We undertook an announced inspection of Abicare Domiciliary Care Agency (DCA) on 25 January

2017. We told the provider two days before our visit that we would be coming.

Abicare provides personal live in care services to people in their own homes. At the time of our inspection 44 people were receiving a personal care service.

At the previous inspection on 26 and 27 January 2016 we found the service was not always deploying staff effectively to meet people’s needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, which relates to staffing.

At this inspection we found that the service had made significant improvements to address the areas of concern and bring the service up to the required standards. Staffing rotas confirmed and people told us there were enough staff to meet people’s needs.

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.

People told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training.

The service sought people's views and opinions and acted upon them. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern. Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe.

People received their medicines as prescribed. Records confirmed where people needed support with their medicines, they were supported by staff that had been appropriately trained.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with the staff who had a caring approach to their work. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The registered manager and staff understood the Mental Capacity Act (MCA) 2005 and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery. The service had systems to assess the quality of the care provided. Learning from audits took place which promoted people's safety and quality of life.

People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

We undertook an announced inspection of Abicare Domiciliary Care Agency (DCA) on 26 and 27 January 2016. We told the provider two days before our visit that we would be coming.

Abicare provides personal live in care services to people in their own homes. At the time of our inspection 65 people were receiving a personal care service.

There was 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.

People were supported by staff who could explain how they would recognise and report abuse. However, people did not always feel safe because they experienced visits by carers they either did not know or were unfamiliar with. This was because staff were not always deployed effectively.

People were not always protected in line with the principles of The Mental Capacity Act 2005 (MCA). Staff were not always clear about how they would support someone, in line with the principles of the MCA, If a person’s needs changed.

Records showed staff had been trained in the MCA. Some staff we spoke with had an understanding of the principles of the MCA. However, some staff told us that they were unsure what the MCA was. The impact of this was limited because these staff members did not support people who lacked capacity. We spoke with the registered manager about this and they gave us there assurance that MCA training would be revisited with all staff.

There was a whistle blowing policy in place that was available to staff. However not all staff we spoke with were confident in their ability to raise concerns with their seniors.

People benefitted from caring relationships with the staff who had a caring approach to their work. Staff understood people’s needs and preferences and were knowledgeable about the support people needed.

Risks to people were managed and reviewed. Where people were identified as being at risk, assessments were in place and action had been taken to reduce the risks. Records relating to the recruitment of staff showed relevant checks had been completed before staff worked unsupervised at the home.

Where people needed support with their medication and personal care. They were supported by staff that had been appropriately trained. Individual medication administration records were fully completed which showed that people received the medication when needed.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. Staff received regular supervision (one to one meeting with line manager), spot checks and appraisals.

People were supported to maintain good health. Various professionals were involved in assessing, planning and evaluating people’s care and treatment. Were people needed support to eat and drink they were supported by staff who followed the correct guidance.

Accidents or incidents were documented and any actions were recorded. There were effective systems in place to assess the quality of the service. Regular audits were conducted to monitor the quality of service and learning from these audits was used to make improvements.

Summary

We carried out an inspection to gather evidence to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Is the service safe?

People were cared for safely. Safeguarding procedures were in place. All care staff had been trained in safeguarding vulnerable adults and they knew how to raise concerns if they suspected abuse was happening. People who used the service and their relatives told us they knew how to raise concerns.

Care workers were appropriately recruited and selected. Background checks were conducted and references sought before care workers started work. All care workers received appropriate training to carry out their role.

People had risk assessments in place where there were identified risks. Care needs and risk assessments were reviewed regularly. People were involved in their care. People told us they were treated with dignity and respect.

Is the service effective?

People received a service that was effective. People told us they were happy with the care that had been delivered. One person told us, “I get good care and get on well with the carers.”

People were assessed within 48 hours of receiving a service. People were involved in determining their care needs. Each person had a care plan in place that reflected their needs.

Is the service caring?

People were supported by a caring staff. People we spoke with were complimentary about the staff who supported them. One person told us, “They are very friendly and chatty. They always ask me how I want things done.” A relative told us “We have recently had a stair lift installed, they encourage him to use it. It means he can come downstairs now.”

Care workers we spoke with showed genuine caring. One care worker told us, “I imagine how I would want my own family treated.” Another care worker said, “I like to get to know them as a person.”

Is the service responsive?

We saw that the service responded to people’s needs. Regular reviews of people’s care needs identified changes to the support they needed and action was taken. Care workers reported changes to the manager and action was taken to meet people's needs. This included involving health and social care professionals. For example an occupational therapist was contacted when a person was having difficulty with mobility. We heard one care staff member speaking to a pharmacist. The care staff member was arranging collection of medication prescribed by the General Practitioner for a person who was unwell.

Where families/friends were involved in a person’s care they were included in assessments and reviews. One relative told us, “They are really helpful. They call me if there are any problems.”

Is the service well-led?

The service was not always well-led. Accidents and incidents were recorded but not always investigated. This meant that learning from accidents and incidents was difficult and did not allow the manager to look for patterns and trends. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People’s opinions were sought and acted upon. Annual service user surveys were carried out. This allowed people the opportunity to raise issues with the service. The results of the survey were responded to and action taken. One issue was related to staff, we saw evidence this was addressed at a staff meeting. All staff were sent copies of the meeting minutes.

The provider dealt with complaints appropriately, in line with their complaints policy. There were several complaints in relation to late visits. This was being addressed by changing responsibility for scheduling visits to a central location using an electronic timed monitoring system.