Archived: ABCare

We visited one person in their home, looked at records held there and spoke with the member of staff who was caring for the person. We also spoke briefly with the person's relative. We visited the agency's office where we spoke with the provider and looked at some records.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the following questions:

Is the service safe?

Is the service effective?

Is the service well-led?

Below is a summary of what we found.

Is the service safe?

The service was not always safe.

At our previous inspections we found shortfalls in the way people's medicines were managed that placed people at risk. We served a warning notice in August 2014. At our inspection on 30 September 2014 we found that the requirements of the warning notice had not been met.

At this inspection on 12 March 2015 our pharmacist inspector checked to see whether any improvements had been made. The provider told us that only one person required staff to assist them with their medication. We visited this person at their home. We noted that although some improvements had been made in the recording of medicine administration there were still some concerns.

The provider did not have evidence that staff who were administering medicines had received training and were competent to do so.

We found a number of dates when there had not been enough staff to care for one person safely. This person's care records confirmed that two members of staff were required to assist the person with all movement in and out of bed, in and out of their chair and on and off their commode. We found that there had been days when the person had only been able to get out of bed after lunch as no second care worker had been available in the morning. The person had had to be assisted to bed in the afternoon as no second care worker was available during the evening.

The provider had no evidence available that they had carried out the required checks for new staff. This meant that we could not be assured that new staff were suitable to work in a care environment.

Is the service effective?

The service was not always effective.

Although we found at this inspection that care plans had been updated, they still did not contain sufficient guidance for staff. This meant there was a risk that people would not receive the care they needed and in a way they preferred.

Is the service well-led?

The service was not always well-led.

Following our inspection in July 2014 we took enforcement action against the provider and issued the provider with warning notices relating to the management of medicines and to quality assurance. Many of the concerns we found had been raised at our previous inspections in April 2011, June 2012 and February 2014. This demonstrated to us that the provider had been ineffective in implementing and sustaining the necessary changes to improve the service people received.

During our inspection on 30 September 2014 we found that the provider had failed to meet the requirements of the warning notices in that there were continuing breaches of the regulations. The way in which medicines were managed had not improved and the provider did not have an effective monitoring and auditing process in place to ensure that people were receiving a high quality, safe service.

During this inspection on 12 March 2015 we found that there had been no improvements in the way the service was managed. There were continued shortfalls in medicine management, care planning and staffing levels. We also found shortfalls in the provider's recruitment and selection process, which meant the provider had failed to ensure that new staff were suitable to work in a care environment.

The provider did not have an effective system in place to gain and act on the views of people using the service or staff. The provider did not have an effective system in place for auditing and monitoring the service that was being provided to people. This meant that people were at risk of receiving a poor quality service.

We visited two people in their own homes and spoke with them and the staff providing their care. We visited the agency's office and spoke with the registered manager/provider and the office manager. We looked at records relating to the regulations we were checking.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the following questions:

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found.

Is the service safe?

During our previous inspection we found shortfalls in the way people's medicines were being managed that placed people at risk. At this inspection our pharmacist inspector assessed if people's medicines were being managed safely and if arrangements were in place to protect people against the risks associated with the unsafe use and management of medication.

We looked at how information in medication administration records and care notes for people using the service supported the safe handling of their medicines. We found that records about medicine administration were sometimes inaccurate so we could not be assured people's medicines were always being administered as intended by their prescribers. We found there to be failings in the way medicines were handled when administered to people and we found failings in supporting information, such as prescriber's instructions, which could have led to people not receiving their medicines appropriately and as intended by the prescriber. We noted that staff handling and administering people's medicines had not recently received training or been assessed as competent in medicine management. We noted that there had been a lack of monitoring of the quality of medicine management that would protect people using the service against the unsafe management of their medicines.

The provider stated that there were enough staff to provide the care and support that each person needed and that there had not been any missed calls. However, the lack of records meant that there was no evidence to confirm this.

Is the service effective?

