Absolute Home Care Nottingham Limited Also known as Arnold Home Care

Absolute Home Care Nottingham Limited (also known as Arnold Home Care) is a care at home service. Not everyone who uses care at home services receives personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

We visited the provider’s registered office at 106A-116A Front Street, Arnold, Nottingham NG5 7EG on 9 May 2023. We were unable to access the premises as the entrance was boarded up. There was no sign at the office to tell us where the provider had moved to.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 12 October 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We received concerns in relation to the quality and safety of people’s personal care. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Absolute Home Care Nottingham Limited on our website at www.cqc.org.uk.

Follow up

Full information about CQC’s regulatory response is added to reports after any representations and appeals have been concluded.

Absolute Home Care Nottingham Limited (also known as Arnold Home Care) is a care at home service providing personal care to 14 people at the time of our inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People and relatives had mixed views about the management of the service. Checks and audits on the quality and safety of the service were not consistently effective. The registered manager's checks had not identified the shortfalls found during the inspection. Further improvements were needed to identify and address the issues we identified in Safe section of this report, particularly in relation to staff training.

People had mixed views about staffing. Whilst they all felt there were enough staff employed, we received feedback that care calls were not always at the times agreed, and that staff did not always have the skills and experience to support people safely. The provider did not confirm that they carried out appropriate checks before employing staff.

Accidents and incidents were individually reviewed. However, the provider did not always carry out any overall monitoring to identify trends and to prevent reoccurrences.

Risks to people in relation to their personal care were managed safely. Staff were knowledgeable about what support people needed to keep them safe and to reduce the risk of accidents and incidents. The provider had a policy on safeguarding people from the risk of abuse, and staff confirmed they knew how to recognise and report concerns in relation to abuse.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 31 July 2021). At that inspection we found two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the quality and safety of people’s personal care. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Absolute Home Care Nottingham Limited on our website at www.cqc.org.uk.

Recommendations

We recommend the provider reviews people’s call times to ensure that people are supported with their medication as prescribed, including for time-sensitive medications.

We recommend the provider considers how to use feedback to inform their service action plan to improve quality of care.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and phone calls to engage with people using the service as part of this performance review and assessment.

Absolute Homecare Nottingham Limited is a domiciliary care agency, providing personal care to people living in their own homes. There were 32 people receiving personal care at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

There remained little analysis of incidents and accidents. Management had no oversight of this, and information was not analysed to pick up themes and trends. However, management were working towards having systems and processes to improve overall management of the service.

Medicines management had improved since our last inspection and regular medicines audits were conducted by management. However, there were further improvements required in the management of medicines prescribed to be taken ‘as required’.

Care records had improved; however, some risk assessments had been placed into care plans even when they were not relevant to that person. Further work was required to make risk assessments more person-centred as, although risk management had improved, some people’s risk assessments still lacked detail.

Governance had improved, and we could see that tasks were delegated, by the registered manager, to others in the management team to ensure a better management oversight. However, further improvement was needed as there remained a lack of scrutiny by management. This included oversight of incidents, accidents, and complaints. We discussed this with the management team, and they were responsive and were implementing changes and improvements during the inspection.

Staff training had improved, and we could see that mandatory training had been completed by staff and supervision and appraisals were being carried out more frequently. However, training in specific health conditions had not been carried out in all cases. Staff were recruited safely.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 9 November 2020). There were breaches in Regulation 12 (Safe Care and Treatment). Regulation 13 (Safeguarding People from Abuse and avoidable Harm) Regulation 17 (Good Governance) and Regulation 19 (Fit and Proper Persons) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that not enough improvement had been made and the service remained in breach of Regulation 12 and 17.

At this inspection, we found that enough improvement had been made and they were no longer in breach of Regulations 13 and 19.

Why we inspected

We undertook this focussed inspection to check whether the Warning Notice we previously served in relation to Regulation 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to check the previous breach of Regulation 13 (of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has improved from inadequate to requires improvement.

This service has been in Special Measures since 9 November 2020. During this inspection the provider demonstrated that improvements have been made. The rating awarded at this inspection was ‘requires improvement’ because the service had not yet demonstrated improvements made were fully embedded or could be sustained. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Absolute Homecare Nottingham Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Absolute Home Care Ltd is a domiciliary care agency, providing personal care to people living in their own homes. There were 33 people receiving personal care at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People using the service were at risk of harm due to concerns identified around poor medicines management which was not always safe.

Staff were not always recruited safely and the provider did not always follow its recruitment policies and procedures.

Care records did not contain sufficient information and guidance to enable staff to support people in a safe way. Risk management was not always in place for falls, pressure area care, catheter care or choking.

Although staff told us the training was good, it was unclear if staff had received adequate training for their roles. Training records were out of date, and there were gaps in some staff training records. There was a lack of competency assessments, supervision and spot checks recorded.

Governance arrangements did not provide assurance that the service was well-led. The provider had not ensured that their systems and processes to monitor the quality of care was effective.

There was a lack of analysis of incidents and it was not clear that lessons learnt and improvements were made when things went wrong. It was not clear if the service told people and their families when things went wrong.

