We carried out this inspection on 26 July 2017.

Abbey Care is a domiciliary care service that provides personal care and support services for a range of people living in their own homes. These were predominantly older people with age related frailty some of whom were also living with dementia. Younger adults with a range of conditions including learning disability, physical disability and mental health needs also used the service. At the time of our inspection 15 people were receiving support with their personal care on a regular basis. A further 32 people received a service under the local authorities voucher scheme. The majority of people receiving support under this scheme received a sitting service which did not require staff to deliver personal care on a regular basis however some people did on occasion's receive minimal support from staff such as assistance to go to the toilet.

At the last inspection on 13 and 14 April 2016 we identified breaches of legal requirements and the service was rated requires improvement. The registered provider did not have processes in place to systematically audit records such as people’s care plans and staff files. We also found the records relating to the administration of one person’s medicines had not been completed appropriately and the risk assessments for another person had not been reviewed when their needs had changed.

Following our last inspection, the provider wrote to us to say what they would do to meet legal requirements and sent us an action plan detailing how they intended to ensure they met the requirements of the law. At this inspection, we found the provider had followed their plan and improvements had been made.

The service had a registered manager. 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.

Since the last inspection the registered provider had introduced systems for reviewing, monitoring and assessing the quality of the service. Audits of care plans and staff files were taking place which enabled the registered provider to identify gaps in the records and take corrective action. However we also identified these systems needed further development to drive improvement, become fully embedded into practice and sustained. Whilst we did not assess any harm had occurred, it is an area of practice that we identified needed improvement.

Improvements had been made to ensure people’s risk assessments had been updated and reviewed to reflect changes in their needs. Individual assessments identified environmental and individual risks. They were up to date and detailed guidance for staff to follow to reduce these risks effectively.

Improvements had been made to ensure that people’s medication administration records (MAR) were fully completed and these had been checked by office staff for accuracy. People received their medicines on time and staff had the guidance they needed to ensure people received their medicines safely.

People were supported by kind and caring staff that knew them well and were aware of their personal preferences, likes and dislikes. One person told us “They talk to me, tell me what they are going to do”. A relative commented “It’s all about the individual”.

Care plans were in place detailing how people wished to be supported and people and/or their representatives were involved in making decisions about their care. People were supported with their healthcare needs and staff liaised with their GP and other health care professionals as required.

People confirmed they felt safe with the staff. One person told us “I feel very safe with them”. A relative told us they felt their loved on was “Very safe and quite confident with the carers around”. Systems were in pl

We visited Abbey Care on the 13 and 14 April 2016. Abbey Care provides care and support to people living in their own homes . At the time of our visit, the service was providing support for 80 people, and 41 care and support staff were employed.

The service had a registered manager. 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.

We last inspected the care home on 28 April 2014. At that inspection we found the service was meeting all the essential standards that we inspected.

At this inspection we found a number of breaches relating to the care plan and risk assessment review records that were not all up to date or had not reflected the changes of the health of people using the service. Medication was not documented safely.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. Staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager or a supervisor immediately.

The service used safe systems for recruiting new staff. Staff were recruited safely, with DBS checks in place and annual self-disclosure checks made with the manager. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing in the community. Staff received regular training to enable them to work safely and effectively.

Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened. Incidents and accidents were recorded and learnt from.

The responses from people who spoke with the inspector were that the service was either very good or excellent. People told us they were very happy with the staff and felt that the staff understood their care needs. People confirmed that staff stayed for the length of time allocated and arrived on time. People also confirmed that calls were rarely missed and that an on-call system was always available. All of the people we spoke with had no complaints about the service.

The staff employed by Abbey Care knew the people they were supporting and the care they needed. People who used the domiciliary service and staff told us that Abbey Care was well led and staff told us that they felt well supported in their roles. We saw that the registered manager, office manager and senior staff had a visible presence and it was obvious that they knew the people who they supported really well.

