Archived: Absolute Care Services (Sutton)

• Absolute Care Services (Sutton) is a domiciliary care agency that provides personal care to people living in their own houses and flats in the community. CQC only inspects the service being received by people provided with ‘personal care’, that is help with tasks related to personal hygiene and eating. Where they do this, we also take into account any wider social care provided. At the time of our inspection there were 76 people using the service.

People’s experience of using this service:

• People said staff were caring and supported them in a dignified, respectful way which maintained their privacy and independence.

• People’s views were sought to help the provider plan and deliver care that was tailored to their needs.

• People’s records contained up to date information for staff about how their care should be provided in a way that not only met their needs but kept them safe. People told us staff were able to meet their needs and respected their preferences and choices about how their care and support was provided.

• People said they felt safe with staff who understood the risks to their safety and wellbeing. Staff followed good practice to minimise risks from poor hygiene and cleanliness when providing personal care and when preparing and handling food. Staff knew how to safeguard people from abuse and how to report any concerns to the appropriate individual and/or authority.

• Staff asked for people’s consent before providing any support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

• People were supported to stay healthy and well. Staff helped them to eat and drink enough to meet their needs and to take their prescribed medicines. Staff sought extra help and support for people if they need this, for example when they became unwell. They worked with other healthcare professionals to ensure a joined-up approach to the care people received.

• There were enough staff to support people. The provider made sure staff were suitable to support people through their recruitment and selection practices. They gave staff relevant training to help them meet people’s needs and supported them to continuously improve their working practices.

• People knew how to make a complaint if needed and the provider had arrangements in place to deal with this. The provider recorded and investigated any accidents and incidents that occurred, and kept people involved and informed of the outcome. Learning from complaints and investigations was shared with staff to help them improve the quality and safety of the support they provided.

• The service had a new manager in post. They, and staff, were well supported by the provider who made sure they had clearly defined roles and responsibilities for delivering high quality care and support to people.

• The provider had improved those areas of the service where we had previously found concerns. We saw positive changes made to systems for reporting notifications, staff recruitment, medicines audits and arrangements for scheduled visits to people.

• The provider was continuing to improve the quality and safety of the service and sought people and staff’s views about how they should do this. New technology was being introduced at the service that would give people more access to information about their support. This would also provide staff instant information about the support provided to people to help them monitor that people were getting the right care and support at the right time.

• The provider worked in partnership with other agencies such as local authorities funding people’s care to develop and improve the support provided.

Rating at last inspection:

• At the last inspection the service was rated ‘Requires Improvement’ (18/04/2018). At this inspection we found the service meet the characteristics of a good service. The service rating has improved to ‘Good’.

Why we inspected:

• This inspection was planned based on the previous rating of ‘Requires Improvement’. In these instances, we return to a service within 12 months of the publication of the last report to check that the service had taken the action needed to improve.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule or in response to concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

This inspection took place on 21, 22 and 23 February 2018 and was announced. At our last comprehensive inspection of the service in January 2016 the service was rated ‘good’ overall and ‘requires improvement’ in our key question “is the service well led?” Although we did not find the provider in breach of legal requirements at that time we found some people using the service had concerns about the quality of communication when there were changes to the service and about the consistency and continuity in staffing levels.

At this inspection we found some improvement had been made as people’s feedback indicated they were now more satisfied with the support they received from regular, familiar staff. However people using the domiciliary care service in the community were less satisfied with support they received from staff at weekends, who they were less familiar with. People who lived in the extra care housing schemes had more positive experiences and told us they were supported by regular and familiar staff which helped build and maintain continuity and consistency in the support they received.

We received mixed feedback from people about the length of time staff spent with them during their scheduled visits. People using the domiciliary care service in the community were less satisfied with this aspect of the service. However people who lived in the extra care housing schemes gave us positive feedback about this aspect of the service. The provider was aware of the concerns people had and an action plan was being developed in response to people’s feedback to address the inconsistencies in these aspects of the service.

