This announced inspection took place on 24, 25 and 30 May 2017. Abicare Service Ltd provides a domiciliary care service to enable people living in Basingstoke, Aldershot and the surrounding areas to maintain their independence at home. At the time of our inspection there were 66 people using the service, who had a range of health and social care needs. Some people were being supported to live with dementia and autism, whilst others were supported with specific health conditions including epilepsy, diabetes, learning disabilities and mental health diagnoses. At the time of the inspection the provider deployed 25 staff to provide 520 hours care per week to meet people’s assessed needs.At the time of the inspection the service had a registered manager, however they had recently tendered their resignation. 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 were kept safe as staff understood their role and responsibility in relation to safeguarding procedures. Staff had undergone safeguarding training and understood the different types of abuse and how to recognise signs of such abuse.
Risks to people had been initially assessed and control measures put in place to minimise their occurrence. However, these were not reviewed regularly to ensure the most up to date guidance was provided to staff. This meant the provider could not be assured that all risks to people were being managed appropriately to keep people safe. One person had experienced a fall whilst being supported by staff which demonstrated staff did not always consistently apply safe moving and positioning practices. The registered manager had identified that some people’s risk assessments had not been regularly reassessed and was in the process of ensuring this work was completed as a priority.
The registered manager completed a daily staffing needs analysis to ensure there were sufficient staff deployed to meet people’s needs. However, this frequently required the registered manager, care coordinator and community team leaders to work overtime to provide hands on care, which deflected them from other responsibilities, such as reviewing care plans and risk assessments.
Records demonstrated the service had a recruitment process that met legal requirements and recruitment files confirmed that most required pre-employment checks had been completed. However, the provider had not consistently followed their own recruitment processes and taken appropriate action to assure themselves that staff employed were of suitable character to support people safely.
People’s medicines were administered by suitably trained staff, although the provider had not consistently assured their knowledge and skill to do so had been maintained.
The provider’s required training had not been updated in accordance with the provider’s policy. This meant that the provider had not ensured staff were supported to maintain their skills at the required standard to meet people’s assessed needs effectively.
People’s care and support was always provided with their consent, although records did not always clearly reflect this. The registered manager and staff ensured best interest meetings and processes were followed to protect people’s human rights.
Staff encouraged people to eat and drink sufficiently to maintain their health.
People and their relatives had a mixed experience in relation to the caring attitudes of the staff supporting them. Regular staff were caring and compassionate and treated people with respect although some staff were task focused and did not show an appreciation of the need to meet people’s emotional wellbeing.
People were involved in making their decisions and planning their own care and support. If they were unable to do this, where appropriate, their care needs were discussed with their relatives or representatives. Regular staff treated people with dignity and respect. However this was not always demonstrated when people’s regular staff were not available to deliver care.
People’s care plans were not person centred and did not contain sufficient information relating to their personal histories, individual preferences, interests and aspirations. Regular staff knew such information. However when regular staff were not available other staff may not be aware of this information. This meant that the provider could not be assured that all people’s needs were always being met.
People’s care needs had not consistently been reassessed regularly which had resulted in their care plans being out of date. This placed people at risk of receiving inconsistent care and/or not receiving the care and support they need.
The provider had processes for seeking feedback in various ways such as quality assurance visits, telephone surveys and questionnaires. However these processes had not been completed effectively.
People had a copy of the provider’s complaints procedure in a format which met their needs and knew how to make a complaint and raise any concerns about the service.
People and staff had experienced poor leadership and management until the appointment of the current registered manager in January 2017. However, the service was now demonstrating signs of improvement due to the commitment and dedication of the registered manager and their management team. The registered manager had created an open positive culture within service, which was supportive and inclusive.
The provider had quality assurance systems in place but these had been inconsistently applied since the service began, which meant they had failed to address the concerns identified in this inspection. The provider’s leadership was reactive rather than proactive.
We found one breach of the Health and Social Care Act (2008) Regulated Activities 2014. You can see what action we told the provider to take at the back of the full version of this report.