Abicare Services Limited – Salisbury is a domiciliary care agency. It provides personal care to people living in their own homes, in Wiltshire, Dorset and West Berkshire. People either received the service through home care visits or had a live-in carer service. At the time of the inspection a total of 104 people were receiving a service from the Salisbury branch of Abicare Services Limited.

The inspection took place on 11 and 12 October 2018 and was announced. We gave the registered manager 24 hours’ notice of our inspection. We did this to ensure that we would be able to meet with the registered manager during the inspection.

This inspection was brought forward from the intended inspection date, due to the nature of statutory notifications received from the service. These notifications related to concerns regarding medicines management for people receiving live-in care in the Dorset region.

At this inspection we found the service remained good overall, with requires improvement for safe. Because the overall rating remains good, the report has been written in a shorter format.

Two members of staff that were responsible for administering medicines were not up to date with their medicines training. However, there were procedures in place to monitor staff competencies. Staff received supervision meetings with their line manager, where they refreshed their knowledge on policies and could discuss any concerns.

Records of administration for topical prescriptions, such as creams and lotions were inconsistent, with gaps in records. We also saw that gaps in the medicines administration records had improved, but continued to be present. There were systems in place to monitor these, which could be further developed.

Where people lacked mental capacity regarding certain decisions, there was evidence to show that health and social care professionals had been consulted with.

People told us staff were kind, considerate and caring. If people wanted to have a different carer, this choice was accounted for. Most people told us staff were on time for each visit. Staff enjoyed working for the company, they felt happy in their role and supported by their manager.

The service had received positive feedback during surveys. Complaints were followed up and technology was used to reduce the likelihood of complaints recurring.

There were plans to expand the live-in care service in the future, however it was understood that staff recruitment would need to grow first.

Further information is in the detailed in the report.

Abicare Services Limited – Salisbury, is a domiciliary care agency which supports people to live in their own homes. At time of the inspection 62 people were using the service. At our last inspection we also inspected the Newbury area. However, during this inspection Newbury was no longer registered under Abicare Services Limited - Salisbury.

The inspection took place on 31 August and 7 September 2017 and was announced. We gave the provider 48 hours' notice of our inspection. We did this to ensure we would be able to meet with the registered manager.

The service had a registered manager in post. 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.

At our last comprehensive inspection in February 2016 we identified the service was not meeting three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not receive proper and safe management of medicines, there were no systems or processes in place to monitor the quality and safety of services, staff were not deployed effectively and staff did not receive appropriate supervision and appraisal as is necessary to enable them to carry out their duties. In response to that inspection we issued requirement notices. The provider developed an action plan to address the shortfalls, which they submitted to us following the inspection.

At this inspection we found that the provider had taken action to address the issues highlighted in the action plan. However, although an improvement had been made with medicines management, the changes made to systems had not been fully implemented by staff consistently. This meant people's medicines were not always managed safely.

There were sufficient staff to meet people’s needs and staff were deployed effectively. People told us the service’s time keeping had improved. The service had implemented a new system for rostering to ensure staff were deployed within a geographical area. This also meant staff travel time was reduced.

People were supported by staff who had supervisions (one to one meeting) with their line manager. Staff had also received their annual appraisals. Staff told us supervisions were carried out regularly and enabled them to discuss any training needs or concerns they had.

The provider regularly assessed and monitored the quality of the service provided. Feedback from people and their relatives was encouraged and was used to make improvements to the service.

People told us they felt safe when the carers visited them in their homes. Comments included "I feel very safe", "I do trust the carers", "I am very well looked after" and "It's all very good".

Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. Staff had all received safeguarding training and we confirmed this from the training matrix.

New staff were supported to complete an induction programme before working on their own. Induction records were in place which showed that new staff had been supported to understand their role, complete required training and spent a period of time shadowing an experienced member of staff.

Staff had received training around the Mental Capacity Act (2005). Staff explained how they supported people with making choices about their daily living. People's individual wishes were acted upon, such as how they wished to receive their personal care.

People received care and support from staff who had got to know them well. People usually had a small group of care staff visiting them, ensuring continuity in care where possible.

People or their relatives were involved in developing their care plans. Care plans were personalised and detai

Abicare Services Limited in Salisbury is a domiciliary care agency which supports people to live in their own homes. At the time of the inspection, Abicare Services Limited, Newbury was also registered under this location while they were waiting for registration of suitable office premises.

The inspection took place over three days on the 24, 26 and 29 February 2016 and was announced. We gave the provider 48 hours’ notice of our inspection. We did this to ensure we would be able to meet with the registered manager and people where they were receiving the service.

During our last inspection in June 2014 we found the provider had satisfied the legal requirements in all of the areas that we looked at. Abicare Services Newbury was last inspected in July 2015 and had met all legal requirements.