Some people told us aspects of the communication they received from the service needed to improve. People using the domiciliary care service in the community told us they often did not receive a rota in advance of scheduled visits to advise them who would be coming to provide them with care, particularly at the weekend. This lack of information from the service had made some people using the service anxious about who they might get to provide their care and support.

The service continued to have a registered manager in post. We found the registered manager had not met their legal obligation to submit notifications to CQC of events or incidents involving people at the service. Failure to notify CQC of these incidents meant we could not check that the provider had taken appropriate action to ensure people's safety and welfare in these instances. The provider took steps during this inspection to ensure senior staff understood the legal requirement to report these incidents to CQC.

People were safe when being supported by staff. Staff had access to appropriate guidance on how to minimise identified risks to people due to their specific needs to help keep people safe from injury or harm in their home and community. Staff were supported to take appropriate action to ensure people were protected if they suspected they were at risk of abuse.

There were enough staff to meet people’s needs. The provider carried out appropriate checks on their suitability and fitness to support people. Staff had relevant training and were well supported by senior staff to meet people's needs. They said senior staff were approachable and dealt with their concerns appropriately.

People contributed to the planning of their care and support. People’s needs and specific preferences for how they wished to be cared for and supported were set out in their personalised support plan. Senior staff reviewed people’s care and support needs regularly to ensure staff had up to date information about these.

People said staff were able to meet their needs. Staff demonstrated a good understanding about people’s needs and how these should be met. Staff were helpful and attentive. They provided people with support that was dignified, respectful and which maintained their privacy at all times. They prompted people to be as independent as they could and wanted to be.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff received training in the MCA and were aware of their responsibilities in relation to the Act. Records showed people’s capacity to make decisions about aspects of their care was considered when planning their support.

People were encouraged to eat and drink sufficient amounts to meet their needs. Staff supported people to take their prescribed medicines when required. Staff monitored and recorded their observations about people’s general health and wellbeing and shared this information with all involved in people’s care. When they had concerns about people they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

Overall, people were satisfied with the care and support they received. People knew how to make a complaint if needed and the provider had appropriate arrangements in place to deal with these. The provider promoted a culture of openness and transparency within the service. They sought people’s views about the quality of support provided and how this could be improved. Senior staff used this information along with other audits and checks to monitor and review the quality and safety of the support provided. We found some gaps in medicines administration records (MARs) maintained in respect of people using the domiciliary care service in the community. Senior staff assured us this issue had been addressed and a new system of checks had been introduced to help improve their ability to address identified issues more quickly.

The provider made improvements when these were required to enhance the quality of the service. We saw a new ‘on call’ service had been introduced, the service’s policies and procedures had been updated to inform staff in current best practice and national guidance and changes had been made to the management structure which meant there was improved leadership across all aspects of the service to respond to issues and concerns as they arose.

The provider used learning from complaints and incidents to improve the quality of support people experienced. For example, they had identified staff would benefit from additional coaching and support on how to develop and maintain professional boundaries with people they supported. The provider worked in partnership with other agencies such as the local authority to develop and improve the delivery of care to people. Following an incident involving a person using the service the provider had worked with the local authority in ensuring an appropriate policy and procedure was in place for staff to follow if they were unable to make contact with a person when attending a scheduled visit.

At this inspection we found the provider in breach of legal requirements with regard to notifications of other incidents. You can see what action we told the provider to take with regard to this breach at the back of the full version of the report.

Absolute Care Services (Sutton) is a large domiciliary care agency which provides personal care and support to people in their own homes. People either pay for their own care or are funded by their local authority. The service also has contracts to provide personal care to approximately 80 people living in extra care housing schemes within the London Borough of Sutton. These schemes are operated by independent housing providers.

