Absolute Care at Home Limited Head Office

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The provider was in breach of legal regulation in relation to safe care and treatment, safeguarding, staffing, fit and proper persons employed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems were in place for the listening and recording concerns. Staff were aware of their responsibilities in reporting all issues and felt senior staff were responsive and supporting in dealing with matters raised. Electronic records were completed to evidence any issues or concerns raised. However, information did not fully reflect actions taken, including how this was shared with staff. As part of the on-going development of governance systems, records needed further review identifying any themes and patterns, helping to further inform areas of learning and development across the team.

The service worked in partnership with a range of health and social care professionals, so people’s current and changing needs were met. In addition to long term support the service also provided ‘Stabilise and Make Safe’ (SAMS) support. This focused on helping people build confidence, maintain or regain their ability following a hospital stay or some other incident. The SAMS service was supported by a small group of staff who had been trained to complete basic assessment for any required aids, such as toilet raiser or handrails. SAMS provided short term intensive support with advice and support from therapeutic services. Assessments of needs were completed prior to the service commencing support. This involved staff meeting with people and their relatives to establish the support they wanted and needed. It was acknowledged this was more difficult for those people who received SAMS support, due to the need to respond quickly to those people being discharged from hospital. Staff said they had access to relevant information about people’s care and support needs, which they would read on the electronic held devices. If they had a concern about people’s changing needs, staff would report back to senior staff so that appropriate referrals could be made to the relevant agencies, where necessary.

People we spoke with felt they or their relative were safe but at times felt staff were unreliable. One person told us, “There ‘room for improvement’, due to their attitude and inexperience. Others said, “I feel very safe with all the carers" and “The carers are variable, but in general I’m safe with them.” The relative of one person also said, "We are very happy with them and feel [relative] is as safe as she can be having them watch out for her." Staff had access to policies and procedures in safeguarding, mental capacity act and human rights. Records also showed e-learning training had been undertaken in these areas. Staff told us they had received safeguarding training and were able to describe what might constitute a safeguarding concern. All the staff spoken with said they would report any concerns to the office staff and complete an incident form. Staff were confident they would be listened to. Systems and process were not sufficiently robust to help identify potential safeguarding concerns. Prior to our visit we identified only 6 incidents had been reported to CQC during 2023 and 2024. We reviewed the incident records which related to potential safeguarding concerns and unsafe discharge from hospital. Whilst these had been escalated to managers it was not always clear what additional action had been taken to improve people’s experience and support areas of learning. In addition, incidents had not always been referred to CQC, where necessary. The provider was in breach of the legal regulation relating to safeguarding.

People told us staff helped to keep them safe when providing care and support. People said, “They discuss any risks they feel there may be, and we try to rectify it", "I am at risk of falling due to my [condition], and they try to keep my path clear for me and anything I might need for the day within easy reach" and “Yes, risks are supported, for example, when I'm in the shower, they make sure I'm safe." This was supported by the relatives of people who also told us, "[Relative] is bed-bound, but they watch out for sores or torn skin" and “They always check that her toilet booster seat and surrounding frame are secure and won't topple off." We were told senior staff would complete an initial assessment of people’s care needs prior to commencing support. Assessments included areas of potential risk and the use of equipment. People’s care records varied. Some were personalised and provided good information about the persons needs and wishes, others lacked detail and did not reflect how people were to be safely supported to meet their current and changing needs such as skin integrity, behaviour or agitation and malnutrition. Where recent reviews had been completed changes to people’s care and support had not been transferred to the care. Staff accessed people’s records via the handset. Visits logs were completed detailing tasks undertaken as well as any concerns, which would also be raised with office staff. Policies and procedures were in place with regards to areas of risk. Staff completed practical moving and handling training. E-learning was offered in other areas of health and safety. However, we noted there were gaps in the completion of training in falls, nutrition and hydration and first aid. The provider was in breach of the legal regulation relating to safe care and treatment.

