The inspection took place on 16 February 2016 and the inspection was announced.

Able Care is a care agency who provides a domiciliary care service and an introductory service for self-employed carers, who offer a live in care service. This inspection only relates to the domiciliary care element of the care agency. The Care Quality Commission (CQC) does not regulate self- employed care.

At the time of this inspection the service was supporting four people, three with a night sitting services and one with a day sitting service. During these periods support with personal care and meals maybe required.

There was a registered manager in place. 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 were supported by staff who demonstrated the skills and knowledge required to perform in their role. They had been safely recruited.

Staff demonstrated they understood how to prevent and protect people from the risk of abuse. The service had procedures in place to report any safeguarding concerns that could arise and staff understood these. Staff had knowledge of how to report incidents of suspected abuse. People and staff were protected from harm as the service had identified and assessed any risks to them and reviewed these on a regular basis. Risk assessments were individual to the person and their environment.

Staff did not administer prescribed medication.

Staff had not attended recent training relevant to their role; the manager undertook to address this immediately.

People benefited from staff who felt valued by the service and were happy in their work. They had confidence in the management team.

Staff demonstrated that they understood the importance of promoting people’s dignity, privacy and independence. They gave examples of a caring and empathetic approach to the people they supported.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 and report on what we find. Staff were aware of the MCA and demonstrated they understood the importance of gaining people’s consent before assisting them.

People’s needs had been assessed prior to them receiving a service. People received individualised one to one care. The service regularly reviewed people’s needs.

Staff assisted people, where necessary, to access healthcare services. Staff had a good understanding of people’s healthcare needs and demonstrated they had the knowledge to manage emergency situations should they arise.

The management team demonstrated an inclusive approach to the management of the service and people had confidence in them. They were supportive and accessible to people’s advocates and members of staff.

People told us that they were able to make choices about how they were supported in their day to day living. People felt they were in control and that the service met their needs effectively. One person said “I am happy with the service.” A person’s representative said, “The best I’ve known.”

We were told that people received the care and support package that had been agreed with them and that this was reviewed regularly. One person said, “I get a lady come and she goes through everything.” We saw that the service was responsive to people’s changing needs in a timely way. Other people described the kind of activities they were able to take part in within the local community with the help of a carer. One person told us, “They take me out locally but we go further in spring and summer.”

Staff were trained to operate equipment used by people in their own homes. Arrangements were in place to ensure that regular servicing and timely breakdown visits were made to keep all equipment in safe working order so that people remained as independent as possible.

There were sufficient staff available to ensure that people’s needs could be met, including during periods of staff absence. People described carers as, “Respectful and polite.” The service ensured that where people request a change in carer that this is complied with without delay.

People’s views and comments were asked for on a regular basis and they were acted on where possible. The outcome of the survey completed in March 2013 showed high levels of satisfaction and this was confirmed by the people we spoke with. People knew how to complain and felt able to do so without fear of recrimination. The service dealt with any expressions of concern quickly and within the timescale stated within the complaints procedure. Arrangements were in place to regularly check the quality and accuracy of records kept about the person so that they reflected their individual needs.

People who used this agency had the relevant information in their care plans that was centred around their needs that gave us a clear picture of how carers would support each person in their own home. The documents were regularly reviewed by a senior staff member and updated as and when required. They were signed by the people using the service and we saw the response forms completed by people receiving the service on the quality of the support provided.

We spoke with the staff members in the office who gave us examples of how other professionals would work in the individuals’ home with the carers to ensure the continuity of care and treatment was carried out safely.

The people we spoke with told us that the carers supported them over the 24 hour period, 365 days of the year and that they had always received their medication correctly.

People who used the agency told us that all the staff, although some were better than others, had been suitable, confident in their role and that they felt safe with them in their home.

The information on how to make a complaint was clear and people were told their complaint would be acted on.

We checked surveys that the agency conducted on current people who use the service, those who had used it recently and their relatives. Comments included: “It has been a pleasure dealing with your efficiently run company” and “I have greatly appreciated the efforts you have made to provide my relative with appropriate carers. This was particularly important in the final stage or their life.” One comment stated that, “It was your carer who ensured that my relative was able to spend their last two weeks at home, with their family and friends around them. “

A number of positive comments were seen in the original comments that the agency collected from people who use the service and their relatives, not only for good care but for the right choice of carers who were allocated to individual people who use the service.