At the time of our inspection there were approximately 180 people in total using the service. People who use the agency include older people and younger adults with disabilities. Their range of needs include those associated with dementia, mental health, sensory impairment, palliative care and learning and/or physical disabilities.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

People had mixed views about the management of the service. People with poor perceptions of the service said there was a lack of communication about changes and no consistency and continuity in staffing levels. Other people were satisfied and spoke positively about the care and support they received.

The service had received a number of complaints from people over the last twelve months. The majority of these arose following significant changes at the service during this time. Senior staff had taken action to deal with people’s concerns appropriately. This included addressing issues around staffing and improving the timeliness of scheduled visits. Some people confirmed things had improved. However others felt they had not. It was too early to judge at the time of this inspection whether these improvements had improved outcomes for all of the people using the service.

The provider was committed to ensuring people experienced good quality care. A new staffing structure improved accountability and responsibility at all levels. Specific issues and concerns could be readily dealt with by an appropriate, responsible member of staff. All staff were aware of their responsibilities for ensuring people received good quality care. They were encouraged to report poor practices by reporting these immediately to senior staff, or anonymously through the provider’s whistleblowing procedure.

Senior staff monitored the quality of the service. Through their checks, people were asked for their views on how the service could be improved. When issues were identified through these checks appropriate action was taken to make improvements. The provider used learning to continuously improve the service. Feedback from people’s complaints had been used to address shortfalls and gaps in the care and support people experienced. The provider worked closely with the local authority contracts team to address any concerns or issues about the service and to identify improvements that were needed. Following a recent CQC inspection of one of their other services, the provider had improved management monitoring arrangements to enable staff to react quicker when shortfalls or concerns were identified.

People and their relatives told us they felt safe with the care and support provided by the service. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse and not harmed by discriminatory behaviour or practices. Risks to people’s health, safety and wellbeing had been assessed by senior staff. Staff were given guidance and instructions on how to minimise any identified risks to keep people safe from harm or injury. Staffing levels were continuously monitored by senior staff to ensure people’s needs could be met at all times.

The provider ensured people were supported by staff that were suitable and fit to work for the service. The provider had robust recruitment procedures and carried out employment and criminal records checks on all staff. Staff received relevant training to meet people’s needs. Senior staff monitored training to ensure staff’s skills and knowledge were kept up to date.

Not all staff had received recent supervision so that they were appropriately supported in their roles to care for people. Senior staff had taken action to remedy this. Meetings had been scheduled to take place in the coming weeks to bring these up to date. Staff said they were well supported by senior staff and felt able to discuss any issues or concerns they had. They were asked for their views and suggestions about how the service could be improved.

People told us their views were taken into account when staff assessed their care and support needs. Each person had a support plan which was reflective of their specific needs and preferences for how they wished to be cared for and supported. People said staff had a good understanding of their needs and how these should be met. Senior staff reviewed people’s needs regularly to ensure staff had up to date information about people’s current care and support needs.

Where the service was responsible for this, people were encouraged to eat and drink sufficient amounts to reduce the risk to them of malnutrition and dehydration. They received their medicines as prescribed. Staff monitored people’s general health and wellbeing. Where they had any issues or concerns about this they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

People told us staff looked after them in a way which was kind, caring and respectful. People’s right to privacy and dignity was respected and maintained by staff, particularly when receiving personal care. People were encouraged to do as much as they could and wanted to do for themselves to retain control and independence. People were supported, where the service was responsible for this, to take part in activities at home or out in the community.

If people were unhappy with any aspect of the service they knew how to make a complaint if needed. The provider ensured all information was easily accessible to people and was able to provide this in different formats to meet people’s specific communication needs.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff received training in the MCA so they were aware of their roles and responsibilities in relation to the act. Records showed people’s capacity to make decisions about aspects of their care was considered when planning their support. Where people lacked capacity to make specific decisions there was involvement of their relatives or representatives and relevant care professionals to make these decisions in people’s best interests.