This was a planned inspection and the first day was unannounced. We visited the office location on 22 May 2018 to see the registered manager, care manager, a senior care worker and office staff, to review care records and policies and procedures. On the 23 and 24 May we visited people who used the service in their homes (with their permission) and made phone calls to people who used the service, relatives and members of the staff team.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to 170 older adults in the Trafford area.

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 registered manager in place at the service who was also one of the company directors. They had been registered since 2006. 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 inspection in April 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2104. These were in regard to not meeting the requirements of the Mental Capacity Act (2005) where people lacked the capacity to agree to their care and support, the documenting of any medicines administered and the auditing of the medicine administration records (MARs).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At this inspection we found improvements had been made and the Regulations were now being met.

Medicines were administered as prescribed and the MARs were completed by staff. Care plans clearly identified the support people required when taking their medication. MARs were audited each month and a system was now in place to follow up any missed signatures or errors found with the staff member concerned.

Where people may lack the capacity to make decisions about their care and support a capacity assessment was completed. If it was assessed that the person lacked capacity a best interest decision was made, involving the relevant people, for example family members. People’s capacity was re-assessed at each review of their care; however, this was not formally documented. We have made a recommendation to follow best practice guidance for recording all areas reviewed.

People told us the care staff were kind and caring. People felt safe when the Absolute Care At Home staff visited them and said the staff maintained their privacy and dignity when providing support. The staff knew people and their needs well and were able to explain the safeguarding procedures in place if they had any concerns.

Travel time was not built into staff members rotas. Therefore, it was accepted practice that visits were shorter than commissioned to enable staff to travel to the next person’s house. People told us this was not an issue and staff would always ask if there was anything else the person wanted them to do before they left. Staff told us that their calls were all close together so there was limited travel time involved between calls.

People told us there were very few missed calls. The cause of any missed calls was investigated and action taken where required. People told us that their visits could be late and they were not always informed about this. Regular staff supported people, although this was more variable for the evening calls.

There was a safe recruitment process in place. Staff received the induction and training to carry out their role. St

We inspected Absolute Care at Home Ltd on 18, 20, 21, 24 and 25 April 2017. We gave the provider 48 hours' notice we would be visiting the office to make sure the appropriate people would be there to assist us with our inspection.

When we last inspected the service on 29 February, 02 and 03 March 2016 we found they were not meeting the required standards. At this inspection we found some improvements had been made, but the provider was still not meeting the required standards, we found continued breaches of regulations. There were still areas that required further development.

Absolute Care at Home Ltd is a domiciliary care agency providing personal care to 250 people in the Trafford and Stockport areas. Care workers support the people using the service with a wide range of needs, including assistance with washing and dressing, domestic tasks, shopping and making meals.

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.

During the last inspection we found interviews for new care workers were not documented and gaps in their previous employment were not explored. At this inspection we found a number of improvements had been made and the safe recruitment checks were now being followed.

The causes of missed visits were analysed and disciplinary action taken when needed. The provider was in the process of accessing assistive technology to provide a clearer overview of staff visits.

At the last inspection we found not all care workers recorded whether medicines had been taken on people's medicines administration charts. At this inspection we found this was still the case.

The service was not acting in accordance with the Mental Capacity Act as people thought to lack capacity had not been assessed for their ability to give consent or make decisions.

The service used a rota system which did not include travel time for staff. It was therefore accepted practice by the provider for care visits to be shorter than described in people's care plans so care workers had time to travel to the next person's house.

People told us they felt safe when using the service. Staff we spoke with could tell us about safeguarding and said they would report any concerns to their managers. Records we saw confirmed this.

Care workers received an annual appraisal and competency spot check. The service had an informal approach to supervision which the care workers were happy with.

People and their relatives told us care workers were caring and supported people's privacy and dignity.

Care workers could demonstrate they knew people well, as they could describe their likes, dislikes and preferences.

People's personal information was stored securely. They were also signposted to advocates or other specialist support organisations if they needed them.

People and their relatives were involved in developing care plans. People said their care plans were updated regularly and they received the support they had asked for.

Records showed the service acted upon the written complaints it had received in accordance with their complaints policy.

The service had an effective system in place for logging and following up accidents and incidents. The registered manager and quality assurance manager met weekly to discuss any issues.

Management systems were in place and people's opinions about the service provided were sought. These enabled the manager to look at where improvements were needed to the service. The manager was aware of improvements needed in the monitoring and auditing of people's medicines administrating records.