People told us staff helped them to keep their home and equipment safe. One person said, “They always check that her toilet booster seat and surrounding frame are secure and won't topple of.” The relative of another person also told us, "[Person] had unplugged their call alarm, and they went straight round and got it set up and put back on again” and "They also dealt with the stairlift when it was playing up." Staff told us if they had any concerns they would record on the electronic records and raise with managers. Senior staff were said to be responsive when needed. One staff member commented, “If I have a problem the office staff are helpful and take care of it. Policies and procedures were in place to support and guide staff in areas of risk. E-learning training was also provided in health and safety, fire safety in care and the safe use of equipment. An environmental checklist was completed. This explored the safety of the premises and equipment.

Not everyone received consistent reliable support. Some people said they had a regular staff team who visited at the time and duration agreed. However, others did not have the same experience. People told us, “The time keeping does vary, but it doesn’t affect my care overall” and "Timings are not always good. It is a bit hit and miss.” Staff spoken with said in general they did the same ‘run’ every day and had enough time with people and had travel time. An electronic planning tool was used to schedule all visits which, could be easily monitored. We reviewed the visit logs for those people in receipt of a regulated activity. Records did not demonstrate visits were effectively planned and co-ordinated, so staff were appropriately deployed. We received a mixed response from people about staff skills. Some people felt the younger, less experienced staff, did not have knowledge and skills needed to support them. People and their relatives told us, “I’m very frustrated to find that some carers are very good and some really fall short” and “In my view, the carers look confident and well trained”. A review of training records identified some gaps in training in areas of risk. The provider also advertises other area of support can be provided, such as learning disability, dementia care and mental health. However, training had not been provided. Staff felt supported in their role and acknowledged training was available and spot checks were carried out to checks their working practice. Supervisions were said to be informal. We reviewed the recruitment records for 5 new staff. Not all necessary information was in place prior to staff commencing employment. Working arrangements should also be considered for those staff aged 16/17years of age as outlined within the Skills for Care guidance. The provider was in breach of the legal regulations relating to staffing and fit and proper persons employed.

Most people were complementary of staff in keeping their home clean and organised helping to promote their safety and comfort. People said staff completed tasks like washing pots, handling laundry, cleaning the microwave and discarding food passed their dates. Comments included, "The kitchen is always tidy, and they will also empty the waste for me and do the recycling too", and “All the carers have good hygiene standards and keep me and the house clean”. People said staff wore protective clothing when assisting them with their care and that items were cleaned away and disposed of properly. One person said, “The hygiene standards are very high with all the PPE at all times.” Systems were in place to promote good hygiene standards. Relevant training and policies and procedures were available to guide staff in areas such as, Health and safety, Food hygiene and Infection control. Staff also said they had access to personal protective equipment (PPE) which they collected from the main office. Care plans needed expanding upon to clearly outline the practice to be followed by staff when providing personal care or with meal preparation to help minimise the spread of infection.

Not everyone required support with their prescribed medicines. Whilst people told us staff ensured they took their medicines when required, a review of people’s records did not reflect effective systems were in place to ensure people were kept safe. People and their relatives told us, "They are hot on my medication, they now get the blister pack out for me and watch me take the right medication” and "They check up on my medication, and it is kept in a safe now for them to get out because I was stockpiling them." Staff had received training in the safe administration of medicines and annual spot checks were carried out to check staff were following best practice. Staff told us where there had been errors in the administration of people’s medicines, they had been offered retraining and support from senior staff. The agencies policy and procedures reflected good practice guidance. A review of people’s care records showed best practice was not always followed. We found information to show where an item had run out, prescribed medicines were not listed, referring only to ‘blister pack’ and visits were not undertaken at regular interval for those people requiring medication 4-hourly. Medication administration records showed medicines had been administered at the schedule time of the visit, these did not reflect the actual times the visits were undertaken as recorded on the visit logs. People’s records needed expanding upon to include the arrangements for ordering, storage and disposal of items, a list of their current prescription and how people wanted or needed to be supported. The provider was in breach of the legal regulation relating to safe care and treatment.