Archived: Portsmouth

Portsmouth, Apex Companions Limited, provides personal care services to people in their own homes. They provide services to older people and people living with dementia. At the time of our inspection there were 180 people receiving personal care from the service. There were 70 care staff, one senior co-ordinator and two co-ordinators who planned people’s care. There were three senior care staff, one deputy manager who was on maternity leave, one administrator and 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.

People’s care visits were sometimes provided later than planned because travel time was not allocated. People felt safe and had regular care staff who met their needs. However, people may not always be receiving a safe service if certain aspects of their care were not provided at specific times, such as medicines, personal care and preparing meals.

People were not always supported to eat and drink at the times they requested and this could have an effect on their well-being.

The registered manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 but did not always put this understanding into practice. We have made a recommendation for the provider to review the Mental Capacity Act 2005 and its subsequent codes of practice.

Feedback was sought and individually responded to. However the overall results were not analysed or evaluated to help improve service delivery. Audits were not completed or evaluated to help improve practice. Recording systems were duplicated and caused confusion on what was the most up to date information. Notifications had not been sent to the Commission for all four safeguarding concerns received by the service.

Staff received an induction programme and regular on-going training. Staff felt supported but did not always receive regular supervision in line with the provider’s policy. However, people and their relatives said they received care from regular staff and felt they were well matched with care staff and they had the skills and knowledge to carry out their roles effectively.

People were supported to maintain good health and access on-going healthcare support.

Risk assessments were completed of the environment and any manual handling equipment that would be used to support people with their care safely. Safe recruitment practices were followed.

People and their relatives were positive about the care and support received from care staff and the office staff. People were involved in their care and made decisions about their care. People’s independence, privacy and dignity was respected and promoted.

People’s needs were regularly assessed and reviewed. People’s care plans were personalised and individual, detailing how people like to receive their care. People were involved in their care planning and confirmed they had control over their care planning.

People and their relatives raised concerns with the service and felt these concerns were dealt with. People and their relatives we spoke to said they had never made a complaint but felt confident to raise one and that this would be dealt with. Complaints which had been received had been dealt with, responded to and actioned where required.

There was a registered manager and they demonstrated a good understanding of the service. There was a mixed response from people about the management and leadership of the service.

Staff felt supported by the registered manager. Staff were supported to question practice and were confident that concerns would be dealt with by management. Staff demonstrated an understanding of what to do if they felt their concerns were not listened to by management.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

At this inspection we did not set out to answer our five key questions about whether the service was caring, responsive, safe, effective and well led; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?. At this inspection we set out only to follow up on previous non-compliance in the area of Supporting Workers (outcome 14). Below is a summary of what we found

We found the provider had taken the appropriate action to ensure suitable arrangements were in place to ensure staff were appropriately supported in relation to their responsibilities to enable them to deliver care to people safely and effectively. Staff were able to request additional training to meet people's changing needs and this was actioned. People and their relatives told us they felt safe. One person said, 'I feel very safe.' A relative said, 'Could not ask for better care, very safe.'

There was not a registered manager in place at the time of our inspection. However there was a manager in place who was applying to become the registered manager.

During our inspection of Apex Care Portsmouth we spoke to 17 people who used the service, 15 relatives of people who used the service, six members of staff and the regional manager and the manager who was applying to become the registered manager. We also reviewed the care records of five people.

An inspector carried out this inspection with an expert by experience. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

People told us they felt safe. One person told us, 'Yes, I trust them.' and another person told us, 'Better now about feeling safe- things have improved since we went over to regular workers.'

We found there was a system in place for members of staff to report accidents and incidents but the recording of incidents was inconsistent with the provider's policy. Which meant that risks to people who used the service may not be managed effectively.

We looked at the recruitment records for staff. They demonstrated the provider operated a robust recruitment process and appropriate checks were made on staff before they were able to commence work.

We found the provider had ensured there were sufficient numbers of staff. We found staff had received supervision and training and felt supported. However not all staff had received an appraisal and supervision and training was not updated regularly in line with the provider's policy.

Is the service effective?

People's care needs were assessed but care plans and risks assessments were completed but not updated in line with what the manager told us. The manager told us that care plans and risk assessments would be updated every three months; however care records showed that assessments were not up to date but staff we spoke with understood the care needs of the person.

Is the service caring?

People told us most staff were kind and caring. One relative said, 'They are kind and they talk to [relative] a lot because they are very chatty' One person who used the service said, 'Yes, their attitude is good, I've not had anyone be rude or rough, anything like that.'

Is the service responsive?

Most people told us the service was responsive and we found the manager to be aware of concerns and changes that need to take place. We found the service had a responsive out of hour's service and a member of staff told us 'There was always someone on the end of a phone and they would get back to you straight away if you left a message.'

Is the service well led?

The service had effective quality monitoring systems in place. People told us they had opportunities to express their views and they were acted on.

The manager told us they had developed an action plan since they had taken on the responsibility as manager for the service. They told us this included, updating care plans, risk assessments supervision and training and improving the recording of incidents and accidents.

Members of staff and people we spoke with told us they felt the service had improved since the current manager had been in place and was confident that they could raise concerns and they would be dealt with.

One person told us. 'I can't fault them in anyway'. Other comments from people included: ' The carers do what I ask of them extremely well and 'I am happy with everything and have no complaints'.

We spoke with the manager, the area manager and nine members of staff. They all told us they were well supported by Apex Care Portsmouth. They told us training was good and they were provided with the information they needed to support people effectively. However all of the care staff we spoke with told us that they did not have any time allowed to travel between care calls and this caused some problems. One person told us 'If I have to stay a little bit longer with my first call of the day, this will have a knock on effect for the rest of my calls because I have no time to catch up'.

One person told us, 'The staff are very kind'. Other comments from people included: 'I am quite happy with the carers who call.' 'I have no had any problems, they are all very nice'.

Each person we spoke with told us that they had an information pack in their home and this had details about the care and support they needed. Relatives of people told us that their family members were well supported by staff to receive the care they needed.

People told us they felt safe and had no concerns about the staff who supported them. They said staff treated them well. Relatives we spoke with were all were happy with the support their relatives received.

Two of the people we spoke with were not fully aware of the agency's complaints procedure but told us they would make any complaints to the office. They said they were confident that any complaints would be dealt with appropriately.

We spoke with eight members of staff. They said that they were well supported by the agency and that they were provided with the training and information they needed to support people effectively.