Apple Homecare Limited

Apple Homecare Limited provides domiciliary care services to people living in their own homes. At the time of the inspection, the service provided care and support to 39 people who were receiving a regulated activity of ‘personal care.’ CQC only inspects where people receive the regulated activity of personal care. This is help with tasks related to personal hygiene and eating. Not everyone who used the service received personal care. Where they do, we also consider any wider social care provided.

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

We received consistently positive feedback from people using the service and their relatives. They told us they felt staff were respectful of working in their home, and treated them as individuals, with kindness and care. People told us they looked forward to the staff visiting, as they enjoyed a laugh and a joke which put them at ease, particularly when receiving personal care.

People told us that staff supported them as required with their medicines, applying creams to their skin, and with managing their nutritional and hydration needs. Relatives told us they felt confident with the consistent standards of care being provided by staff, to maintain people’s safety and independence in their own homes. People and their relatives told us the staff arrived at their care visits on time, stayed for the agreed length of time and would let them know if they were running late.

People and their relatives told us staff wore the required personal protective equipment and disposed of this correctly, to keep them safe and protect them from the risks of catching infections, including COVID-19. 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.

People and their relatives told us that their views and feedback were regularly sourced by the registered manager, and felt able to contact the office team as required. A relative said, “There is nothing to change, the staff make [Name] laugh and care for them how they like, they [the staff] are a great bunch of people and they give their all while they are there.”

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 with breaches of regulation (published 29 February 2021). Following on from the last inspection, the provider completed an action plan to show what they would do and by when to improve. Enforcement action was also taken as an outcome of the last inspection.

At this inspection, whilst we found improvements had been made the provider remained in breach of regulation 17 (good governance).

This service has been in Special Measures since July 2021. During this inspection the provider demonstrated that improvements continue to be 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 inspection was carried out to follow up on action we told the provider to take at the last inspection. As an outcome of the last inspection, conditions were imposed on the provider’s registration relating to breaches of regulation 11 (consent), 17 (good governance), 18 (staffing), 19 (fit and proper persons employed). A warning notice was served in relation to breaches of regulation 12 (safe care and treatment).

We undertook this focused inspection to check the provider had addressed the previous breaches of regulation and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apple Homecare Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We have identified a continued breach of regulation in relation to good governance (regulation 17) 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.

Follow up

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

Apple Homecare is a domiciliary care agency providing personal care to younger and older adults in their own homes. The service was supporting 51 people at the time of this inspection. 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

The provider’s failure to keep accurate records, demonstrate appropriate knowledge of legislation and regulation and effectively monitor the service in order to drive improvement had resulted in widespread and significant concerns for the third consecutive inspection. This meant we could not be assured that the provider was able to act on feedback in order to improve the safety and quality of the service, or have effective systems in place to do so, and this put people at risk of harm or receiving inappropriate care. We again identified breaches in regulations.

Although the people who used the service told us their needs were met by caring and respectful staff, the provider could not assure themselves that their staff had the right skills, experience, knowledge or competency. This was because not all staff had received the training they required for the role or had their competency to deliver care assessed. Furthermore, full recruitment checks as required by law had not been completed on all staff further contributing to the failure of the provider in seeking assurances on the suitability of staff and ensuring a safe service.

People were not always supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The service could not demonstrate they were adhering to the Mental Capacity Act 2005 (MCA); the associated knowledge of the staff and registered manager was poor.

However, the people who used the service, and their relatives, told us the service met needs and did so in a compassionate and consistent manner. They told us the registered manager was accessible, approachable and helpful as were staff. People were supported by consistent staff teams who demonstrated they knew people’s needs well, met the principles of care and demonstrated, through discussion with inspectors, dedication, compassion and a caring approach.

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 requires improvement (report published 18 March 2020) 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. They had failed to meet this action plan and at this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service in February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their compliance in relation to safe care and treatment, meeting the Mental Capacity Act 2005 (MCA) and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apple Homecare on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, MCA, recruitment processes and governance 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Apple Homecare provides domiciliary care services to people living in their own homes. At the time of the inspection, the service provided care and support to 58 people, of those, 46 people were receiving a regulated activity of ‘personal care.’

People’s experience of using this service

We identified ongoing concerns around medicines management, oversight of certain environmental risks, which did not always ensure people’s safety. Governance arrangements within the service remained an area of concern, as they were not always identifying shortfalls and making changes to address them.

There were breaches of regulation impacting on the quality of service provided to people.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; policies and systems in the service were not always followed to support good practice.

