Background to this inspection
Updated
19 December 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection was completed between 15 and 20 November 2018. We made telephone calls to people who use the service on 15 and 16 November 2018 and visited the office to speak with staff and review records on 19 and 20 November 2018. This inspection was completed by two adult social care inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience had experience of caring for older people.
Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law.
Prior to the inspection we received feedback from a Commissioner of the service. During the inspection we spoke with seven people and four relatives by telephone. We also spoke with five care staff, the deputy manager, the Regional Manager and the Regional Trainer for the service.
We case tracked two people which is when we speak with the person or their relatives and review their care plans, medicine records, staff rosters and daily records. We reviewed the same types of records for a further four people. We also reviewed staff recruitment and supervision records for three staff and staffing rosters for four staff.
The service was last inspected in October 2016 when it was rated as good in all areas. We identified seven breaches of Regulations at this inspection.
Updated
19 December 2018
The inspection took place from 15 to 20 November 2018, with office visits on 19 and 20 November 2018. The office visits were announced to ensure staff we needed to speak with were available. 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, younger disabled adults and people living with dementia or mental health needs. Not everyone using Apex Prime Care Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The service was providing care to 64 people on the morning of 19 November 2018, 54 of whom were receiving the regulated activity of personal care.
The service was last inspected in October 2016 when it was rated as good in all areas. Following this inspection in November the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
Following the inspection the provider submitted an application to de-register this location and the management of the regulated activity for people who continued to receive care was transferred to another of their locations.
There was inadequate leadership and governance of the service. The service had seen frequent changes in management and there was a lack of a registered manager which had resulted in inadequate oversight of the service, lack of support for staff and poor quality of care. 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.
There were insufficient numbers of suitable staff to keep people safe and to meet their needs. People reported they had experienced late and missed calls and inconsistency in staffing. Staff had worked excessive hours to provide people’s care but the sudden departures of care staff at the end of October and November 2018 had precipitated a staffing crisis. On the morning of the inspection the service had to arrange to hand back 25 people’s care packages to Commissioners, to ensure people’s safety. The provider had failed to ensure full pre-employment checks had been completed for all staff and that staff had the skills required for their role.
People’s medicines were not managed safely. The guidance and record keeping in relation to medicines management meant that the provider could not demonstrate staff provided safe care in this area.
Risks to people had not always been identified, assessed or addressed within their care plans for people’s safety. There were not fully effective systems to protect people from the potential risk of financial abuse.
The provider did not have an electronic system in place to monitor when and if people received their care. The lack of an electronic call monitoring system meant we could not identify how many care calls had been missed. There had been a failure to identify and report missed calls to the local authority under safeguarding procedures as acts of neglect. The provider could not demonstrate people had always been sufficiently supported to ensure they ate and drank sufficient for their needs.
Staff had not all had the opportunity to update their training to ensure it remained current. One staff member was still rostered to provide people’s care although some of their training had expired in 2015. Staff had not all received supervision at all this year, which put people at risk of receiving ineffective or unsafe care.
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; the policies and systems in the service did not support this practice.
People did not consistently receive person centred care that fully reflected their needs and preferences. People’s care had not always been regularly reviewed and their care plans updated accordingly. People’s needs for accessible information had not always been identified. There was a lack of written information for staff to refer to about who was receiving end of life care.
There had been a lack of management oversight to monitor, assess and mitigate potential risks to people and staff from the provision of the regulated activity. Issues with the standard of care plans and staff recruitment had been identified at the start of 2018, but there had been a lack of effective action to address them for people. There had been a failure to effectively record, investigate and monitor people’s complaints or to identify trends.
People’s care needs had been assessed prior to the provision of their care and the provider had obtained commissioner’s assessments of people’s care needs. However, the provider was not able to consistently demonstrate people’s care and treatment had been delivered in line with legislation and current guidance to achieve effective outcomes for people.
There was mixed feedback from people and their families about how caring the staff were, some said staff were kind whilst others felt they were treated as a job rather than a person. People’s records did not consistently demonstrate what decisions they had been involved in by staff about their care. People’s privacy and dignity had been upheld.
There was not an open culture within the service. There was a culture of staff working excessive hours and staff had failed to alert senior management of the extent of the issues at the service, feeling they should cope themselves. There had a been a failure to alert external services with regards to the issues related to staffing to enable them to act to ensure people’s safety.
Processes were in place to seek people’s views on the service they received and staff’s views on the service. Staff were happy working for the provider.
The risks to people from acquiring an infection were safely managed. There were examples of how staff had contacted healthcare services for people.