Apex Prime Care - Dorchester

Apex Prime Care - Dorchester provides care and support to people in their own homes in and around Blandford Forum, Dorchester, Weymouth and Portland in Dorset. Some of these people live in one of 3 extra care housing complexes in Dorchester, Weymouth and Portland. These are blocks of housing association flats where Apex Prime Care – Dorchester are based on site.

At the time of the inspection, Apex Prime Care – Dorchester was providing personal care to 83 people. Of these people, 38 lived in the extra care housing.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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.

The registered manager and staff understood their responsibilities to recognise and report potential abuse.

Right Care:

People and their relatives told us they felt at ease with the care staff. People tended to have regular staff providing care, although depending on where they lived some people experienced more new staff.

People and relatives told us the service was organised in a way that respected their wishes and ensured their care needs were met. People had care plan review meetings at least annually with a senior member of staff, where they, and where appropriate their relative, reviewed and discussed how their care should be provided.

Risks to people and the staff supporting them were managed in a way that respected people’s preferences, whilst supporting them to remain safe. Medicines were managed safely so people received their medicines as prescribed.

Right Culture:

There were enough staff to provide people’s care. The registered manager was careful not to take on new care packages unless there were staff available to cover these. People and relatives told us staff stayed for the allotted time unless everything had been completed and they were happy for the staff to leave. The provider operated recruitment checks before new staff started providing care, to help ensure staff were suitable for care work.

People and relatives had confidence in the ability of care staff. Staff had training in key topics at induction, with regular updates following this. Some staff told us they would value face-to-face training. The registered manager confirmed this could be provided at neighbouring Apex Prime Care locations and that the opportunity would once again be offered to staff.

The registered manager and staff worked in partnership with health and social care professionals to help ensure good outcomes for people.

People and relatives said they felt able to contact the office if they had queries or concerns.

Staff told us they felt well supported. There were regular audits and checks on the quality of service provided. The registered manager had recognised that staff spot checks and supervision meetings were out of date, and was in the process of addressing this.

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 25 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation regarding staff awareness in relation to safeguarding children.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. This service provides care to older people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing. There were 39 people who received personal care from this service at the time of the inspection.

There was a registered manager in place. 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 the last inspection in October 2015, the service was rated Good in all domains and at this inspection we found the service remained Good.

People continued to receive care from staff that were caring, kind and compassionate. People and their relatives spoke very highly of staff.

People told us they felt safe. All staff were clear about how to report any concerns and were confident that any concerns raised would be responded to. The registered manager knew how and when they should escalate concerns following the local authorities safeguarding protocols.

The registered provider had a system in place to ensure people received their medicines as prescribed. Staff continued to receive training to administer medicines safely.

People continued to receive care from staff who had the right knowledge and skills to meet their needs.

People's needs were assessed and their care was planned to maintain their safety, health and wellbeing.

There were systems in place to monitor incidents and accidents.

Staff treated people with dignity and respect and asked for people’s consent before providing care.

People continued to be supported to have maximum choice and control of their lives and staff supported them to maintain their independence where possible.

Staff told us there was good communication with the management of the service and they felt supported. Staff continued to have good levels of support and supervision to enable them to carry out their roles.

The provider had processes in place to monitor the delivery of the service. People's views were obtained through surveys, one-to-one meetings, meetings with people's families and social workers.

The provider had a process in place to enable them to respond to people and their concerns, investigate them and had taken action to address their concerns.

Staff were knowledgeable about people's needs and told us they left drinks and snacks for people where required.

Staff told us that they seek the guidance from healthcare professionals as required. They told us they would speak with people's families and inform the management team if they had any concerns about people's health.

The management team were proactive in identifying continuous learning to drive improvements within the service.

We looked at the handling of medicines by the agency. We found that there was a policy and guidance to ensure people had the medicines they were prescribed, but that the guidance was not always followed. For example, we saw that some medicines had not been given as prescribed.

People spoke positively about the capabilities of the staff. One person told us that they were 'All quite capable of doing the job.' Staff also told us they felt supported. We saw that their training was current and they received regular supervision and monitoring checks. One member of staff told us, 'I'm proud of the team we've got, everyone works hard.'

The provider had systems in place to monitor quality. For example, staff received monthly monitoring to ensure the care they delivered was appropriate and safe and people were asked for regular feedback about the care they received. However, the provider was not auditing care delivery records, and errors and omissions found by this inspection had not been identified.

Although we found that people experienced care, treatment and support that met their needs and protected their rights. We found that a risk assessment was missing for a person who needed bedrails.

People told us that the care they received from the agency was good and that the care workers followed the information on the care plan. One person told us that the care workers were, 'Fantastic.'

We found that the provider was not meeting requirements in relation to Management of medicines because appropriate arrangements had not been made on two records for recording of how medicines were to be managed.

People who use 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. However, we found that the multi-agency policy on safeguarding vulnerable adults was not available at the agency for staff to use. This policy provides information on the local arrangements for managing safeguarding concerns.

We found that here were enough qualified, skilled and experienced staff to meet people's needs.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.