Apex Prime Care - Basingstoke

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care for not involving people in their care plan reviews and not respecting people’s preferences.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not consistently place people at the centre of their care and treatment. People did not always receive care that met their needs or respected their preferences. The provider’s policy states that staff must make every reasonable effort to respect people’s preferences about who delivers their intimate or personal care, including requests for staff of a specified gender. Most people we spoke with told us their preferences for intimate personal care were not respected. They said their requests for staff of a particular gender were often not met, which caused them stress and anxiety.

One person told us they experienced significant distress when a male member of staff arrived to provide personal care, despite having clearly requested that only female staff carry out this support. A relative explained that poor communication made this worse and said their loved one would not accept personal care when male staff attended. People’s comments included, “I want female carers only. They say they hardly have female carers now. I had this male carer for the bed call, even when I told the office I don’t want him anymore,” and “It’s awkward when it’s a man. They’re very professional, but I don’t know if there is a choice.”

Some people also felt they did not always receive their care visits as planned. They described late or inconsistent visit times that affected their daily routines and increased their anxiety. One person told us, “I’m not sure they are very good at listening. It has taken me ages to get them to understand I need an early visit on a Sunday, and if that’s not possible then I don’t want them at all.” Another person said, “I have various health issues, including severe anxiety, and if the carers don’t come at the time they say, then I get very anxious.” Other comments included, “It’s not very effective when they don’t come at the right time, because it’s either a rush or I can’t go out,” and “Sometimes they are hopeless and will do her breakfast visit around 11–11:30am. Then someone turns up for her dinner visit around 12 noon – what good is that.”

People and family members also told us they did not always feel involved in care planning. People who transferred from a previous agency had not all received a review of their care or an update to their care plan to ensure all their needs continued to be met by their care arrangements. One person said, “No one came out to see if everything is OK, and if that is what he still needs.” Records showed reviews had fallen behind schedule. The service had developed plans to improve this and ensure reviews were brought up to date

Following our feedback, leaders told us they deeply regretted the distress caused. They said they had worked to improve rota planning so that people’s preferences were now met and confirmed that female staff were being allocated to those who had requested this.

The provider did not always demonstrate a full understanding of the diverse health and care needs of people and their local communities. As a result, care was not always joined-up, flexible or supportive of people’s choice and continuity.

People gave mixed feedback about having regular staff that supported continuity of care. When people received support from a consistent team, they were satisfied with their care. However, many people told us they experienced a lack of continuity. One person said, “They regularly keep changing the rota. I am so anxious now I check the rota about eight times a day to see what has changed and who might be coming. Sometimes it is still wrong and someone completely different turns up.” A relative told us, “It’s seriously affecting my mental health as his wife because I am anxious all the time about who is coming.” Another relative explained, “I had a discussion with [manager’s name]. They talked about improving continuity and consistency of carers, but it never happened.”

Communication with other health and social care professionals was effective and enabled prompt adjustments to people’s care when required.

The provider supplied appropriate, accurate and up‑to‑date information in formats tailored to people’s individual needs.

People’s care plans reflected their physical, mental and emotional needs. Care staff told us they had access to clear information about people’s communication needs and understood how to support people to express themselves fully. People received information in a format that was suitable for their needs.

The provider did not always make it easy for people to share feedback or raise complaints about their care, treatment and support. Staff did not consistently involve people in decisions about their care or inform them of any changes made as a result of their feedback.

People told us the agency’s response to concerns or complaints was generally poor, although experiences varied. Several people said they had not been advised of the complaints process. The provider had a complaints policy and process, and records showed the service responded to complaints in line with this policy, and people were satisfied with the outcomes. However, some responses were delayed because previous staff had left, and the provider had not been fully aware of all ongoing issues. People did not always feel confident raising concerns. One person said, “There is no point in putting in a complaint as mostly they don’t listen.” Another person told us, “I haven’t raised a concern, because they won’t listen.”

Feedback about communication was mixed, although most people described ongoing concerns and said they did not feel listened to. Comments included, “Recently I have tried ringing seven times with no answer. The answer machine says it’s full”, “There would appear to be no office staff left as no one ever calls us back,” and “Up until now they have been quite complacent and not really responded to any of our requests.”

The service had recently introduced an out‑of‑hours service delivered by an external company to support staff. However, feedback from staff and people was not always positive. One person said, “The out‑of‑hours night/weekend service is the worst. If you ring for help and advice, they are quite abrupt and not at all pleasant. This is not helpful as most calls are made at stressful times. Often, they will just say they cannot help and tell you to ring the company in the morning.”

The service had recently recruited a new manager. People told us the manager had started to make improvements and communicate more effectively. Comments included, “Recently a new manager has been involved; she has started to communicate better, so I am hopeful she may make a difference”, “We had a meeting with the new manager last week and she did listen to us. I am hopeful she will make some interventions to improve the situation,” and “Recently there has been a new manager. She did listen and understood. I think things may have improved slightly, but there is still much wrong with the service.”

We discussed concerns with the provider. They were aware of the telephone issues and believed these related to historic problems with the system, which they stated had now been resolved so calls no longer went to a full voicemail. Following our feedback, they sent updated communication to all people using the service with the correct office and out‑of‑hours contact numbers.

The provider made sure people could access the care, support and treatment they needed when they needed it.

The provider had equality and diversity policies in place. The manager told us equality and diversity were included within the safeguarding training that all staff had received to ensure staff understood the barriers people might face when accessing care or how to support them to overcome these.

Staff and leaders listened to people who may be at greater risk of inequality in their experience or outcomes and used this information to tailor their care, support and treatment.

Staff treated people equally and without discrimination. Care plans included information about people’s protected characteristics and set out how staff should ensure these did not become a barrier to fair and equitable treatment.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. However, we found improvements were needed.

At the time of our inspection, no one was receiving end‑of‑life care. The provider told us that, should end‑of‑life support be required, staff would deliver care in line with the person’s wishes. However, most staff we spoke with said they had not completed end‑of‑life training, and training records confirmed this. One member of staff told us they had supported someone receiving end‑of‑life care without any training being provided.

The provider’s policy states that all staff must be competent and up to date in the knowledge and practice required to deliver good end‑of‑life care. This was not always in place to ensure people received safe and appropriate support at the end of their life. The provider told us they had specialised training for end of life care but records and staff feedback did not support this.