APT Care Limited Also known as Chaucer House

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they were happy with the care and how the company provides small care teams to ensure continuity of care. One person told us, “[Staff] are very pleasant and I certainly feel safe. I chat with them and feel I could confide in them too. I have the same group of [staff] coming in.”

People were supported by a staff team who understood how to meet their needs safely and reduce risks related to their various health conditions including support to mobilise.

People were happy that staff always wore gloves, aprons and masks and regularly washed and sanitised their hands to reduce the risks of COVID-19 spreading.

People had very detailed care plans and risk assessments that were kept up to date and detailed how they preferred their care to be delivered. Some relatives told us they were involved in this process also.

The manager had processes and systems in place that ensured people were safe and risks monitored. Where any changes to risks were identified, action was taken to resolve them and put additional or different measures in place.

People were happy that if any problems arose, they could speak to the staff or manager and would be listened to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 February 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about COVID-19 practices both in the office and the community and the understanding and management of these risks. We also had concerns about manual handling training, staff inductions and the culture of the management. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

APT Care Ltd is a domiciliary care agency providing personal care and support to a total of 78 people at the time of inspection. The service supports people who require short term hospital discharge care packages of between 10-42 days as well as people receiving longer term care packages.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they received good care that was personalised to their needs and provided by staff who knew them well. They told us they felt safe because they were supported with a regular team of staff who they trusted. Staff understood how to keep people safe and were trained in all aspects of care to meet people’s needs. Staff were confident to report any concerns.

People received their medicines correctly and on time and had support with meals and drinks where they required this. People’s care records were up to date and detailed their needs, preferences, interests, personal history and the people who were important to them.

People told us they were supported to access various health and social care professionals when they needed it. They also told us the staff were flexible to meet their needs for hospital visits. Most people told us the care visits were on time and there had not been any missed care visits.

Staff supported people to assess their needs and then regularly reviewed their care needs and sought their feedback through other methods such as surveys and telephone calls. People knew how to complain and were confident to do so should they have any concerns.

People told us they thought the service was now well managed as communication was good and the staff knew what they were doing. People thought the care had improved compared to previous months.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was inadequate (published 08 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 08 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

APT Care Ltd is a domiciliary service providing personal care and support. APT Care Ltd were supporting 173 people at the time of the inspection. The service supports people needing long term care packages as well as people needing short term care for between 10 and 42 days when discharged from hospital.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they felt safe due to the caring approach of staff. However, we found people were not safe due to insufficient assessment of risks in relation to care, treatment and medicines. The provider did not manage people’s medicines safely. Staff had access to gloves and aprons to help prevent the spread of infection. Staffing levels were safe and people told us timing had improved.

People did not have their needs fully assessed or documented. Staff training had improved, and people felt staff had the right skills to support them. Staff supported people with food and drink but the management team had not assessed risks around choking for at least one person. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice.

People told us staff were kind and caring and treated them with respect. People felt staff upheld their dignity and supported them to keep their independence where possible. People told us they were involved in reviews of their care but staff did not document changes in care plans. This resulted in missing or contradictory information and care plans not updated.

The provider did not ensure people’s care plans promoted person-centred care. People were happy that staff asked about their needs when they supported them. People told us that complaints management had improved but that office staff did not always get back to them. Staff supported people receiving end of life care but training for staff and the development of end of life care plans for people had not yet been implemented.

People and staff did feel they could call the management team at anytime but did not feel consulted and informed on issues related to the running of the service. Systems to check how well the service ran did not enable effective monitoring and improvement. Care and risk planning for people was not enough to support good and safe care. The provider had continued to fail to meet the standards for a fifth inspection.

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 February 2019) and there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what actions they would be taking to make improvements. This service has been rated requires improvement or inadequate for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for APT Care Ltd on our website at www.cqc.org.uk.

Enforcement

We have found breaches in relation to ensuring that people have safe and personalised care and support. We have also found a breach around effective systems to support good management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Since the last inspection we recognised that the provider had failed to notify us about significant and serious events. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This inspection took place between 31 October 2018 and 13 November 2018, and was announced. This was a planned inspection based on the rating at the last inspection. The rating at the last inspection on 30 October 2017 was requires improvement. This is the fourth consecutive time the service has been rated requires improvement.

We carried out a follow up visit on the 17 December 2018 to get more information to support our judgement. We saw that many changes had taken place and improvements had been made in the areas we were particularly concerned about in November 2018.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 people raised concerns around staff’s levels of spoken English being poor, complaints and missed visits. During this inspection we saw some areas where improvements had been made since our last inspection and others where it had not. The impact of this in relation to the risk of harm and poor governance has meant the rating remained requires improvement. The service has been rated overall requires improvement for the fourth consecutive time.

