The inspection took place on 8, 9 and 18 October 2018 and the first day was unannounced. The service was last inspected in March 2018 and was rated ‘Inadequate’ overall.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, younger adults with a disability and children. At the time of this inspection the service was supporting 44 people.

Not everyone using Abbey Nursing and Care receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a manager in post who had been registered with CQC since October 2010. 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 and their relatives told us they received care and support that was safe.

Recruitment processes had improved. All relevant documentation was collected prior to staff commencing employment. Where required risk assessments were completed to ensure staff were suitable to work with vulnerable people. But control measures in place to reduce risk had not been carried out as stipulated.

Most people were supported safely because the provider had assessed the risks involved and staff had sufficient details and guidance to carry out their duties safely. We found one example where no guidance had been developed and the registered manager addressed this issue during the inspection.

People using the service were protected from harm due to the agency’s reporting systems and staff knowledge. Staff were well-informed about the types of abuse and the action they would take if they suspected that abuse was taking place.

People were supported by staff who knew and understood their needs. People and their relatives told us they had consistent staff supporting them. People told us staff most times arrived punctually for their visits and they were informed if staff were running late.

People told us staff had good hygiene practices and wore personal protective equipment (PPE) when carrying out their duties. This should help to ensure that people were protected from the risk of infection.

Where required, people were supported to take their medicines safely. Staff had the relevant training and competencies to administer medication safely and recorded these appropriately.

Staff had the right knowledge and skills and received continuous support to function in their caring role. People and their relatives told us staff did their jobs effectively. Staff received an induction and mandatory training prior to working with people. There was evidence that all staff were supported with ongoing training including refresher training as required. However, we found two examples where staff should have completed refresher training in one topic area but there was no record of this. Staff received regular supervisions and appraisals to help ensure they received the necessary support to carry out their roles.

People’s rights were protected because the service worked within the principles of the Mental Capacity Act (MCA). Staff sought people’s consent before undertaking tasks. Care records we looked at contained evidence that people had consented to the care they received.

Where assessed as a need, people were supported to maintain good nutrition and hydration. Everyone we spoke who required this support told us they were satisfied with the way staff consulted them prior to carrying out the task.

People told us the service supported their access to heal

The inspection took place on 28 February, 1, 5, 7 and 9 March 2018 and was announced. The service was last inspected in October 2016 and was rated ‘Good’ overall.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults, younger disabled adults and children. At the time of this inspection the service was supporting 52 people.

Not everyone using Abbey Nursing and Care receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a manager in post who had been registered with CQC since October 2010. 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.

We found six breaches of the Health and Social Care Act (HSCA) regulations in relation to recruitment processes, safe care and treatment, effective safeguarding systems, staffing training, managing complaints and good governance. We found one breach of the Care Quality Commission (Registration) Regulation 2009 in relation to notifications of incidents. In light of the concerns we found at this inspection, we asked the registered provider to enter into a voluntary agreement with the CQC, to which they agreed, to suspend new packages of care until the service was compliant with all regulations.

We made a recommendation that the registered provider review current good practice such as National Institute for Health and Care Excellence (NICE) guidelines in relation to the safe disposal of medicines in the care at home sector.

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.

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. You can see what other action we have told the provider to take at the back of the full version of the report.

We found the service

This inspection took place on 12, 13, 14 and 17 October 2016. The provider was given 48 hours' notice to make sure someone would be in. The last inspection was carried out in May 2013. The service met the regulations we inspected at that time.

Abbey Nursing and Care Agency is a domiciliary care agency which provides personal care and support to adults and children living in their own homes who have a variety of needs. The service is managed from an office located in Sale. At the time of this inspection 32 adults and one child were receiving assistance with their personal care.

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 told us they were happy with the care they received. Comments we received from people who used the service included, "extremely satisfied," "very satisfied" and "can't fault them at all." People and relatives felt there were enough staff to carry out visits and said the service was safe.

Staff completed safeguarding adults training as part of their induction, and this was updated regularly. Staff knew how to report concerns and were able to describe various types of abuse. Staff were confident any concerns they had would be taken seriously.