We spoke with three people using this service, six relatives of people and a total of seven members of staff. We did this to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

We considered all of the evidence that we had gathered under the outcomes that we

inspected. We used that information to answer the five key questions that we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that care and support was initially carefully planned to meet people's needs. Staff were suitably trained staff to meet those needs and support people at home and in the community. The manager told us that if lack of capacity to consent was suspected, they would involve a social worker and the person’s G.P. No one currently using the service had been assessed as lacking capacity to consent. Some staff had received training about mental capacity to consent. Measures were in place to safeguarded people from abuse and staff received regular training about safeguarding vulnerable adults. Staff told us that they had all received training about protecting people from abuse and were knowledgeable about the topic.

Is the service effective?

People told us that staff had helped them to improve the lives- not only of the person receiving care and support, but of their family. People told us that they were happy with the care they received. A person said, "We have all been impressed with (the staff) and all the family like them." With one exception, people told us that they had no concerns about the welfare of people using the service and would recommend it to others.

Is the service caring?

We observed that when staff interacted with people they were warm, kind and cheerful. When staff talked to us about people and their needs they expressed care and concern for their welfare. Relatives of people using the service told us that the provider endeavoured to provide the same carer or carers most of the time. Continuity of care is important to make people feel safe and that care is delivered consistently in the same way. More than one person that we spoke to told us that care staff were caring. A relative said, "They are kind" (to the person using the service.)

Is the service responsive?

We found that the service did not maintain a record of all telephone calls received from people or their relatives. Co-ordinators told us that they received many phone calls each day and always dealt with them, but did not always make a record. We did see two electronic records for people where a problem or issue had been dealt with by telephone. One of these was from 2013 and they were the only examples that we were shown that evidenced that the service responded to verbal complaints. Verbal complaints were not treated as complaints and investigated using the policy and procedure for complaints that we saw. No record was held by the service of verbal complaints. We saw that two people using the service had completed survey forms and said they had made a complaint in the last year. One said they were unhappy with the outcome. Neither of these had been recorded as complaints. One of the co-ordinators remembered what the complaint had been about. We saw that several people who had responded to the survey had said that they did not know how to make a complaint or that support could be provided to help people to attend religious services. This was not responded to appropriately.

We saw that although initial assessment of peoples’ needs was comprehensive and reflected in care plans, follow up review meetings or information from carers did not always result in an updated care plan. This showed us that the service could not provide evidence that they were always responsive to changes in people’s needs.

Is the service well led?

Care staff told us that the managers and co-ordinators were approachable and dependable. Staff told us that they were supported to obtain appropriate training. The care manager held regular supervision meetings and annual appraisals with all care staff. The general manager conducted annual appraisals with the senior staff. We saw that policies and procedure documents were clear, legible, and up to date. The service had a system to monitor the quality of the service they provided, however negative responses did not lead to an action plan to improve people’s experience. Other audit results were not analysed by the service in a way they led to an action plan for improvement. The service was generally well led although some improvements could be made.

We spoke with two people who were receiving support from Abbey Care. We also spoke with three relatives. All were positive about the service they received. One person told us, “I am very pleased with the support and there is good communication from the office.” Another person said, “The carer is very nice and a good listener. She will help with anything. She is very genuine.”

Effective arrangements were established for monitoring the safety and quality of the service. Clear arrangements for recruiting staff were in place and appropriate checks were carried out for each new member of staff.

As part of our inspection we spoke over the telephone with five people who used the service and five staff to obtain their views about the service. We also spoke with a relative of one person who used the service.

People told us they had been given a choice about using the agency and were given information about it. They said they had a care plan in their homes and other information so that staff knew how to support them. People said they had been happy with the support they had received and described staff as ‘Fantastic’ and ‘Brilliant’, They said staff had listened to them and respected their wishes and choices. People told us they knew how to complain and would do so if they were unhappy about any aspect of their care and support.

People confirmed that they had received support from the same carer/s most of the time and when their regular carer had been unavailable they had been informed in advance by staff who worked at the office. People said carers had always turned up on time and stayed for the right amount of time.

People felt safe using the service and were confident about reporting any concerns about the way they were treated and they said they had all the information to enable them to do this.

People said office staff had regularly visited their homes and contacted them by telephone to ask what they had thought about the quality of the service and if they had had any suggestions for improvement.