This announced comprehensive inspection was carried out on 31 January 2018 and was concluded on 7 February 2018.

Abigail Court (Domicillary Care) provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing and this inspection looked at people’s personal care and support service. At the time of the inspection, 15 people were being supported by the 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.

At our last inspection we rated the service ‘good’. At this inspection we found the evidence continued to support an overall rating of ‘good’, and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. However, we found the provider had made further improvements to their quality monitoring systems to ensure that people received good care. The exceptional leadership and management of the service fostered a culture that encouraged collaborative working and openness. The registered manager provided stable leadership and effective support to the staff. People, relatives and staff feedback was listened to and improvements made in a timely way. The registered manager and the provider had systems in place to turn their vision and values into ensuring that they consistently provided a service that was safe, effective, compassionate and of good quality.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences, and choices. Staff had regular supervision and they had been trained to meet people’s individual needs effectively. The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing. They were also supported to access healthcare services.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives, and the policies and systems in the service supported this practice.

Staff regularly reviewed the care provided to people with their input to ensure that this continued to meet their individual needs, in a person-centred way. The provider had an effective system to handle complaints and concerns. Where people were able to remain in their own homes, staff ensured that they remained comfortable, dignified and pain-free at the end of their lives.

Further information is in the detailed findings below.

We carried out an announced inspection on 12 November 2015. The service provides care and support to people living in their own homes, within an extra care housing scheme and the care staff are based in the building. At the time of the inspection, 16 people were being supported by the service, some of whom may be living with chronic health conditions, physical disabilities and dementia.

The service did not have a registered manager following their retirement in September 2015, but the provider had started the process of looking for a new manager. A team leader was managing the service at the time of the inspection. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm and suitable equipment was in place so that people were supported safely.

The provider had effective recruitment processes in place and there were sufficient numbers of staff to support people safely. Staff received supervision and support, and had been trained to meet people’s individual needs.

Staff understood their roles and responsibilities to seek people’s consent prior to care being provided. Where people did not have capacity to consent to their care, this was provided in line with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported by caring and respectful staff. They were supported to access other health and social care services when required.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive continuous improvements. 

During our inspection of Abigail Court (Domiciliary Care) on 25 October 2013, we spoke with people who use the service about their experiences. They told us they felt well cared for by a reliable staff team. They said care workers attended all of their scheduled appointments and delivered the care and support they were supposed to. People said the agency staff used by the service were also competent in their roles. They told us they regularly had the opportunity to feedback to the service about their care and experiences and had no complaints to raise. One person said: "I see my care workers four times each day without fail." Another person said: "I can't speak more highly of them."

We saw that each person received an assessment of their care needs, including any risks associated with their care provision. In all the cases we looked at, we found that the care provided matched with the care required and this was what people had agreed to. We saw that the care was provided by a sufficient number of suitably qualified and trained staff.

We saw the service had effective systems to regularly assess and monitor the quality of service that people received. These included team leader visits, care documentation audits and surveys. There was an effective complaints system available and comments and complaints people made were responded to appropriately.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an “expert by experience”, people who have experience of using services and who can provide that perspective.

We used postal surveys, telephone interviews and home visit to people who use the service and to their main carers (a relative or friends) to gain views about the service.

People told us that the staff always spoke to them appropriately and used the name they preferred. They also told us that the door was always locked when personal care was being given to prevent anyone walking in. People told us that they believed they could tell their care workers about anything and it would not be shared inappropriately. We were told that people were provided with the care they needed and wanted at a time that suited them. One person said, “I want to do as much for myself as possible, but I know the care staff will take over if necessary”. Other people confirmed this by telling us that staff helped them to maintain their independence.

People told us that their care was provided when and how they wanted it and if there were any changes to the timing, or who was to provide the care, they were informed. People also told us that they felt safe when receiving care and believed the staff treated them well. They told us that staff behaved appropriately when visiting them and were always friendly and polite and respected their property.