Care plans in people's homes were not up to date and did not accurately reflect the care that people needed. Care plans had not been updated when people's care needs had changed. This meant there was a risk of people not getting the care and support that was necessary to maintain their health and well-being and not getting their care and support delivered by the staff in the way the person wanted it.

Is the service well-led?

Following our inspection in July 2014 we took enforcement action against the provider and issued the provider with warning notices relating to the management of medicines and to quality assurance. Many of the concerns we found had been raised at our previous inspections in April 2011, June 2012 and February 2014. This demonstrated to us that the provider had been ineffective in implementing and sustaining the necessary changes to improve the service people received.

During this inspection on 30 September 2014 we found that the provider had failed to meet the requirements of the warning notices in that there were continuing breaches of the regulations. The way in which medicines were managed had not improved and the provider did not have an effective monitoring and auditing process in place to ensure that people were receiving a high quality, safe service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found.

Is the service safe?

Risk assessments were carried out and actions put in place so that people who received a service, and staff, were protected from potential harm.

However, we found that there were not enough staff employed to ensure that people received the visits they required to meet their assessed needs. We noted that some care calls had been missed and people told us that sometimes staff arrived very late.

We found a number of issues with the way medicines were managed. This meant that people could not be assured that they were given their medicines safely and as they had been prescribed.

Records, and our discussions with staff, showed us that staff had not been properly trained, for example to administer medicines or to use a hoist. This meant that people could not be assured that staff had the skills and competence to deliver care safely.

Is the service effective?

People we spoke with and their relatives were generally happy with the service they received and they were particularly happy with the staff. One relative told us, 'The carer who looks after my [family member] is wonderful.' Another said, 'Generally the staff do the best job they can. They are kind and respectful. My [family member] is happy with the service.'

People's needs were detailed in a personalised way in their care plans so that staff were clear about the care people needed and the ways in which they preferred that care to be delivered by the staff.

Is the service caring?

We looked at several of the completed questionnaires and found that generally people were happy with the service being provided. One person wrote, 'The carers have always been very good and have gone beyond the call of duty to make life as comfortable as possible.' We spoke with people who used the service and with people's relatives. They all told us they liked the staff. One relative said, 'The carer is wonderful. I'm so pleased with the carer my [family member] has got.'

Staff we spoke with spoke very kindly about the people they looked after. One said, 'I like working for the agency, I love the people I look after.'

Is the service responsive?

Staff wrote detailed notes of the care they had carried out at each visit, including whether the care detailed in the person's care plan had changed. Care plans were altered at the following review to ensure they were up to date.

People and relatives we spoke with told us that staff generally did a good job and offered each person the care and support they needed. However, people, relatives and staff all told us that sometimes care calls were missed or staff arrived very late and people had not been informed.

Is the service well-led?

Many of the issues we found during this inspection had been raised at our previous inspections in April/May 2011, June 2012 and February 2014, yet still required improvement. This demonstrated to us that the provider had been ineffective in implementing and sustaining the necessary changes to improve the service people received.

During this inspection in July 2014 we found numerous issues with the management of medicines. No formally recorded audits had been undertaken to ensure that staff were competent to handle people's medicines and give them safely, nor to ensure that medicines were being managed correctly. Although we were told that the records were audited when they were returned to the office, the provider agreed that the issues we found had not been identified nor rectified.

There were insufficient staff employed by the agency to make sure that people received a good quality service.

The provider's quality assurance system was not effective and had failed to monitor the quality of the service being provided. The issues we found during our inspection had not been identified by the provider.

Staff we spoke with said they felt well supported in their work. One staff member who had had previous experience in care told us: 'It's the best (agency) I've worked for. You're backed 100%.'

We found that care records were not current and did not reflect the needs of people who used the service; however staff demonstrated a good understanding and knowledge of the care and support people required.

Staff received the necessary training to meet the needs of people who used the service.

There were no medication audits in place to ensure people were administered their prescribed medication.

There was no effective system in place to assess and monitor the service being provided by Abacus Care Cambridgeshire.