This inspection took place on 12 June 2018 and was announced. We gave the provider prior notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office.

Absolute Care UK Limited is a domiciliary care agency that provides personal care to people in their own homes. It provides a service to older adults, people living with dementia, physical and learning disability and sensory impairments. The Care Quality Commission (CQC) only inspects the service being received by people provided with the regulated activity ‘personal care’; help with tasks related to personal hygiene and eating. Not everyone using the service receives the regulated activity. Where they do we also take into account any wider social care provided. At the time of our inspection the service was providing personal care to 120 people.

The service had a registered manager in place. 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 the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People felt safe while supported by the staff. Relatives agreed the staff supported their family members and made them feel reassured. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these appropriately.

People and their relatives were treated with respect, and their privacy and dignity were promoted. People and relatives felt the staff supported them in the way they wanted. Staff were responsive to the needs of the people and enabled them to improve and maintain their independence with personal care.

People were supported by sufficient numbers of staff to meet their individual needs. Where possible, the registered manager scheduled visits so the same staff went to see people to maintain continuity of care and support. People were informed about the changes to their visits as necessary. The service had an appropriate recruitment procedure that they followed before new staff were employed to work with people. They checked to ensure staff were of good character and suitable for their role.

Staff training records indicated which training was considered mandatory. The registered manager and senior staff had planned and booked training when necessary to ensure all staff had the appropriate knowledge to support people. Staff had ongoing support through regular supervision and appraisals. They felt supported by the registered manager and maintained great team work. People and relatives were very complimentary of the staff and the support and care they provided.

People received support that was individualised to their specific needs which was kept under review and amended as changes occurred. People's rights to make their own decisions, where possible, were protected and respected. Staff were aware of their responsibilities to ensure people's rights were promoted.

The staff monitored people's health and wellbeing and took appropriate action when required to address concerns. People and relatives felt confident they would be looked after well. The service assessed risks to people's personal safety, as well as staff and visitors, and plans were in place to minimise those risks. There were safe medicines administration systems in place and people

This inspection took place on 31 March and 11April 2016 and was announced. Absolute Care (UK) Limited is a domiciliary care service. At the time of the inspection they provided personal care to ninety people living in their own homes.

At the time of the inspection 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 and their relatives were happy with the service they received from Absolute care (UK) Limited. They said they felt safe using the service. Risks were assessed and managed effectively to keep people and staff safe. Staff had received training in safeguarding people and understood how to keep people safe. They were confident any issues reported regarding people’s safety were dealt with by the management staff.

Recruitment procedures were robust and helped to ensure suitable staff were employed at the service. Staff received ongoing support from the management team. They felt they could discuss any issues openly and receive guidance when they needed it. Appropriate and regular training was provided to ensure staff had the skills to care for people safely and effectively.

Medicines were managed safely and people received their medicines when they required them.

Policies and procedures were reviewed regularly and gave suitable guidance to staff.

People’s rights were protected. Staff understood their responsibilities in relation to gaining consent before providing support and care. People were happy with the support they received from the service. They had been involved in making decisions about their care and felt they were respected.

People were treated with kindness, dignity and respect and they were supported to remain as independent as they wished.

Staff were provided with information concerning people and changes to their care in a prompt manner. Communication in the service was praised by staff, people and relatives. When necessary, staff contacted healthcare professionals to seek advice regarding people’s well-being.

Regular feedback and a system of audits helped the registered manager to monitor the quality of the service and take action to make improvements.

At an inspection on 11 November 2013 we found the provider did not meet all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Recruitment checks were not completed in accordance with Schedule 3 of the regulations. We did not find effective systems in place to assess or monitor the quality of services provided. Documentation available did not record all necessary information to protect people from potential harm.

At our inspection on 25 March 2014 we found the provider had taken steps to meet the requirements of the regulations. Since our last inspection the manager had completed an audit of all the recruitment files of staff employed by the service. Gaps identified in employee's work histories had been investigated, and explanations recorded. All other recruitment checks required by the regulation were documented.

Care plans and risk assessments had been reviewed and updated to ensure risks affecting the health and welfare of people who use the service and others were appropriately identified, and actions put in place to reduce the risk of harm. The provider undertook regular quality assessments to ensure care provided met people’s needs.

Records were maintained accurately. The provider carried out audits to ensure information was kept up to date. Information was stored securely to maintain confidentiality.

We spoke with 15 people who use the service and 13 relatives of other people who use the service. Everyone stated they were satisfied with the care they received. People told us staff helped them to maintain their independence and treated them respectfully. One person told us “Staff are polite and on time. They do what I want them to do.” Another said “I couldn’t do without them.”

We spoke with five members of staff. They all told us they regularly read people’s care plans and discussed care with people to ensure they provided this as they wished. Care plans reflected the person’s care needs.

The provider did not complete all relevant checks before staff began work in accordance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We did not see written explanations of gaps in employment history. Not all recruitment files included sufficient evidence of proof of identity. We did not find recorded evidence of sufficient investigation of conduct in some staff’s previous employment positions in a health and social care field.

The provider regularly sought feedback from people who use the service and their relatives. They used this information to improve care provision. However, they did not have effective systems in place to identify, assess and manage risks. They did not ensure documentation recorded all necessary information to protect people who use the service and others from potential harm.

The provider ensured information was protected in accordance with the Data Protection Act 1998. They followed their internal policy for the storage and appropriate disposal of confidential records.

People told us they were mostly happy with the service provided. They told us they were involved in the development and agreement of their care plan. They told us they were given opportunities to contribute their views about the quality of the services provided. Some people told us staff timekeeping could be improved, although they told us staff had been arriving within a reasonable time of the agreed times.

We spoke with relatives of people who use the service. One person said, “It is the best part of the day for him, he looks forward to the carers coming”. Another person said, “Yes there is a care plan, and in the book the carers write in, there is a telephone number you can call if anything is wrong”.

Staff we spoke with were knowledgeable of people’s specific health and personal care needs and how they wanted those needs to be met. We looked at people's care plans and supporting documents. We found peoples care plans detailed their needs, and how to meet those needs whilst minimising identified risks.

The provider had ensured staff received appropriate professional development and support to deliver care and support to the people who use the service.

The people we spoke to told us that they were treated well by staff. They said they were able to make choices about the care and support they were to receive from the agency.

They told us that they were involved in the review of their care plans and that changes are made only if they are in agreement.

People told us that they had no concerns or worries about the care they received. They said that they are kept fully informed and can approach the agency staff if they were worried or concerned.