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Inspection carried out on 10 January 2019

During a routine inspection

This comprehensive inspection was carried out on 10, 14 and 15 January 2019 and was announced.

Accessible Care is a domiciliary care agency which provides care and support for people in their own homes. Care is provided for a range of people including older people, people with dementia, learning disabilities or autistic spectrum disorder, physical disabilities and younger adults. Not everyone using Accessible Care receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection there were 292 people using the agency at the time of our inspection.

The agency had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection in May 2016 we rated the service ‘Good’ overall, with the responsive key question rated as ‘Outstanding’. At this inspection we found the evidence continued to support the rating of ‘Good’ overall and ‘Outstanding’ in responsive. There was no evidence or information from our inspection and ongoing monitoring that demonstrated any risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager and management team were committed to developing the agency through continuous improvement. People and relatives told us that staff went the extra mile to ensure their needs and wishes were met. Staff went over and above the role to ensure people led a happy and fulfilled life.

Feedback was sought and acted on to improve the quality of the service that was provided to people. People were given opportunities to raise any concerns or make suggestions about improvements to the agency.

The registered manager had developed links with other agencies to promote people’s safety and well-being. Staff said the service was open, transparent and that they felt supported by their managers. There were audits in place which checked the quality of the service being provided. Staff were involved in developing the service.

People felt safe and were protected from the risk of abuse. Staff had access to the branches safeguarding coordinator for advice. Potential risks had been assessed and mitigated.

People were provided with consistency and continuity of care. There were enough staff to meet people’s needs and safe recruitment procedures were followed. Staff were supported in their role by the management team and received ongoing support through their induction. Staff were trained to meet people’s needs and could request additional training.

Medicines were managed safely and were administered by staff that had been trained and competency assessed. People were supported to remain healthy with support from health care professionals where required. People received support to manage their nutrition and hydration. Staff worked alongside health care professionals to ensure people’s nutrition was maintained. Staff understood the importance of infection control procedures.

People’s needs were assessed prior to receiving support from the agency. People were at the centre of their care and informed staff how they wanted their needs met. Care records were kept under continuous review to ensure they met people’s needs. People were encouraged to be as independent as possible. People’s dignity and privacy was respected. People’s personal information was kept confidential.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive

Inspection carried out on 9 May 2016

During a routine inspection

We inspected this service on 9, 10 and 11 May 2016. The inspection was announced. The provider was given two working days’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available at the locations office to see us.

Accessible Care is a domiciliary care agency which provides personal care and support for people in their own homes. The agency provides care for people in Maidstone and the surrounding villages. The service includes short term respite care as well as long term care. At the time of our inspection they were supporting approximately 280 people.

There was a registered manager in place who was also the provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The feedback we received from people using the service was excellent. People and their relative’s spoke very highly of the management team and staff. For example, one relative said “From day one they knew my mum, they found out her likes and dislikes and they encourage her to do things for herself we are very happy.” One person said, “Couldn’t get any better care.”

The registered manager was committed to continuous improvement, and, feedback from people was used as an opportunity for improvement. Processes were in place to continually monitor and review the quality of the service being provided to people. People gave their feedback on a regular basis and changes were made to the service as a result. The registered manager demonstrated the organisation’s values and a desire to learn about and implement best practise through links with the local community.

People experienced a service that was safe. They received support and assistance from enough staff to fulfil their expected care packages and meet their assessed needs. Staff, the registered manager and the management team had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s and staff’s safety had been assessed and recorded with measures put into place to manage any hazards identified.

Staff had a full understanding of people’s care needs and had the skills and knowledge to meet them. People received consistent support from staff who knew them well. People were treated with dignity and respect by staff who also maintained people’s privacy. People’s independence was maintained and encouraged by staff.

People’s needs had been assessed to identify the care and support they required. Care and support was planned with people and regularly reviewed to make sure people continued to have the support they needed. Detailed guidance was provided to staff within people’s homes about how to provide all areas of the care and support people needed. People, if required were supported to eat and drink enough to maintain good health.

Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support.

Where staff were involved in assisting to managing people’s medicines, they did so safely. Policies and procedures were in place for the safe administration of medicines and staff had been trained and assessed to administer medicines safely.

