Archived: Apex Care - Totton

At the time of our inspection Apex Care Totton was providing care and support to 101 people in their own homes. People who were being supported by the service had various needs including age related frailty, dementia and physical health conditions.

There was not a registered manager in place although the agency had recently appointed a general manager. The nominated individual said the general manager would be applying to become registered in due course. 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.

The agency had expanded rapidly since April 2016 as they had taken over a number of other domiciliary care agencies. Staff who had worked for the previous agencies also transferred over to Apex Care Totton but some did not stay.This had resulted in the service becoming overstretched and at times they were not able to cover all people's care packages..

People involved with the service felt communication had been poor. When they had tried to contact the agency, the response had not always been reliable. The difficulties experienced had a negative effect both upon the confidence people had in the agency and in the way in which the service had been delivered. At times the lack of effective communication had compromised the health and wellbeing of people using the agency.

The management team acknowledged the quality of the service had been compromised because of the rapid expansion. They were working on improving their reliability and the standard of care and support they provided. They had apologised to people for the disruption experienced over the summer. At the time of our inspection some improvements had been demonstrated for example people were reporting staff were visiting more consistently at the time they expected them. However there were breaches in legislation in a number of areas:

There were not sufficient staff deployed to meet people's needs in a consistent and timely way. The agency was relying on some support from the local authority to ensure they could cover people's calls.

Staff did not have sufficient guidance to support people consistently when risks to people's health and welfare had been identified.

The management of medicines needed to be more consistent to ensure staff, where they provided support with this, acted in in line with people's needs.

Staff were not provided with sufficient training or support to meet people's needs and people's capacity to consent to their care and support had not always been appropriately addressed.

People were not always provided with the gender of carers of their choice. People's documented care needs were not always accurate or up to date and so the agency could not be assured the care provided was appropriate, and met people's needs and preferences.

Quality assurance processes were not yet robust.

People felt safe with their care worker and most said they responded quickly to offer appropriate support when their health care needs changed. People highly praised their regular carers and care staff also demonstrated a real desire to do a good job. They were knowledgeable about the needs of the people they supported and clearly cared about them.

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

Below is a summary of what we found.

Is the service safe?

A relative of a person using the service told us they felt their family member was safe and well cared for by the agency. Risks to people's safety both personal and environmental were assessed, recorded and kept under regular review. Staff received training on protecting people from risk of abuse before commencing working in people's homes.

Is the service effective?

People's physical and mental health care needs were assessed and recorded. People were involved in the assessment process and in planning the care they received. A staff member we spoke with told us, 'We provide a service to the client that is focussed on their care plan. We ensure that this is what the person wants for themselves and always check they are happy with the care'.

Is the service caring?

Records we examined and feedback from a family member showed us that people were supported in a kind and caring manner. Comments included, 'The staff who work with my relative are very capable, friendly and caring. They do over and above what the care plan says if needed'.

Is the service responsive?

Records we examined showed that changes to people's needs were identified and recorded. A healthcare professional who monitors the home told us, 'The manager is very responsive and passes on issues or concerns very quickly so that they can be addressed'. A family member of a person using the service told us, 'When I did have a concern, I contacted the manager. The next time I visited my relative it had been put right and the manager checked I was happy with the outcome'.

Is the service well-led?

There were systems in place to audit the quality of service provided and to monitor the care being delivered. We saw there were clear guidelines in place concerning codes of conduct for staff and their practice was monitored by the manager. A staff member we spoke with said, 'We have the on call number that we can use at any time and the manager is very supportive and helpful'.

The manager carried our regular quality audits. This included monitoring checks on staff practice, people's personal safety and safety of the environment. Staff told us they felt well supported and could call the manager for advice at any time.