The registered manager ensured the rotas had enough staff on duty and the deputy manager has introduced a system of checking visits manually each day. As a result, people told us the concerns around missed visits had improved. However, from records on daily notes and what people told us, visit times were still being cut short meaning some people felt rushed. Concerns around how complaints were managed has greatly improved and there are now systems in place to effectively manage these.

Other concerns around staff using mobile phones on shift, staff`s poor levels of spoken English and staff speaking to each other in their own languages while supporting people who did not understand those languages had not improved. Some effort by the provider to resolve these concerns had taken place. People told us that this often left them frustrated and concerned that staff did not understand what they said.

We discussed our observations with the provider who was keen to improve the quality of care people received. The provider has informed us since our visit, they were working with a local education centre to provide staff with language support where needed.

During the follow-up visit, we found that action had been taken by the provider to discuss the concerns around language and use of mobile phones with staff. In time this should reduce the concerns that people had.

Overall, people told us they felt safe and were very happy with the care provided except for the areas of communication and short visits. However, we found that staff knowledge and current systems and processes for assessing risk, staff training and medicines meant that people were not always safe from the risk of harm and abuse.

People told us they felt well cared for by staff who knew them well. However, people had concerns over some staff not being able to communicate clearly and unfamiliar staff who did not know how to meet their needs such as how to use hoists.

People had good health care support from external professionals to manage people's nutrition and clinical care.

Staff training was not always effective meaning staff were not always suitably skilled and competent to safely meet people’s needs. We recommend that the service finds out more about training for staff, based on current best practice, in relation to specialist areas of care provided and competency checks for staff on practical application of learning.

During this inspection, we found concerns around management of medicines, safe and effective risk management and staff competence, skills and knowledge. We recommend that the service seek advice and guidance from a reputable source, about safe management of medicines, personalised care planning and assessing risk.

On our follow-up visit, we found improvements in how medicines were managed. We found that although overall the risk had reduced, there were still some concerns around timings and clarity of instructions which could lead to mistakes being made. We discussed this with the provider who will take r action to improve this.

We found that in staff member's files that we reviewed, one staff record did not show that a Disclosure and Barring Service (DBS) check had been completed. In four staff files that we reviewed out of 6 files there were gaps in employment history which had not been followed up. These are all important checks for the registered manager of the service to be confident that people are safe in the company of the care staff.

During our follow-up visit, the provider showed us evidence that the missing DBS had been completed. We still had concerns that employment history was not followed up. Also in three staff files, we found staff had been shadowing more experienced staff in people’s homes prior to their full DBS check. We also found that one staff had a DBS from a previous employer, but not from APT Care Ltd. This raised concerns around the safety of people. We discussed our concerns with the provider and they will be checking each file and promised to ensure that this practice did not happen again.

The care records we viewed did hold basic information about people’s needs but were not personalised, sometimes difficult to read and information not consistently recorded. Audits were not always correct and some did not mention outcomes and actions taken.

All staff and management told us that it was their desire to give a good quality of care and for the best interests of people to be maintained. However, the registered manager did not show an understanding of their role in engaging with and managing people and systems to ensure safe and effective running of the service.

Quality assurance systems and processes were not operating effectively. It is important that all records, systems and audits enable the registered manager to clearly identify and manage risks and concerns. The registered manager must have full knowledge of all issues, actions and outcomes. We recommend that the service seek support and training, for the management team, about leadership and quality assurance systems and processes.

During the follow-up visit, we found that improvements had been made to quality assurance systems. However, we found the registered manager was not the person responsible for the implementation of these changes. Therefore, while the changes were positive, we still had concerns around the lack of oversight and governance.

The provider is legally required to notify the CQC and share relevant information about risks and incidents that have occurred while supporting people with personal care. We found the CQC were not notified of safeguarding incidents that had occurred.

Since the inspection in November we have found that the service is now notifying the CQC of incidents that occurred.

More information is in detailed findings below

You can see in detail what action we told the provider to take at the back of the full version of the report.

We will meet with the provider following this report being published to discuss how they will make changes to ensure the provider improves the rating of the service to at least good. We will revisit the service in the future to check if improvements have been made.

This inspection was carried out on 26, 27 and 28 July 2017 and was announced. When we last inspected the service, it was rated as 'requires improvement' overall. Responsive was rated 'inadequate'; safe, caring and well-led were rated as 'requires improvement' and effective was rated 'good'. At that inspection we also identified two breaches of legal regulations. We fond that the service was no longer in breach of any regulations at this inspection.

The systems in place for the management of medicines were not always safe and medicines were not always correctly accounted for. During this inspection we found that there had been improvements to the ways that medicines were managed. These systems had highlighted and reduced recording errors, however; further work was needed to ensure that improvements continued in this area.

We also found that action had not always been taken in response to complaints and people did not always feel that they would get a satisfactory outcome as a result of their complaints. During this inspection we saw that complaints had been well managed and responded to. The service still had areas to develop, in particular demonstrating how they used complaints and positive feedback to develop the service.