There were thorough recruitment and selection procedures to check new staff were suitable to care for and support vulnerable adults.

Risks to people’s health and safety were assessed, managed and reviewed regularly. There were clear risk assessments relating to a person’s medicines, mobility, nutrition and other areas of need in care plans. Medicine records were completed accurately.

People and relatives we spoke with said they were happy with the service and felt staff had the right skills to provide the care they needed. One person told us, "They know what they are doing.”

Staff told us they received appropriate training and opportunities to shadow established staff before providing care on their own. Staff received regular spot checks, supervisions and appraisals.

People told us care staff were caring, friendly, helpful and respectful. People’s comments included, “Staff are excellent and very friendly” and "They're so kind, they've got time for me." Staff had a good understanding of the importance of treating people with dignity and respect.

Staff spoke fondly about people who used the service and how thy enjoyed their role. One staff member told us, “I absolutely love the job as I know I’ve made a difference to someone’s life. Staff have a bond and a relationship with a client that is overwhelming.”

Staff had access to detailed information to help them better understand the needs of people they cared for. This information included a person’s life history, hobbies, preferences and daily routine. Care plans and risk assessments were specific to the needs of the individual and were reviewed regularly and whenever a person’s needs changed.

People knew how to complain if they had a concern. People were frequently asked for their views about the service and these were acted upon.

The provider ensured the quality of the service was assessed and monitored by carrying out regular audits of all aspects of the care provided.

Staff told us they felt supported by the management team and felt able to voice any concerns they may have. Staff told us there was a positive culture at the service.

A relative told us “The care plan was reviewed about three months after starting with the service and we have had one since then. It gives us an opportunity to discuss any issues. They are very good and an excellent service”.

We saw evidence that the provider had effective working partnerships with other stakeholders and other health and social care providers including the NHS Trafford Clinical Community Group and safeguarding team.

We found medicines were safely administered and that people who used the service received their medicines in the way that had been prescribed for them.

One person who used the service told us; “They treat me with respect. They give me my medication from the blister packs and record it all in my care file. They are very efficient”.

One member of staff told us; “They are really supportive. I’ve been given a chance to do a national vocational qualification (NVQ) which I’m waiting to here about. I have also just recently done a dementia course. I feel very supported by the team”.

Regular unannounced spot checks were undertaken by senior staff which involved direct observation of care staff. One person who used the service told us; “They come in and do spot checks on what the girls are doing. They are all very good. We have had meetings to review my care needs which is good. I have no concerns at all”.

Since we last visited this service in 2011 improvements had been made by including person centred information in care plans. This provided staff with good information on what they must do to promote the rights and meet the specific needs of the people they provided care and support to. Two relatives and a person using the service confirmed that staff provided respectful and dignified care and support. Care plans had also been updated to include evidence that people had consented to the service they received.

A person using the service told us that staff provided support in a manner that suited their preferences. They said that staff always took time to have a laugh and a chat with them before they left. They described staff as 'smashing' and 'really great'.

Further improvements had been made by ensuring that a robust system was in place to monitor the performance of staff following their appointments, based on the assessment of risk. The person using the service and two relatives that we spoke with told us that the service was provided in a safe way. They also said that staff had been trained well.

We found two concerns during our visit. Staff had been administering medication to a person who did not have a care plan or risk assessment confirming that it was safe to do so. We also found that although the service had quality assurance system in place, it had failed to identify concerns relating to care plan reviews and the issue with administering medication.

People told us:

• “The agency continues to support my care needs and I am very satisfied with the service”

• The agency provided a ‘flexible service’. The agency had ‘well matched’ her support worker to meet her needs and said she ‘highly rated the agency’ and the way in which her support worker provided care.

• A service user told us that she was consulted when her support plan was drawn up, during reviews and when changes were made.

• We were told staff appeared skilled and competent

• One relative spoken to said that some staff were better than others but she was very happy with the care her mother was receiving.

• One person said the agency continues to support her care needs and she is very satisfied with the service.