life care — “There were no end of life care plans in place or any evidence of people's preferences and choices in relation to end of life care had been explored with them.”
moderateConsent / capacity — “The registered manager and quality manager were unsure if any relatives or representatives had Lasting Power of Attorney (LPA) for property and finance or health and welfare.”
minorCare planning — “Care workers knew people well and how they liked their care and support to be delivered. This level of detail had not always been recorded in their care plan.”
minorMissed or late visits — “People we spoke with told us care workers did not always arrive at the time they expected.”
Strengths
· Staff were kind and caring; people were treated with dignity and respect and involved in decisions about their care.
· Staff received training in areas such as first aid, dementia and moving and handling, and had competency assessments.
· People were supported to maintain independence, with one person no longer needing a domiciliary care service.
· Staff liaised effectively with health professionals including district nurses, GPs and occupational therapists.
· The registered manager took immediate action following the first day of inspection to address medicines management issues.
Quality-Statement breakdown (24)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choicesGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enoughGood
effective: Staff working with other agencies; supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving careGood