Abicare Service Ltd

Abicare is a domiciliary care agency. 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

Processes and systems were in place to protect people from the risk of abuse, staff understood what to report and how. Incidents were reported and reviewed and any learning for staff was shared. Staff assessed potential risks to people and these were managed safely. There were sufficient, suitable staff to provide people’s care. The provider took prompt and effective action during the inspection to address issues in relation to staffing records. People’s medicines were properly and safely managed by trained staff. People were protected from the risk of acquiring an infection.

People’s care was assessed to establish their care and support needs. Staff were well supported within their role, through their induction, training and on-going support. Staff ensured people received sufficient food and drink for their needs. Staff made sure people’s healthcare needs were identified and appropriate referrals were made. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff treated people with kindness and respect. People were supported to express their views about their care and their wishes were respected. People’s privacy and dignity were respected and promoted during the delivery of their care.

People received personalised care that was responsive to their needs and preferences. Processes were in place to enable people to raise complaints and these were responded to, in order to improve people’s experience of the care provided. The service was not providing end of life care but training was available to staff if required.

There was a positive culture within the service. The provider had put in extra management for the service and staff felt well supported in their role. There was good communication with people and staff. There was a shared understanding of risks and regulatory requirements. Processes were in place to engage people and staff with the service and to seek their views, which were used to drive service improvements. Processes were in place to ensure the provider had oversight of the performance of the service. The service worked in co-operation with key organisations to ensure the safe and effective delivery of people’s care.

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 requires improvement (published 16 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

The provider had addressed a period of instability in the management of the service by the appointment of one of their established and experienced managers from another of their locations. The new manager had submitted their application to become the registered manager for the service and this was being processed. 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 the last inspection in May 2017 we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the provider had failed to provide people with person centred care. At this inspection we found the requirements of this regulation had now been met. People received personalised care that was planned with them and was responsive to their needs. People’s care plans reflected their expected outcomes and any preferences they had about the delivery of their care. The care was regularly reviewed or sooner if their care needs changed. People were supported to pursue their interests where this was commissioned. The service has been rated as requires improvement overall for a second time, as although improvements to the service have been made, further time is required for the manager to complete and embed them across the service.

People were safeguarded from the risk of abuse. Staff had undergone relevant training and understood their role and responsibilities. The provider had identified those staff who needed to update their annual safeguarding training to ensure their knowledge remained relevant and this work was underway. Potential risks to people in relation to a range of aspects of their care had been assessed and where required measures were in place to manage them. Processes were in place to ensure risks were regularly reviewed. Staff had undertaken infection control training and understood their responsibilities in this area. Processes were in place to identify and apply any learning points from incidents.

There were sufficient staff to provide people’s care, but following a recent loss of some staff, some people reported their calls were not always delivered in a timely manner and that there was less consistency in their staffing. The provider was aware of this issue and relevant action had been taken to rectify this for people.

People received their medicines from trained staff. Improvements were required to ensure all staff always signed people’s medicine administration records in addition to recording in people’s daily notes they had received their medicine, to ensure a complete record was maintained.

People’s assessments and care planning reflected relevant legislation and guidance. The provider ensured staff had the required skills, knowledge and experience to support the people they cared for. Staff were supported to undertake relevant training for their role. Staff were adequately supported in their role with regular supervisions and spot checks of their practice.

Staff supported people to receive sufficient food and drink for their needs, both during and between visits. Staff worked with relevant agencies to ensure people received co-ordinated care and that their health care needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they found staff to be caring. We observed staff treated people with kindness, compassion and respect when they visited them. Staff were instructed about how they should support people to express their views about their care and how to involve them in making decisions. Staff supported people to be able to retain their independence.

There was a clear vision for the delivery of people’s care and the new manager promoted a positive working culture. Staff understood their responsibilities and legal requirements. Processes were in place to engage people and staff with the service. People’s feedback had been acted upon and used to improve the service. Processes were in place to enable people to raise complaints about the service and these were investigated.

Overall the processes to assess the quality of the service were effective. However, some required further embedding to ensure they were fully functional. The manager was aware of these issues and had taken relevant action to address them.

At the time of the inspection the service had a registered manager, however they had recently tendered their resignation. The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were kept safe as staff understood their role and responsibility in relation to safeguarding procedures. Staff had undergone safeguarding training and understood the different types of abuse and how to recognise signs of such abuse.

Risks to people had been initially assessed and control measures put in place to minimise their occurrence. However, these were not reviewed regularly to ensure the most up to date guidance was provided to staff. This meant the provider could not be assured that all risks to people were being managed appropriately to keep people safe. One person had experienced a fall whilst being supported by staff which demonstrated staff did not always consistently apply safe moving and positioning practices. The registered manager had identified that some people’s risk assessments had not been regularly reassessed and was in the process of ensuring this work was completed as a priority.

The registered manager completed a daily staffing needs analysis to ensure there were sufficient staff deployed to meet people’s needs. However, this frequently required the registered manager, care coordinator and community team leaders to work overtime to provide hands on care, which deflected them from other responsibilities, such as reviewing care plans and risk assessments.

Records demonstrated the service had a recruitment process that met legal requirements and recruitment files confirmed that most required pre-employment checks had been completed. However, the provider had not consistently followed their own recruitment processes and taken appropriate action to assure themselves that staff employed were of suitable character to support people safely.

People’s medicines were administered by suitably trained staff, although the provider had not consistently assured their knowledge and skill to do so had been maintained.

The provider’s required training had not been updated in accordance with the provider’s policy. This meant that the provider had not ensured staff were supported to maintain their skills at the required standard to meet people’s assessed needs effectively.

People’s care and support was always provided with their consent, although records did not always clearly reflect this. The registered manager and staff ensured best interest meetings and processes were followed to protect people’s human rights.

Staff encouraged people to eat and drink sufficiently to maintain their health.

People and their relatives had a mixed experience in relation to the caring attitudes of the staff supporting them. Regular staff were caring and compassionate and treated people with respect although some staff were task focused and did not show an appreciation of the need to meet people’s emotional wellbeing.

People were involved in making their decisions and planning their own care and support. If they were unable to do this, where appropriate, their care needs were discussed with their relatives or representatives. Regular staff treated people with dignity and respect. However this was not always demonstrated when people’s regular staff were not available to deliver care.

People’s care plans were not person centred and did not contain sufficient information relating to their personal histories, individual preferences, interests and aspirations. Regular staff knew such information. However when regular staff were not available other staff may not be aware of this information. This meant that the provider could not be assured that all people’s needs were always being met.

People’s care needs had not consistently been reassessed regularly which had resulted in their care plans being out of date. This placed people at risk of receiving inconsistent care and/or not receiving the care and support they need.

The provider had processes for seeking feedback in various ways such as quality assurance visits, telephone surveys and questionnaires. However these processes had not been completed effectively.

People had a copy of the provider’s complaints procedure in a format which met their needs and knew how to make a complaint and raise any concerns about the service.

People and staff had experienced poor leadership and management until the appointment of the current registered manager in January 2017. However, the service was now demonstrating signs of improvement due to the commitment and dedication of the registered manager and their management team. The registered manager had created an open positive culture within service, which was supportive and inclusive.

The provider had quality assurance systems in place but these had been inconsistently applied since the service began, which meant they had failed to address the concerns identified in this inspection. The provider’s leadership was reactive rather than proactive.

We found one breach of the Health and Social Care Act (2008) Regulated Activities 2014. You can see what action we told the provider to take at the back of the full version of this report.