The service had a registered manager in post. 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 and their relatives did not have regular contact with the registered manager, however; they felt well supported by members of care and office staff and had no concerns about the way the service was being run. Staff also felt well supported by the registered manager and the provider and received the training and supervision they needed to perform their roles. There were management and quality assurance systems in place, however; these were not completed on a regular basis and there was no clear evidence to show how they were used to help improve the service.

People generally felt that their privacy and dignity were promoted by the service, however; there were occasions when this was not the case. Staff were reported to sometimes speak in languages other than English or to use their mobile phones during visits, which made people feel uncomfortable.

Care plans were in place for people and work had been carried out to help develop and improve these. Further work was needed to continue this improvement and to ensure that all care plans were reviewed and updated on a regular basis. In addition people's involvement in the planning and reviewing of their care was not always clearly evidenced.

People felt safe with the care they received from the service. Staff members were knowledgeable about abuse and the reporting procedures they should follow to safeguard people against it. There were systems in place to record accidents and incidents and potential abuse was reported when necessary. There were sufficient numbers of staff to meet people's needs. There were occasions when call times differed from people's expectations, due to the flexible nature of the care provided by the service. There were risk assessments in place to help manage risks to people's health and well-being.

The service had a positive and open culture. People were happy with the care and support they received and staff treated people with kindness and compassion. Where necessary, staff members provided people with support to meet their nutritional needs and preferences, as well as supporting people with healthcare appointments and referrals if required. People's consent was sought by members of staff and there were systems in place to ensure the principles of the Mental Capacity Act 2005 were being followed.

APT Care Limited is a domiciliary care service providing personal care and support to people in their own homes. They provide care to people requiring both long-term and short-term support, usually following hospital discharge. At the time of our inspection, the service was providing care and support to 79 people.

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.

While there had been improvements to the quality of the service in some areas we found that others still required improvement.

People told us they felt safe but raised concerns about staff not always arriving on time. While some people received consistent care from the same staff, others reported having many different staff attending to their needs. People’s dignity and privacy was upheld and we were told that the staff team were kind and caring, but some people felt rushed and couldn’t develop positive relationships with their care staff because of frequent changes.

Risks to people were assessed and control measures implemented to support people’s safety. The management of people’s medicines had improved but there were still some inconsistencies in practice.

While there had been significant improvement to the quality of care plans, people still did not always feel involved in care planning or making decisions about their care. People consistently told us that they did not feel that their concerns or views were listened to by the management of service and did not have faith in complaints being resolved. While some complaints were being investigated and resolved correctly, others were subject to delay.

There were enough staff available to meet people’s needs. However the process for recruiting new staff was not always robust and references were not always acquired from previous employers. Staff received a comprehensive induction and completed a range of training which enabled them to carry out their roles effectively. They were able to contribute to the development of the service through team meetings.

There were improved quality monitoring systems in place which were effective at identifying trends and identifying areas for improvement. People were sent questionnaires and surveys to ask for their feedback on the quality of care delivered.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 12 February 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘APT Care Ltd’ on our website at www.cqc.org.uk.

APT Care provides personal care and support to people in their own homes. The service provides a mixture of long-term care packages and 10 day placements for people following discharge from hospital.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

Risk assessments were in place for new service users and were comprehensive enough to support staff to help keep people safe from the risk of harm. There was a greater level of detail included in these assessments, which were person-centred, corroborated people’s discharge assessments and included measures to minimise identified risks where possible.

Records of medicine administration records were audited regularly. The service had a system in place to identify any errors or omissions and take appropriate action to address these with staff to reduce the risk of recurrence.

The service had implemented a quality assurance system for identifying improvements that needed to be made. Feedback was sought from staff and people using the service and this was used to highlight any areas for development.

We reviewed the care records for 18 people and noted that people were offered support at a level which encouraged independence and ensured that specific needs were met. The people we spoke with told us that staff were always respectful and competent to carry out their roles. One person said, "Staff are lovely'. they know what they are doing." Staff told us they felt supported. One staff member said, 'If I am not confident, they will give me more training.'

We observed from the care records that people were supported to express their views within care reviews and were given the opportunity to complete satisfaction questionnaires on a regular basis. The results of which were used to develop the service and make improvements for people and staff.

The provider had appropriate arrangements in place for the recording, dispensing and safe administration of medicines. The provider had systems in pace to monitor the quality of service provision.

We reviewed the care records for six people and noted that people were offered support at a level which encouraged independence and ensured that specific needs were met. The people we spoke with told us that staff were always respectful and competent to carry out their roles. One person said, "I have no concerns. They do a good job under great pressure and are always friendly."

We observed from the care records that people were supported to express their views within regular care reviews and were given the opportunity to complete satisfaction questionnaires on a regular basis. The results of which were used to develop the service and make improvements for people and staff.

People also told us that they felt able to raise concerns with the manager or staff team and felt confident that they would be listened to.