A registered manager was in post. 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.

At time of the inspection 82 people were receiving a service in the Salisbury area and 54 people in the Newbury area.

People told us that they felt safe with all the carers that attended to them in their homes. They said they had built up a good relationship with their regular carers. Staff had the knowledge and confidence to identify safeguarding concerns and act upon them to protect people.

People and their relatives told us they couldn’t fault the quality of the care. Comments included “I would not be able to find any better carers than I get, they are amazing” and “The carers are absolutely brilliant. I look forward to them coming.” People in the Newbury area told us they had noticed a high turnover of staff, which meant they didn’t always know which care worker would arrive. In both the Salisbury and Newbury areas, people told us care workers were always late and they were not informed when care workers would be arriving.

Staff were not receiving regular one to one supervision with their line manager. This meant their performance was not being monitored effectively and feedback on best practice was not being provided. Staff meetings were not regular which meant staff were not kept up to date with changes in policies and procedures.

People felt involved and listened to, they contributed to what was written in their care records and risk assessments. People received a service which was based on their personal needs and wishes. Changes in their care needs were identified and amended as required. The review of care needs was not consistently recorded, which meant it was not clear if there had been a change. People were supported to (when necessary) access healthcare services and referred to the doctors when needed.

There were systems in place to ensure the risks to people's safety and wellbeing were identified and addressed. People who required support to take their medicines received this , however medicines administration was not always consistently recorded on the medicine administration record, placing people at risk of medicine errors. This also meant it was not clear if people had received the right medicines at the right time. The registered manager told us they would address this by completing a medicines audit and provide refresher training for staff.

People were supported by staff with the right skills and knowledge to meet their individual needs. People felt they were treated with respect and dignity and the staff were mindful of their privacy. People were asked for their consent before care and support was given. Staff and the registered manager knew about the Mental Capacity Act 2005, and how it impacted upon the care people received.

People and their relatives were able to complain or raise issues on an informal and formal basis with the

People told us they were asked what care they would like and their privacy and dignity were respected. We saw staff interacted with people as equals with exchange of humour and banter.

One person told us “I can’t fault the care although sometimes it's rushed” another said “The care is pretty good. I want to remain with Abicare” We observed care which was respectful and caring and in line with care plans. Staff were knowledgeable about the people they supported.

People said they 'felt safe and knew how to contact the provider if they had concerns. Staff knew about the signs of abuse and how to report it.

People told us that visits were sometimes late and they were not always informed. The provider had worked to recruit staff but there were still unfilled positions. Staff had not received training and supervision in line with the provider's recommendations.

The provider had a system in place to monitor quality of the service and had plans to resolve outstanding actions identified. The recruitment process had the necessary checks in place to ensure staff were suitable for their roles.

People we spoke with told us that they were happy with the care provided by Abicare. They told us that they had been involved in the planning of their care. They said that their privacy and dignity was respected by agency staff.

We saw that risk assessments were completed for finances, medicines and care. However, specific risk assessments for diabetes and catheter care were not in place.

There is scope to further improve some elements of record keeping. Within some daily records we saw that there was a lack of evidence to show that a situation had been monitored and what the outcome had been.

Some staff members reported that communication with external health care professionals had not been as effective as it could have been. The provider had been actively working to address this.

We saw that systems were in place to safely recruit, train and supervise staff members.

People said that they felt that the agency staff were well trained to carry out their duties. Staff members we spoke with confirmed that they felt competent and that they were well supported by the management.

People knew who to go to if they were not happy. One person summed up the views of people by saying ‘I would not hesitate to speak to the provider, if I had any concerns.’

We considered our inspection findings to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by staff. People told us they felt safe.

People told us they were happy with the support they received and that their needs were met. It was clear from speaking with people and the staff, that they had a good understanding of people's support needs.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in developing their plans of care if they wanted to. People told us their care plan reflected their current needs.

We found the management of people's medicines was well organised and staff were trained effectively to carry this out safely.

Is the service caring?

People described the staff as being “very caring, lovely and helpful.” Another person told us “staff are very good.”

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people's records which indicated they had been consulted with over the care they received. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. This meant that information about people's preferences was gathered and used to plan care to meet their specific needs.

The service worked in partnership with key organisations, such as the local authority, to make sure people received their care in a joined up way.

Is the service well-led?

People using the service had regular opportunities in a variety of formats to have their say about the service. For example, people could discuss their views during each visit with the member of care staff and frequently during spot checks by a member of the management team. Everyone we spoke with said the communication between them and staff was effective.

Regular audits were completed and we saw any shortfalls had been addressed promptly. This meant the quality of the service was continuingly monitored and being improved.

Staff told us they were clear about their roles and responsibilities. All of the staff told us they would report poor practice if they witnessed it. This helped to ensure people received a good quality of service at all times.