This inspection of the office location took place on 22, 23, 28 November 2016 and 8 December 2016. On 21, 23, 24, 25 October 2016 and 3 and 4 November 2016 we contacted people and relatives for feedback about the service they received. On 1, 2 and 11 November 2016 we visited people in their own homes to receive face to face feedback on the service they received.

We gave the provider 48 hours' notice that we would be visiting the office to make sure that the appropriate people would be there to assist us with our inspection.

Abbots Care Limited was registered on 21 November 2010 with the Care Quality Commission. Abbots care Limited is a large organisation which offers personal care and other related services in Hertfordshire,

Buckinghamshire and North London. This inspection covered the services provided in North, West, South and East Hertfordshire reaching out to approximately 1020 people.

The services provided include, domiciliary care; flexi care scheme; live in services; specialist care from home services, parent support and supported living, and a rapid response service.

There was a registered manager in post who was also the managing director of the company. 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 provider had specialist staff teams trained to offer a wide range of care and support tailored to the individual needs of people with complex health and social care needs. These included people with behaviours others may find challenging; adults and children with learning disabilities and mental health needs, dementia and other complex life limiting conditions which required staff to have specific and specialist knowledge. For example tracheostomy care and support, palliative care, PEG feeds (Percutaneous endoscopic gastrostomy) are used for people who are unable to swallow or eat enough and need long term artificial feeding and Stoma care ( An artificial opening that allows drainage to occur from an internal organ)

People told us they felt safe whilst staff provided care and support. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. We found that people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People were supported to take their medicines safely by staff who had been trained and assessed as competent.

Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. We found that people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People were supported to take their medicines safely by staff who had been trained and assessed as competent.

Staff received regular one to one supervision from a member of the senior management team which made them feel supported and valued. People received the support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented staff for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external

People told us they were so pleased to have the support provided by Abbots care. They said the care workers and office staff were wonderful. People told us the service provided was over and beyond the call of duty and nothing was ever too much trouble.

We found the service to be very well structured. All office staff we spoke to had clear lines of accountability. This meant that people received a service in their own homes that was efficient and met their current assessed needs. If people’s needs changed, appropriate referrals were made to other services such as occupational health, or the district nursing service.

We visited the service on the 13 December 2013 and spoke with people using the service on the 31 December 2013. We spoke with 20 people who used the service including their families. The people we spoke with said that overall, they were happy with the service they received. One person said “My son has been having care and support for a number of years. The staff are reliable and helpful”. Another person said, "The staff are lovely. They take me out and I have my rota online and I have the same staff which I like.” A third person said "The service is very good, the staff help me in lots of ways including helping me with personal care. I have no complaints.” However, some people raise concerns about the lack of communication from the office staff in that some people said that they have to chase them for their rotas and different members of staff have been sent to them. Some people did say that things were getting better now.

We found that the provider was meeting the standards we had inspected. People and their relatives had been consented to their care and support they needed. People received care and support in line with their agreed care plans. Staff had been provided with the relevant training and support so that they were competent in their roles. There was a quality assurance system to assess and manage the quality of service. Records and confidential information had been kept securely and safely.