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From Requires Improvement to Outstanding – How did Guardian Angels step up their game?


James Taylor

Health & Social Care Expert

Guardian Angels Carers have an inspirational story to tell. In 2015 they received an overall rating of ‘Requires Improvement’ from the CQC, despite being rated ‘Good’ in the categories; Caring, Responsive and Well-led.

Now, a little over two years later, they have received an overall ‘Outstanding’ rating from the CQC. It has been an improvement across the board; in those categories where they were previously rated ‘Requires Improvement’ they are now rated ‘Good’. In those categories where they were rated ‘Good’ they are now ‘Outstanding’.

Their inspection report from 2015 shows that Guardian Angels always had good foundations in place. For example, they had a strong caring culture, as the inspector reported: “People who used the service felt that they were treated with kindness and said their privacy and dignity was always respected.” Staff were found to be “motivated and proud of their service.”

So what was lacking in 2015? And what are Guardian Angels doing so well now?

In 2015

The CQC’s biggest area of concern was the recording of medications: “Medicines were not managed safely. The records in place did not demonstrate that people had received their medicines as prescribed. There were gaps in the records and some care workers practice had not been observed.”

The inspector noticed discrepancies between different records. Sometimes what was recorded on MAR charts, or was scheduled in care plans did not match up, or did not reflect what actually happened in the real world. This is an all too common issue in care.

“Records that related to medicines management contained either conflicting or insufficient information. This meant that people were at risk of receiving incorrect or inconsistent support with their medicines.”

Action was taken and in 2017:

In response to this Guardian Angels took exactly the right action. They looked for a solution to reduce errors in their MAR charts and other records. They implemented technology to ensure medications were administered and recorded properly. The results of this are clear to see in their 2017 inspection report:

“Electronic Medicine Administration Records (eMAR) had been introduced which care workers completed in line with the contents of peoples assessments and care plans. The new system immediately flagged up if all parts of the eMAR had not been completed before a care worker left a visit.

“This not only helped ensure accurate medicine records, but also helped staff at the office monitor that all medicine needs were being managed safely, because the system alerted them if a task had not been completed.”

CQC Inspection Report, Guardian Angel Carers, Published 15/02/2018


Visit compliance

Back in 2015, there were some issues around visit timing and staffing. The inspector noted that “the majority of people we spoke with said that they had not experienced a missed visit and that visits occurred at the agreed times.”

However, there had been instances where one carer had shown up where there should have been two – for a “double up” visit. The inspector found that “missed calls had occurred due to issues such as incorrect administration and planning and not because of inappropriate staffing levels.”

Since 2015 Guardian Angels have bolstered their visit compliance with the help of The Access Group’s care management software. This proved important during their inspection in 2017:

“The provider had an electronic care planning system which also incorporated a log-in system that care workers activated from a mobile phone when arriving and leaving a visit. The system flagged up if a care worker was late to ensure people received visits as arranged.

“The system was monitored outside of office times by on call staff. Both the registered manager and the provider told us they believed punctuality was an important commitment, and they monitored visit times closely.”

Care compliance


Guardian Angel’s 2015 inspection found that overall care plans were high quality and person centred, although some care plans were missing important details. Now Guardian Angels are using electronic care plans and visit plans. These visit plans are accessible through the Access Mobizio mobile app.

The difference this has made was highlighted in Guardian Angels’ 2017 inspection report:

“One care worker said: ‘The new system gives you all your work in one place and includes care plans, directions to each visit plus lots of other information. It’s great.’

“All the records we looked at were structured and well organised which assisted us to find the information required efficiently. This made information easy to find and would assist care workers if they were required to find information quickly.

“People who used the service and (with the person’s consent) their relatives could log into their own electronic records using a secure password if they wished or could have paper copies if this was their preferred choice.

“The care planning system included key activities that care workers must complete before they leave people’s homes. This had helped ensure certain domestic tasks were completed and reduced complaints in this area.”


One area where Guardian Angels have always been strong is in the responsiveness of their service. Their 2015 inspection records that “changes in people’s needs were quickly recognised and prompt actions were taken, including the involvement of external professionals where necessary.”

They have been able to use software to build upon this. Here is just one example of what the CQC inspector reported in 2017:

“The care planning software allowed information to be shared with people, care workers and the office staff in real time. As a result, the agency was able to respond more rapidly to changes in people’s needs, and where relevant swiftly communicate to multi-disciplinary teams.

“For example, when one person’s health had been deteriorating the agency was able to respond effectively and communicate with other agencies to get additional support for the person promptly and without delay. Therefore, technology helped meet changes in people’s individual needs and to ensure that care workers had the correct information they needed to carry out their roles.”

The right tools in the right hands

Of course Guardian Angels’ ascent to Outstanding has not been due to technology alone. They have reasserted the caring values they already had. This is reflected in the conduct of carers, as the inspector notes “The agency had also received an abundance of compliments about the kind and compassionate approach of staff”.

The organisation as a whole has consistently gone above and beyond the mere requirements of care packages. They have also improved the rigour of staff training and procedures, especially in regard to medication.

That being said, technology has clearly made a profound difference. The best tools in the hands of the best people will certainly produce the best outcomes. The feedback of people using their services, of care staff and of the CQC, all show that Guardian Angels are an exemplar of this maxim.



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