Archived: Abicare Services Ltd

Updated 14 October 2015

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 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.

The inspection took place on 19, 20, 21 and 24 August 2015 and was announced. The provider was given 48 hours notice of the inspection to ensure that the people we needed to speak with were available. The inspection team consisted of two inspectors 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. The expert by experience had personal experience of community services providing care in people’s homes for older people.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.

Prior to the inspection we reviewed information held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law. We also reviewed the provider’s website, local authority contract monitoring reports and spoke with the commissioners of the service.

During the inspection we spoke with the area manager and the managing director who was also the nominated individual with overall responsibility for supervising the management of the service. We also spoke with the training manager, a community team leader, three community team supervisors and the administrator. We spoke with 35 people on the telephone to find out about their experience of the quality of care provided by the service and 12 other members of care staff.

We reviewed 17 people’s care plans and nine care staff recruitment and supervision records. We also looked at information relating to the management of the service, which included audits of the service and the provider’s policies and procedures.

We visited eight people in their own homes. We spoke with them about their care and looked at their care records. We observed some aspects of care, such as care staff preparing people’s meals and supporting them to move. During the home visits we spoke with two further care staff. Following the home visits we spoke on the telephone with two health and social care professionals and the local authority care commissioners.

This was the first inspection of the service since it was registered on 23 June 2014.

Updated 14 October 2015

We conducted this announced inspection on 19, 20, 21 and 24 August 2015 in response to concerns that had been raised regarding the quality of care being provided by Abicare, particularly the high volume of missed calls

Abicare provides a domiciliary care service to enable people living in Basingstoke, Aldershot and Farnborough and the surrounding areas to maintain their independence at home. There were 168 people using the service at the time of the inspection, who had a range of physical and health care needs. Some people were being supported to live with dementia, whilst others were supported with specific health conditions including Multiple Sclerosis and Huntington’s disease. At the time of the inspection the provider deployed 58 care staff to care for people and meet their individual needs.

At the time of our inspection the service had a registered manager but they were not actively managing the service. 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. During our inspection the provider’s area manager was covering for the registered manager, who was absent due to illness. We were informed by the provider that the registered manager had resigned from their position on 16 July 2015. Our records confirmed that the registered manager began the process to become deregistered on 19 August 2015.

People were not always protected from abuse and avoidable harm. Where abuse had been identified the provider had not taken immediate steps to prevent the abuse or taken action to ensure the abuse was not repeated.

The Provider had not ensured people were safe because they had not always provided care and support in accordance with people’s individual care plans. People who required two care staff to support them with moving and positioning frequently had just one member of care staff attend to them, thereby placing people and care staff at risk of physical harm.

We found that the provider had not ensured that people had been protected from the risks of unsafe care because people’s needs had not been appropriately assessed and reviewed. Care plans did not contain enough detail to enable staff to meet the individual needs and preferences of people. Where risks had been identified care staff did not always deliver care in accordance with the risk assessment management plans to keep people safe.

There were not enough staff to meet peoples’ needs. People we spoke with were frustrated at the high level of missed and mistimed calls. The area manager told us this was because the provider did not have sufficient numbers of suitable staff to keep people safe and meet their needs. Committed care staff told us they were working extensive hours and were always stretched to the limit. The provider was actively recruiting more care staff, although current care staff were disillusioned and continuing to leave.

The provider did not have a robust selection and recruitment process and had employed care staff without obtaining all of the relevant information to ensure they were suitable to provide care and support to vulnerable people.

People did not always receive their prescribed medicines safely. Relatives told us that care staff were often in a hurry and did not always ensure people living with dementia had taken their medicines. This meant that people were at risk of harm from not taking their prescribed medicines.

People were not supported to have their assessed needs met by staff with the necessary skills and knowledge. People were sometimes mobilised without the correct equipment and advice from health professionals was not always followed.

Most people told us they were able to see other health professionals and that care staff knew about their appointments and supported them with these where required. Care staff had recognised changes in people’s needs and raised concerns about their health with the office staff who then referred them to other professionals. However, some care staff were concerned that when they informed the office about people’s changing needs nothing would be done until formal complaints were raised by the person or their relatives. The service was not responsive to people’s changing needs.

Positive and caring relationships which had been developed with continuity of care staff were being undermined by chaotic rostering. People told us that they thought most of the care staff were kind and caring but the office staff were unfriendly and often rude. People told us that they were asked about their support and were involved in making decisions about their care and treatment. Some people told us they were not always spoken to in an appropriate manner and they were not always respected by the care staff.

Care plans were generic and focused on tasks, which did not reflect the different needs of each individual. The process for reviewing care plans did not make sure that people’s care was reviewed regularly and changes were not always recorded in people’s care plans or updated in a timely manner. This meant the provider could not be assured that care staff had the correct information and guidance about how to care for people based on their current needs.

People had experienced missed and mistimed calls which often led to them not being able to attend social events at day centres and different activities they enjoyed. They told us this had a big impact on their well-being and left them feeling lonely.

The provider did not routinely listen and learn from people’s concerns. Numerous complaints had been made to the CQC and the local authority because people had become frustrated with the lack of response to their complaints by the provider. The provider did not ensure care staff were supported or listened to, in order to drive improvements in the service.

Care staff told us the atmosphere in the office was not very friendly and at times openly hostile. Care staff were concerned about communication within the office due to the lack of action taken when they had raised concerns. Care staff told us there was chaos and confusion in the office. Without exception people told us the service was poorly managed and lacked leadership. People were disillusioned with the management of the service due to concerns regarding missed and mistimed calls. These concerns were then exacerbated by repeated failure to respond to complaints.

Quality assurance systems were in place but had not been operated effectively, which meant the provider had not identified the concerns discovered during our inspection. Failure to assess and monitor the quality of service meant the provider was unaware of areas that were inadequate and had not taken action to address them.

People were not always supported to have enough to eat or drink. Due to the high volume of missed and mistimed calls people often did not choose to eat as the time was not appropriate for them to eat/ wish to eat or drink anything, or were eating at the wrong time. People regularly experienced late breakfast calls followed shortly by early lunchtime calls. Relative’s whose loved one’s lived with dementia told us they had raised concerns with the provider because care staff were accepting their family member’s first response, rather than encouraging them to eat or offering alternative options.

Care staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by care staff when decisions were made on their behalf. The service had obtained consent from people before providing their care, which had been confirmed by people we spoke with or their relatives.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During the inspection we identified a number of serious concerns about the care, safety and welfare of people who received care from the provider. We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.