Archived: Abbey Care

Updated 18 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At our last comprehensive inspection of the service on 13 and 14 April 2016 we identified areas of practice that needed improvement in relation to systems in place for reviewing risk assessments, auditing, care plans and staff files and the recording of medicine administered covertly. The service received an overall rating of ‘requires improvement. Following that inspection the provider wrote send us an action plan outlining the steps they would take to ensure they were meeting the requirements of the law. At this inspection we checked they had followed their plan.

This inspection took place on the 26 July 2017 and was announced. The provider was given 48 hours’ notice. This was because the location provides a domiciliary care service and we wanted to be sure that someone would be in the office to speak with us. The inspection team consisted of one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we checked the information that we held about the service and the service provider. This included statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events that the service is required to send us by law. We used this information to decide which areas to focus on during our inspection. On this occasion a Provider Information Return (PIR) was not requested prior to the inspection. A PIR asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. However we did obtain the contact details of people, their relatives and staff so that we could speak with them over the phone.

During our inspection, we conducted telephone interviews with three people who use the service and the relatives of another five people who were not able to give us their views over the phone. We spoke with four care staff over the phone. We spoke with a senior member of staff responsible for overseeing staff training, a senior care co-ordinator, a care co-coordinator and the deputy manager all of whom also on occasion's delivered care. We also spoke with the registered manager. We observed staff working in the office as they dealt with issues and spoke with people and staff over the phone.

We reviewed a range of records about people’s care and how the service was managed. These included the care and medicine administration (MAR) records for six people. We looked at four staff training, support and employment records. We examined records relating to the management of the service including quality assurance audits, complaints and records relating to the day to day management of the service.

Updated 18 August 2017

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 place to protect people from abuse and harm and staff acted on any concerns they had. When concerns had been identified these had been passed to the local authority for them to consider under local safeguarding protocols.

People were supported by staff who received regular support, training and supervision and had the skills, knowledge and experience required to support them with their care needs. Staff underwent regular training and updates to ensure they stayed up to date with current good practice guidelines and legislation.

People’s privacy and dignity was respected. Staff had a firm understanding of respecting people and providing them with choice and control.

People, relatives and staff spoke highly of the service, the management and staff. One relative told us “Overall I’m happy with the care”. Another commented “I’m very pleased with them really, I’ve even recommended them”. People and relatives knew how to complain and were confident their concerns would be addressed.

People's right to make their own decisions about their own care was supported by staff. Staff worked in accordance with the principles of the Mental Capacity Act 2005 (MCA) and sought people’s consent before delivering care.

Checks were completed on potential new staff before they started work to make sure they were suitable to support people and the provider made sure there was enough staff at all times to meet people’s needs.

Staff felt supported within their role and described an ‘open door’ management approach. The management team were always available to discuss suggestions and address problems or concerns. A staff member said, “They are very good if you have problems; they listen to you. If you need anything or need to know more about something you can just ask”.