Staff were trained to meet people’s needs. Robust induction processes were in place to ensure staff were able and confident to meet people’s needs. The provider encouraged staff to undertake additional qualifications to develop their skills. Staff were supported in their role and encouraged to develop from the management team.

Inspection carried out on 6 May 2014

During a routine inspection

We spoke with the registered manager, the office manager, the service's care assessor, and three members of care staff. We looked at nine sets of records for people who used the service, four personnel files, staff training records, the service's satisfaction surveys, policies and procedures. We spoke with five people who used the service and three of their relatives. We used the information to answer the five questions we always ask;

- Is the service safe?

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw that all staff were trained in safeguarding vulnerable adults and that the training included the principles of the Mental Capacity Act 2005. All staff had been subject to Disclosure and Barring Services (DBS) checks before they started work. We found risk assessments with clear action plans were in place to ensure people remained safe. People's consent to care and treatment was sought appropriately and people's records were kept securely.

- Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. People who used the service commented, "Excellent service" and "The care workers are very caring respectful and attentive, and the company in general is first class". We saw that the delivery of care was in line with people's care plans and assessed needs. We found that the staff had received training to meet the needs of people who used the service.

- Is the service caring?

We found that people who used the service were supported by kind and attentive staff. Two members of staff told us, "We get a lot of satisfaction about improving and helping people to live a normal life" and, "Privacy and respect are such an important part of our work, we are very mindful of this". A person who used the service said, "When they first assessed what needed to be done, they took time to find out how I preferred to be cared for and what was important to me". Another person said, "The quality of care is excellent".

- Is the service responsive?

People's needs had been assessed before care and support began and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's care plans included their history, wishes and preferences. People and/or their representatives were involved with reviews of care plans and they were kept informed of any changes. People's views were sought about the quality of care that they received and their views were taken into account. A person who used the service told us, "They are very open to suggestions; I have suggested a couple of changes to the routine, my care plan was reviewed the following day and the changes were implemented".

- Is the service well-led?

We found that comprehensive policies and procedures were in place that addressed every aspect of the service. Policies were updated regularly and staff were made aware of the updates. The manager and the office manager operated a system of quality assurance to identify how to improve the service. People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were analysed. Staff told us they were encouraged to express their views and they were listened to if they had any concerns. A member of staff told us, "There is an open door policy and a good team spirit". Staff's practice was regularly observed and monitor to identify whether additional training or refresher courses were needed. People who used the service told us, "Brilliant management, very approachable".

Inspection carried out on 7 May 2013

During a routine inspection

We carried out a visit to the agency�s Head Office which lasted over three hours. During this time we reviewed a variety of documentation and spoke to staff. We obtained people�s views from feedback letters and surveys which had been sent into the office; and from reading comments made by people during senior staff�s �spot check� visits to care staff while visiting people�s homes. We spoke with a health professional who arranged placements for people with the agency when they came out of hospital, and who said that the staff from the agency gave good care.

We saw that people spoke positively about the agency, with comments such as: �We were very impressed with the way you helped X, and have been grateful that the staff have all been approachable and genuinely caring.� And �The staff were very efficient and caring and are a credit to your company.�

We saw from reading care plans and daily records that the care staff carried out their duties in accordance with the care plans, and informed the management if there were concerns about people�s health care.

We found that medication management was carried out safely and reliably.

We saw that staff recruitment procedures were well managed, and staff were suitably trained and supported for their different roles.

The agency provided people with a clear complaints procedure. There had been no formal complaints since the last inspection. We found that there were systems in place to deal quickly with everyday concerns.

Inspection carried out on 27 September 2012

During a routine inspection

The inspection visit was carried out by one Inspector and lasted for three hours. The agency had two registered managers, and both were available throughout the inspection.

We obtained people�s views by reading recent questionnaire responses and letters sent to the service. Some people had also given feedback to the agency�s senior staff when they had carried out competency checks with care staff in people�s homes.

People�s responses were mostly very positive and included the following comments:

�The care and assistance given is excellent.�

�I am very pleased with the service I receive.�

�The carer has been wonderful to our Mum and is a credit to your company.�

�A first class company.