Absolute Care and Support (UK) Limited

Absolute Care and Support (UK) Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. In April 2023, the service also acquired 2 extra care schemes called Birch Court (20 flats) and Portland House (40 flats) situated in the borough of Stockport. Extra care schemes operate in purpose-built properties, which provide accessible and safe housing for older people to live independently. At the time of the inspection, 18 people lived in Birch Court, 36 people lived in Portland House and 67 people used the domiciliary care service.

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's medicines were not always safely managed. Medicine recording systems were not robust. The service was not following the provider’s medicine policy in relation to ‘as required’ medicines. Although staff received training in administering medicines, they did not always receive a medicine competency assessment [an observation to assess staff competency in administering medicines]. People were protected from the risks of abuse and staff were trusted to keep them safe.

Auditing systems were not always robust and auditing processes had not picked up on the discrepancies we found during this inspection. In both of the extra care schemes, there was a lack of governance, leadership and auditing systems.

The provider had systems in place to monitor staffing levels. An electronic system was used to determine staffing levels, issue staff rotas and deploy staff to people’s care visits. However, staff rotas showed travel time was not always allocated between calls. We received mixed feedback from people about them receiving regular staff for their care visits.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the systems in the service did not always support this practice. There was limited information about people's cognition and mental capacity in their care plans and the provider had no specific mental capacity assessments in place. We have made a recommendation about the provider reviewing their systems in place to work within the principles of the Mental Capacity Act (MCA).

Staff had received an induction when they first started working at the service and mandatory training relevant to their roles had been provided. However, there was a lack of training completed related to people's specific conditions. We have made a recommendation about the provider reviewing their training systems. People told us staff were on time for their visits, and if on occasions staff were delayed they were informed.

People's rights were promoted. People were treated with dignity and privacy. Staff had received training in equality and diversity, and they were committed to ensuring people were treated well. People’s views and decisions about care were incorporated when their care packages were devised. People’s independence was encouraged where possible.

People and their relatives told us they were involved in the care planning, which was reviewed regularly. People and their relatives told us the care provided met people’s needs. People’s communication needs were met. Care plans did not contain people’s end of life wishes. The registered manager assured us they will update people’s care plans to incorporate their end of life wishes for those who wanted to disclose them.

The culture was open and inclusive. Staff said they enjoyed their roles and liked the company they worked for.

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 good (published 26 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified a breach in relation to good governance.

We have made recommendations about the provider reviewing their systems in place to work within the principles of the MCA and about the provider reviewing their training systems.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going 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. At this inspection we found the service remained Good overall. There were no breaches, the service met all relevant fundamental standards and exceeded these in the responsive key-question.

People told us they felt safe receiving care in their homes and they did not have any concerns about the care they received. Care workers, office staff and management were knowledgeable in what constituted abuse and their responsibilities in reporting any concerns they had internally and externally to local safeguarding authorities.

Care records and care plans were personalised to each individual and contained information to assist care workers to provide personalised care in a way people wanted and needed. The service operated a matching service where care workers with similar interests, hobbies and personalities were matched to people; therefore people mostly received consistent care and support from the same care workers. All people spoken with agreed they always received support from care workers they knew well.

Recruitment procedures were in place ensuring only those applicants suitable to work with vulnerable people were appointed. Sufficient numbers of staff were available to support the individual needs of people.

Care workers were passionate about their role and felt very responsible for the people they cared for. They had a very good knowledge and understanding of people's care needs, interests and how they liked their care to be provided. They spoke warmly about the people and their families who used the service and it was clear from our conversations with people that people liked and trusted them and were at ease in their presence.

People we spoke with and their relatives told us the care workers went above and beyond what was expected of them. The service had gone the 'extra mile' by considering the needs of people using the service and their relatives by promoting and developing positive relationships with them.

People and their relatives were actively encouraged to make their views known and were involved in making decisions about their care. Care workers had a very good understanding about what was important to people and went out of their way to ensure people's needs and wishes were met.

Policies and procedures were in place and were kept under review. The provider was in the process of sourcing new policies that were geared more towards domiciliary services. Existing policies and procedures helped guide the actions of all individuals involved in the service and provided consistency in all practices carried out within the service.

The provider had up to date complaints and whistleblowing policies and procedures which gave information for staff to follow and time scales to adhere to. This helped to assure people and care workers that their concerns were taken seriously and would be addressed quickly.

Quality assurance systems in place helped to monitor the quality of service people received. The provider undertook various audits which the managing director used to continually scrutinise all aspects of the business.

The registered manager and registered provider recognised staffs caring attributes through observations of staff practices and behaviours and operated an employee reward scheme to acknowledge staff loyalty. This helped the staff team to feel valued and maintain a good standard of care.

People told us were treated with respect and dignity by the staff. People told us they felt safe whilst their care was being provided. They said that staff understood how to safeguard the people who used the service.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, and whistleblowing. This reduced the risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). No applications have been submitted to CQC.

We saw records to show that recruitment practice was safe and thorough. A range of policies and procedures were in place to make sure unsafe practice was identified and people were protected.

Is the service effective?

People's spoken with told us that their health and care needs were assessed with them.

We saw that people's mobility and equipment needs had been identified in the person's care records where required.

Relatives spoken with confirmed they were always welcomed by accommodating and supportive staff.

Is the service caring?

People spoken with told us they were supported by kind and attentive staff. People said, 'I can't say anything other than brilliant', 'They are very flexible' and 'I have increased our hours with this company, they are spot on'.

People told us that the service regularly checked on the quality of the service they provided with people who used the service. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People spoken with were aware of the complaints procedure but had never had cause to complain. They told us that they felt assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw records to show that the service worked well with other agencies and services to make sure people received the care they required.

The service had a quality assurance system. Records seen by us showed that the service had not formally implemented the system because they had not been operating for a year. However the manager told us that a spot check system would ensure the quality of the service was continuingly improving.