We found continued breaches of regulations 12 safe care and treatment and regulation 11 need for consent of the

We inspected Absolute Care at Home Ltd on 29 February, 02 and 03 March 2016. As it was a domiciliary care service, we contacted the registered manager one working day before the inspection so that there would be someone at the office when we arrived on the first day. The service was last inspected in August 2013, when it was found to be compliant in all the areas we looked at.

Absolute Care at Home Ltd is a domiciliary care agency providing personal care to 255 people in the Trafford and Stockport areas. Care workers support the people using the service with a wide range of needs, including assistance with washing and dressing, domestic tasks, shopping and making meals.

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.

During the inspection we found that interviews for new care workers were not documented and gaps in their previous employment were not explored. The other aspects of recruitment were done correctly.

Not all care workers recorded whether medicines had been taken on people’s medicines administration charts. It was therefore unclear whether people were receiving their medicines as prescribed by their GPs.

The service was not acting in accordance with the Mental Capacity Act as people thought to lack capacity had not been assessed for their ability to give consent or make decisions. Some relatives had signed forms for people who had not had an assessment to determine whether or not they could make their own decisions.

New care workers completed the Care Certificate but records showed that little or no training had been provided for care workers after their induction. Some care workers had not received training in moving and handling, safeguarding or medicines administration for over six years.

The system used to audit the quality of care records was not effective; because the registered manager lacked oversight of the process, this had not been identified.

We found that safeguarding incidents were reported to the local authority, but not always to the Care Quality Commission, as is required by regulation.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

The service used a rota system which did not include travel time for staff. It was therefore accepted practice for care visits to be shorter than described in people’s care plans so that care workers had time to travel to the next person’s house.

Most people and their relatives told us that care workers used gloves and aprons, although some people told us that care workers did not wear aprons or wash their hands without being asked.

People told us that they felt safe when using the service. Staff we spoke with could tell us about safeguarding and said they would report any concerns to their managers. Records we saw confirmed this.

Care workers received an annual appraisal and competency spot check. The service had an informal approach to supervision which the care workers were happy with.

The people we spoke with that received support with food shopping and meal preparation gave us positive feedback. Those supported by the service to make appointments other healthcare professionals were also happy with the assistance they received.

People and their relatives told us that care workers were caring and supported people’s privacy and dignity. Care workers could give examples of how they promoted people’s independence.

Care workers could demonstrate that they knew people well, as they could describe their likes, dislikes and preferences.

People’s personal information was stored s

Absolute care at home provides care for people within their own homes.The service offers personal care support alongside non registerable domestic services to its clients to maximise their independence.

People who used the service could request specific time slots and the service would make every effort to adhere to these where possible.

People are given a welcome handbook containing relevant information when they first took up the service and a copy was left in the care file within the home.

People told us: "I feel safe with the carers they look after me well". "They always come on time or ring and let me know why they will be late". "I don't get about as well as I did but they don't rush me they are really patient with me". "They do all my shopping and always manage to get bargains".

“All of my care needs are met.”

”I feel safe with the carers and have no worries”.

“I have no complaints at all.”

“I have no worries at all, everything has been explained to me.”

“The care plan was fully explained to me to make sure I was happy with it”.

“The carers are very good and very helpful.”

“Privacy and dignity is respected by the carers”.

As part of this review process we contacted Trafford Commissioners and Trafford Local Involvement Networks (LINks). LINKs are groups of individual members of the public and local voluntary/community groups who work together to improve health and social care services. They gather the views of local people and use them to influence how health and social care is commissioned and delivered. No major concerns were raised by the Commissioners or LINKs.

People told us: “We are satisfied; everything is satisfactory from our point of view.” “We have two central carers so we have a good relationship with the carers.” and “Time keeping is very good, the carers are always on time, if they are ever late, they let me know.” and “The carers just get on with it; they are very punctual, chat with my X all the time they are here, put them at ease, they are always very pleasant.” and “I think they (staff) are brilliant, it works a bit like clockwork, staff are very respectful with my X, very discreet.”

We looked at seven care records, all included care plans, providing staff with tasks required at each visit, and outcomes people wished to achieve from their care.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We looked at the medication records and noted that medication administration records (MAR) were in place.

The seven staff development files included a record of training, appraisals and any spot checks which had been carried out.

We noted that people were formally asked for their views during a review process at six weeks, and annually. Additional to reviews people who used the service and staff were asked to complete a satisfaction survey. The staff survey was carried out in May 2013, and the manager told us the service user survey was planned for later in the year.