17 September 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
This inspection was undertaken by four inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing. This service also provided care and support to people living in ‘supported living’ settings, so they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service had a manager registered with the Care Quality Commission, who was also the provider. This means they are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure the provider would be available at the office to support the inspection.
Inspection activity started on 30 July 2021 and ended on 18 August 2021. Between 02 August and 06 August 2021, we contacted health and social care professionals working in partnership with the service and requested further evidence from the provider. The Experts by Experience made telephone calls to people and relatives for feedback about the service between 09 and 10 August 2021. Inspectors spoke with some staff by telephone on 10 and 11 August 2021, emails were sent to 36 staff members on 05 August 2021 asking for their feedback. We visited the office location on 18 August 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to help plan our inspection.
During the inspection
We spoke with 36 people who used the service and seven relatives about their experience of the care provided. We received feedback from 21 members of staff, and the provider. We received feedback from nine external health and social care professionals.
We looked at records relating to people’s care and support. We looked at other records relating to the overall management of the service, including quality assurance and audits, staff support meeting minutes, and social events information.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
17 September 2021
About the service
Abbots Care Limited (Hertfordshire) is a large domiciliary care agency providing personal care and other support related services in Hertfordshire. The diverse range of services provided meant there were approximately 911 people receiving support from Abbots Care Limited at the time of this inspection.
The agency provided a wide range of services including domiciliary care; flexi care scheme; live in services; specialist care from home services, parent support and supported living, and a rapid response service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
People received exceptionally effective care and support from the Abbots Care staff team. People were supported to have control and choice over their care and to help develop their own care plan based on their needs, wishes and what was important for them. The care and support people received was extremely effective and enabled them to remain in their own homes and continue to live as independently as possible.
External professionals including local authority representatives and healthcare professionals gave unanimously positive feedback about how the care delivered had enhanced people’s lives. People were overwhelmingly positive about the calibre and the skills and knowledge of the staff team as well as the care provided for them. People said they felt staff were knowledgeable and knew how to deliver care and support in an effective and safe way.
Staff received a robust induction, ongoing training and supervision and felt well supported by the provider. The provider had developed designated 'champions' in the service who actively supported staff to make sure people experienced good outcomes and to support them to remain longer in their own homes.
People received the support they needed to eat and drink and were supported to access healthcare professionals to help maintain their health and well-being. Consent to care had been obtained from people, and staff were aware of people’s rights in relation to offering choices.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Care was centred around each person’s individual needs. People said staff were polite, kind, caring and respectful. The providers ethos, values, attitudes and behaviours were shared by leaders and care staff ensuring people using the service were supported to lead confident, inclusive and empowered lives.
The provider worked exceptionally well with external professionals for the benefit of people who used the service. The provider continued to maintain excellent working relationships with commissioners and local authorities from their catchment area to develop new services in response to the needs of people in the community, especially during the COVID-19 pandemic.
There continued to be a positive, open and empowering culture within the service. Feedback about the leadership and management of the service was overwhelmingly positive. The provider and senior management team were dedicated to promoting a positive, inclusive culture at the service. Quality monitoring processes continued to be robust, and these clearly evidenced actions taken to continually improve the service.
People felt safe supported by staff from Abbots Care Limited (Hertfordshire). Robust safeguarding systems and processes were in place and people were kept safe from harm. Staff demonstrated they knew the process to follow if they were concerned about people’s safety or if people may be at risk of abuse.
People’s individual risks were assessed, and measures put in place to help reduce the risk of harm. People’s medicines were managed safely, and they received their medicines as prescribed. Staff understood infection prevention and control and were provided with appropriate personal protective equipment. Staff had received training and frequent updates regarding COVID-19 and how to prevent community transmission.
The provider and staff continued to be responsive to the needs of people who used the service. Staff supported people to live as full a life as possible. The strong community links and wide range of social initiatives that had paused during COVID-19 restrictions were being re-instated for people to access regularly; supported by staff and volunteers.
People and relatives felt the staff were caring and thoughtful. People said their dignity was maintained and their right to privacy was respected. People's needs were fully assessed before they started using the service. People and their relatives were aware of how to raise concerns should the need arise, and many compliments had also been received by the service. People were asked their views and feedback obtained was analysed so any shortfalls could be addressed, and positive experiences shared with the staff team.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Outstanding (published 05 May 2020).
Why we inspected
This was a planned inspection based on our ongoing monitoring of the service.
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.