Overall, we received positive feedback from people on the standards of care provided, and additional support given to improve social networks and reduce isolation. Staff treated people with kindness and were polite, and people told us they felt the staff to be an extension of their own families.

The service told us they had good working relationships with health and social care organisations to ensure people received joined up care, including where people required end of life care and support.

The registered manager encouraged people and their relatives to give feedback on the service, and areas for improvement through questionnaires and maintaining regular phone and face to face contact.

Rating at last inspection

The last rating for this service was Requires Improvement, (published 06 February 2019). There were breaches of regulations relating to safe care and treatment, and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection some improvement had been made, however, we found that the provider was still in breach of regulations and remains rated as Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified repeated breaches or regulation in relation to the provision safe care and treatment, consent to care and support and good governance processes. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Apple Homecare on our website at www.cqc.org.uk

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection around 50 people were using the service.

Not everyone using Apple HomeCare 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.

There was a registered manager working at the service. 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 of this service on 18 March 2016, we rated the service overall as good. Whilst there were positive elements to this inspection, the overall rating for the service has been changed to requires improvement. This is because the management of records did not consistently meet the Regulations or good practice guidance. The system in place to manage and administer people’s medicines was not safe and risks to people had not always been identified and mitigated. There were also shortfalls in the quality assurance systems designed to monitor the quality of care. Staff supervision did not take place regularly and improved performance management measures are required. Staff training was not always effective especially in relation to safeguarding, medication and the Mental Capacity Act. There were shortfalls in the service’s approach to person-centred care planning and end of life care planning.

For these reasons, the provider is in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We have also made two recommendations to the provider regarding their application of the Mental Capacity Act and their approach to End of Life care planning.

We saw evidence of two medication errors in the past two years, one of which was due to a poor risk assessment. There were also recording errors on medicines charts and medication logs. In one case it was unclear what a relative was administering and signing for on the relevant medication records.

The service only assessed risks relating to medication, moving and handling, health and safety and the person’s property. Some of the risk assessments we saw were lacking in detail so it was unclear whether safety concerns were routinely managed.

People received a person-centred service when supported by staff who knew them well. However, care plans failed to consistently contain person centred information. This put people at risk of receiving care that did not meet their needs in the event they were supported by agency staff or staff that did not know them well.

Record management was not robust and quality assurance systems did not identify issues of concern.

Local authority requirements regarding the reporting of safeguarding concerns were not always followed.

Two of the files we reviewed lacked information concerning assessments conducted under the Mental Capacity Act 2005 (MCA) and related best interests decisions.

The provision of regular and robust training for staff needed to be improved. The service needed to strengthen its approach to performance management and ensure formal supervision and appraisals take place.

Staff enabled people using the service to express their needs and wishes and be involved in decisions relating to their care. However, we found one example where the service could have done more to support a person to communicate.

Staff were recruited safely and there were enough staff to complete all of the visits.

Staff worked well with other health professionals and agencies to ensure people received the support they needed.

People were supported to eat and drink and staff took care to ensure food was available to meet their diverse needs. People were routinely asked before any care was offered.

Staff were very caring and kind. They treated people with respect and promoted their dignity and independence. People’s right to privacy was recognised.

The service promoted an open and caring culture and staff were motivated and dedicated. There was an inclusive approach and feedback was routinely sought from staff, people using the service and relatives. The registered manager was active in the community and involved in a number of related care groups.

People and relatives were happy with the service and care provided.

The service was first registered by us on 22 July 2014. We then re-registered the service on 19 February 2016 because a new private company had been formed to own and run the service. Although the new ownership arrangements did not affect how the service was run, we had to change the registration details so that they accurately described who was responsible for the administration of the service.

Staff knew how to recognise and report any concerns so that people were kept safe from abuse. People were helped to avoid having accidents and they were assisted to safely use medicines. There were enough staff to enable all of the planned visits to be completed on time and background checks had been completed before new staff had been appointed.

Staff knew how to care for people in the right way and they had received all of the training and support they needed. People had been supported to eat and drink enough and to access any healthcare services they needed.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This law is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

People and their relatives said that staff were kind and caring. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had received all of the care they needed including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive and had been supported to pursue their interests and hobbies. There were arrangements in place to quickly and fairly resolve complaints.

Regular quality checks had been completed and people had been consulted about the development of the service. The service was run in an open and relaxed way, there was good team work and staff were supported to speak out if they had any concerns about poor practice. People had benefited from staff acting upon good practice guidance.