Positive feedback was received from people and their relatives about the service and its staff. Staff were positive about the service and support from the management team.

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

Rating at last inspection: The last rating for this service was requires improvement (published 4 April 2019) and there were multiple breaches of regulation. At this inspection we found similar concerns as highlighted at the last inspection. Ineffective action had been taken to improve the service and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines, assessment of risk, reporting of incidents, recruitment processes, and a recent fall. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. We identified breaches in relation to medicines, recruitment, risk assessment, record keeping and improving the quality of the service at this inspection. The provider immediately took action to mitigate the risks identified and has produced an action plan to make immediate improvements.

You can see what action we have asked the provider to take at the end of this full report

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Absolute Home Care Nottingham Ltd on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to risk management, safeguarding people from harm, staff training and recruitment , and good governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take-action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service:

People felt safe with the staff that cared for them. Safeguarding systems were in place, but not all safeguarding’s concerns were reported appropriately. Safeguarding was not always given a priority.

Risks associated with people’s needs had been assessed and planned, but not all risks had been identified. There was a lack of clear guidance available for staff.

Care and support was not always planned and delivered efficiently to ensure people received effective care. Staff rotas were not planned in advance. Staff were knowledgeable about the people and their needs, but we found gaps in the training matrix. We could not tell if staff had completed any recent training with the company or attended relevant refresher courses. The training matrix was not fully up to date, however people described staff as being experienced and competent.

People were very positive about the care they received and the approach of staff. However, staff did not always stay for the duration of the call and if they were running late, they did not always inform people of this. Some people received care from regular staff and they had developed positive relationships with them, but other people had experienced late calls.

Staff received supervision and opportunities to review their work. Robust recruitment was in place and staff completed relevant checks to ensure they were safe to care and support people.

Where people required support for their medicines These were administered safely. There was evidence that incidents and concerns were investigated.

People said the service was not constantly well led. There were times when people felt the register manager was not good at responding when contacted. The culture of the service was not always open and transparent. The registered manager kept information close to hand and had a limited approach to sharing information with others. The electronic system used to monitor calls and care provided was not monitored efficiently. Communication with people was limited as people did not always know who was attending their care call.

Measures were in place so that people were protected from infections. Staff used personal protective equipment and were aware how to protect people from the spread of infection. Staff had completed food hygiene training and followed procedures wherever food was prepared and stored.

People were treated with kindness and compassion. Feedback from people reflected they were treated with dignity and respect. There were clear systems and processes to refer people externally to other services.

People knew how to raise a complaint or concern. People were not confident if they had to raise concerns or complaints the manager would always act upon their concerns. Staff were aware of people’s life history and preferences and they used the information to develop relationships and deliver person centred care. There were systems in place to record and plan people’s end of life care, but these plans were not required at the time of our inspection.

Rating at last inspection: Good date last report published 28/08/2018

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw the service had deteriorated since the last inspection. This meant the service required improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the environment. Details of action we have asked the provider to take can be found at the end of this report.

The service had a registered manager. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe using the service and felt safe with the support workers who supported them. Relatives we spoke with agreed with what they told us. The staff team understood their responsibilities for keeping people safe from avoidable harm and knew to report any concerns that they had to the management team.

The management team knew their responsibilities for keeping people safe from abuse and avoidable harm. This included reporting any concerns to the local safeguarding authority and CQC.

People's care and support needs had been identified and the risks associated with those needs had been assessed and managed.

Plans of care had been developed for the people using the service. The staff team knew the needs of the people they were supporting, including their likes and dislikes and personal preferences.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to check that they were suitable and safe. Once employed, support workers had been provided with an induction into the service and relevant training had been completed.

People we spoke with felt there was a sufficient number of staff on duty each day because their care and support needs were being met. Their relatives agreed with what they told us though some felt that more support workers would be of benefit.

People we spoke with told us that they had regular support workers who, on the whole, arrived on time and stayed the right amount of time. Nobody felt rushed by the support workers who visited them.

The staff team felt supported by the registered manager and the management team. They explained that they were given the opportunity to meet with them on a regular basis and there was always someone available to talk to if they had any concerns or suggestions of any kind.

For people requiring support with their medicines, support workers had received the relevant training. This made sure that people were supported safely.

Support workers obtained people's consent before they provided their care and support. Training on the Mental Capacity Act 2005 (MCA) had been provided and both the management team and the support workers we spoke with understood its principles.

People's health and well being was being monitored daily. They were supported with their nutritional needs and were supported to access health services when they needed them.

People told us that the staff team were kind and caring. They told us that they were provided with choices when they were being supported and their care and support was provided in a way they preferred.

People using the service and their relatives knew what to do if they were unhappy with the service they received. They knew who to speak with if they had a concern and were confident that any concerns would be dealt with properly and promptly.

The registered manager and the management team monitored the service being provided on an on-going basis. This was to make sure that people received the care and support they required. A business continuity plan was in place for emergencies or untoward events.

The management team were aware of their registration responsibilities including notifying the Care Quality Commission of significant incidents that occurred at the service.