Abacus Homecare

About the service

Abacus Homecare is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection there were 95 people receiving a personal 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 the service and what we found:

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: We found concerns around the care information available to staff to safely manage people’s individual risks. 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; the policies and systems in the service supported this practice. Staff underwent an induction and received a programme of training and supervision. We were informed competency checks were regularly carried out, but this was not always evidenced. People were supported to access healthcare and the provider facilitated appropriate and timely referrals to other agencies and professionals. Medicines were managed safely. Staff used safe infection control practices. Staff recruitment was mostly safe; however, we found some minor shortfalls in practice.

Right Care: People received care from kind and caring staff, and we received positive feedback from people and relatives. Care documentation needed improvements to reflect people’s personal preferences and aspirations. People told us staff knew them well. Staff knew how to protect people from the risk of harm and abuse. Staff treated people well and people told us they were supported to express their views and be involved in their care.

Right Culture: Quality assurance processes were carried out; however, they had not identified and actioned the concerns we found with care documentation. The registered manager listened to concerns and promoted a positive culture that was person-centred, open, and inclusive. Concerns and complaints were listened and responded to. Staff support, teamwork and staff morale was good. Learning was shared from within and outside the organisation and relationships with partner agencies were well established.

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 29 January 2018).

Why we inspected

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

Enforcement

We have identified breaches in relation to individual risk management and management oversight.

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.

Abacus Care is registered with the Care Quality Commission (CQC) to provide personal care and support to people living in their own home. At the time of our inspection 90 people were using the service and being supported in meeting their care needs.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 who used the service and their relatives had a very positive view of the service. People we spoke with told us they felt safe and could trust the care staff to look after them. Comments we received included; "I feel very, very safe. The girls that come round here can be trusted." Others told us; "“[My relative] is very much well looked after, they’re very good indeed.” and "They are respectful to me all the time. I dreaded needing care but it’s a treat when they come round.”

Care workers were aware of their responsibilities to protect people from abuse and knew what to do if they had any concerns to help ensure people were kept safe. People who used the service and their relatives said they felt safe and well looked after.

We found the management and administration of people's medicines were safe. Recent improvements had been made to help reduce the risk of any medication errors and to help ensure people received their medication as prescribed.

Appropriate checks were made on applicants ensuring only those people suitable to work with vulnerable adults were employed. In addition to staff volunteering for extra hours, appropriately trained office staff provided back up when care workers went off sick to ensure there were sufficient numbers of staff to meet people's needs.

Care workers were kept up to date with infection control techniques and provided with appropriate protective equipment to help minimise the risk of cross infection.

Regular care worker meetings were held where incidents and issues were discussed to share good practice and identify where improvements to the service could be made.

People told us they felt involved in planning their care and support and that their choices and preferences were respected. Care plans were written by trained staff ensuring that the person's emotional and cultural needs were taken into account when the plans were being developed.

Care workers told us they felt supported by the service both through formal supervisions and the open-door policy of the service. Staff said they felt comfortable raising any concerns they had with the management and were confident that appropriate action would be taken.

People's food and nutrition needs were assessed when they first received care and were kept under regular review. People who need support to eat are drink were referred to Dieticians and Speech and Language Therapists and had clear care and support plans in place including additional charts to record what food and drink they had to ensure their nutritional and hydration needs were being met.

The service has good relationships with the local authority and other supporting agencies like Age UK ensuring that people can be referred to other appropriate professional services if they have needs that cannot be met by Abacus. An employee of the local authority told us; "The provider is generally proactive in raising concerns or issues regarding care delivery or where there has been an issue about an individual's safety or change in needs."

The service supported people to give up smoking and encouraged the use of electronic cigarettes. In addition to reducing the health risks this would also help to reduce the risk of a potential fire in the home. The service has also helped people get support to reduce their alcohol consumption.

Assessments of people's ability to make choices about their care had been made in line with the Mental Capacity Act and people who lacked full capacity to make all decisions themselves were encouraged to make those decisions they were able to as part of the decision making processes.

People using the service told us they felt the service was very caring and they were encouraged to be as independent as possible. They told us their choices were respected. People said that although they were initially reluctant to have care they now looked forward to the visits and would be happy to have more visits from the service if their needs changed.

Both people who used the service and care workers told us they felt their privacy was protected.

People knew how to raise a complaint and said they would have no hesitation in raising concerns and were confident they would be acted on by the management. This was supported by documentation in the office showing initial action taken in response to complaints as well as follow up action to ensure the concerns had been addressed to the satisfaction of the complainant.

The manager of the service encouraged an open and honest culture where people are free to speak up and raise concerns or suggestions. Staff told us they felt proud to work for the agency. Both care staff and office staff were encouraged to continue their learning beyond the required mandatory training and when there were vacancies in the office for trainers and care planners, these were advertised to care staff first.

The service had recently undertaken a comprehensive internal audit, following which an action plan had been developed and the service was working towards addressing the actions identified.