Absolute Care at Home Limited Head Office

Updated 28 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the 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.

This was a planned inspection and the first day was unannounced. Our inspection site visit activity started on 22 May 2018 and ended on 24 May 2018. It included visits to seven people’s homes (with their permission) and phone calls by arrangement to nine people who used the service, four relatives and nine care staff. We visited the office location on 22 May 2018 to see the registered manager, care manager, a senior care worker and office staff, to review care records and policies and procedures.

Two inspectors visited the office location and made the home visits. An expert by experience and one inspector made phone calls to people who used the service and two inspectors telephoned the members of care staff. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert had experience of services for older people.

The provider had completed a Provider Information Return (PIR) prior to our inspection. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information that we held about the service including notifications made to the Care Quality Commission. A notification is information about important events which the service is required to send us by law.

We contacted the local authority commissioning and safeguarding teams. No concerns were raised with us about Absolute Care at Home. We also contacted Trafford Healthwatch who said they did not have any information about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We looked at six care files at the service’s offices and seven care files in people’s homes. We viewed records relating to the management of the service such as the staffing rota, missed call logs, incident and accident records, five staff recruitment files and training records, meeting minutes and auditing systems.

Updated 28 June 2018

This was a planned inspection and the first day was unannounced. We visited the office location on 22 May 2018 to see the registered manager, care manager, a senior care worker and office staff, to review care records and policies and procedures. On the 23 and 24 May we visited people who used the service in their homes (with their permission) and made phone calls to people who used the service, relatives and members of the staff team.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to 170 older adults in the Trafford area.

CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in place at the service who was also one of the company directors. They had been registered since 2006. 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 in April 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2104. These were in regard to not meeting the requirements of the Mental Capacity Act (2005) where people lacked the capacity to agree to their care and support, the documenting of any medicines administered and the auditing of the medicine administration records (MARs).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At this inspection we found improvements had been made and the Regulations were now being met.

Medicines were administered as prescribed and the MARs were completed by staff. Care plans clearly identified the support people required when taking their medication. MARs were audited each month and a system was now in place to follow up any missed signatures or errors found with the staff member concerned.

Where people may lack the capacity to make decisions about their care and support a capacity assessment was completed. If it was assessed that the person lacked capacity a best interest decision was made, involving the relevant people, for example family members. People’s capacity was re-assessed at each review of their care; however, this was not formally documented. We have made a recommendation to follow best practice guidance for recording all areas reviewed.

People told us the care staff were kind and caring. People felt safe when the Absolute Care At Home staff visited them and said the staff maintained their privacy and dignity when providing support. The staff knew people and their needs well and were able to explain the safeguarding procedures in place if they had any concerns.

Travel time was not built into staff members rotas. Therefore, it was accepted practice that visits were shorter than commissioned to enable staff to travel to the next person’s house. People told us this was not an issue and staff would always ask if there was anything else the person wanted them to do before they left. Staff told us that their calls were all close together so there was limited travel time involved between calls.

People told us there were very few missed calls. The cause of any missed calls was investigated and action taken where required. People told us that their visits could be late and they were not always informed about this. Regular staff supported people, although this was more variable for the evening calls.

There was a safe recruitment process in place. Staff received the induction and training to carry out their role. Staff had regular supervision meetings and an annual appraisal. Regular unannounced spot checks were completed by senior members of staff to check staff members competencies.

Staff were kept up to date with any changes in people’s support needs through the daily notes and a weekly bulletin sent out to all staff by the provider.

People and their relatives were involved in developing and reviewing their care and support plans. They said they received the support they had agreed to.

A system was in place for recording and following up any incidents or accidents. A complaints process was in place and records showed verbal and written concerns were responded to in line with the service’s policy.

The quality assurance system had been improved since our last inspection meaning the registered manager had oversight of the service and acted on any issues found. Surveys were used to obtain feedback about the service. The responses were positive and any concerns raised on the survey returns had been appropriately addressed.