Archived: Apex Prime Care - Hailsham

Many of the people supported by the agency were older people, some lived with long-term medical conditions. People received a range of different support with their personal care in their own homes. Some people received occasional visits, for example weekly support to enable them to have a bath. Other people needed more frequent visits, including visits several times a day to support them. This could include two care workers and the use of equipment to support their mobility. Some people needed support with medicines and meal preparation. Services were provided to people who lived in Hailsham and surrounding areas.

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. The provider for the agency is Apex Primecare Limited, a national provider of care.

The agency’s last inspection took place on 6 April 2017. At that inspection, the agency was rated as requires improvement over all and five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified; this was in relation to person centred care, consent, safe care and treatment, good governance and staffing. The provider sent us an action plan after the inspection. This inspection showed the provider had carried out their action plan and all the breaches had been addressed and the service is now rated as good over all.

Improvements were needed in one area relating to consistency in record keeping. This was because some people’s records followed guidelines on record keeping in relation to medicines, but others did not. Also, while most necessary risk assessments relating to medicines were in place, this was not the case for some risk assessments. Some people’s daily records were not as clearly maintained as others. The registered manager told us that once the new app had been fully embedded, such inconsistencies would be easier to identify to ensure all records were completed to the same standard.

Action had been taken to ensure the safety of people. The management of medicines was now safe, risks to people relating to medicines were identified and staff supported people in the way they needed, in accordance with the agency’s procedures.

Where people had risks, including needing support with moving about or risk of pressure damage, the provider had ensured risk assessments were put in place. Each person had a care plan which outlined how their risk was to be reduced. We saw staff followed these care plans to ensure people’s safety. Where staff or the agency’s managers identified issues relating to people’s safety, they took appropriate action, including contacting relevant external professionals. There were safe systems to reduce people’s risk of infection.

Enough staff were employed to provide people with a responsive, flexible service. The agency had effective systems for the recruitment of staff, which ensured that people were supported by staff who had been assessed as safe to work with people in their own homes.

Staff and managers were aware of how to ensure people were safeguarded and worked within the local authority’s safeguarding procedures. They were also aware of how to safeguard people if they had difficulties in gaining entry into a person’s home and were concerned they might need support.

The provider had ensured that people’s consent to care was sought in line with the principles of the Mental Capacity Act (MCA) 2005. All of the staff had a clear understanding of their responsibilities under the MCA. They followed them in practice when they were with people.

Staff now received training to help ensure they remained up to date with best practice. People told us they felt staff were trained in their roles. This was confirmed by staff who commented favourably on the supports they were given to carry out their roles. This was confirmed by the agency’s records.

People who needed assistance with their meals and drinks received the support they needed, in the way they wanted. People’s diverse needs were taken into account when drawing up care plans to support them with eating and drinking.

The agency worked with other professionals to ensure people were supported in the way they needed. Staff told us about their close working relationships with external professionals. This was supported by people’s records.

People's independence, dignity and privacy was respected. People commented on the kindness and support they received from care workers. They also told us that care workers supported their independence and treated them as individuals. We saw staff were very polite to people, showing empathy when supporting them.

The provider provided people with a responsive service. Many of the people commented particularly on the good continuity of care they received from the same group of care workers. People also told us they were sent a rota and staff kept to the timings on their rota. This was confirmed by staff and by the agency’s records. People were involved in drawing up their own care plans so they met their individual needs. Staff followed people’s care plans when they gave them care.

The agency provided people with end of life care in a kindly and supportive way. They had close working links with other professionals involved with people who were at the end of their lives.

Any complaints and concerns were handled appropriately and people were confident the provider would take action if they raised issues. This was supported by the agency’s records.

The agency’s auditing systems had been developed. Where issues were identified, action was taken, this included areas identified through ‘spot checks’ on care workers and any trends in staff sickness rates.

Both people and staff told us the agency’s management systems made them feel valued. Staff said they felt consulted by the management, this included the regular staff meetings. Staff were positive about the new technology which had recently been introduced, and commented on how helpful it would be to them once it was fully embedded.

There was 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.

The provider and registered manager were able to demonstrate how the delivery and provision of care met people’s needs who lived in the Hailsham area. However, they were unable to demonstrate how people who lived in the area of Hastings received care that met their needs. We found a number of concerns which related to the provision of care provided to people living in the Hastings area.

People were supported with medicine management when needed and care workers had received training on how to administer medicines. However, we found unexplained gaps in Medication Administration Records (MAR) and people’s medicine risk assessment did not always record the most up to date medicines they were prescribed.

Risk assessments were in place which considered moving and handling. However, risk assessments did not consistently record the correct level of support required to safely move and transfer a person.

Consent had not consistently been sought and the principles of the Mental Capacity Act 2005 (MCA) had not consistently been complied with. Where people were being supported with the use of bed rails, the registered provider had not considered whether the use of bed rails was restrictive. Bed rails risk assessments were not in place and the provider had failed to demonstrate whether people had consented to the use of bed rails.

Quality monitoring systems were in place, but these were not consistently robust. Incidents and accidents were not audited on a monthly basis for any emerging trends, themes or patterns. The provider’s quality assurance framework had failed to identify that were was not sufficient or robust oversight of the provision of care that people received in the Hastings area. We were also unable to view a range of documentation to explore people’s concerns. Staffing levels were sufficient in the Hailsham area, but the provider was unable to demonstrate how staffing levels in the Hastings area met people’s needs and ensured people received a safe and responsive service.

Some people raised concerns over the competency of care workers. One relative told us, “They are very dedicated; they just don’t have the training.” Care workers in the Hastings area had not consistently received up to date training. However, care workers working in the Hailsham area had up to date training and were supported to develop their skills and qualifications. Care workers told us how they respected people's confidentiality, but we found this was not consistently upheld. We have made a recommendation for improvement.

A complaints procedure was in place and most people felt able to raise a complaint. Some people felt their complaints were not listened to and communication could be improved. We have made a recommendation for improvement.

The provider was unable to demonstrate how people in the Hastings area received a responsive service. Some people raised concerns over care calls not always being covered and not receiving care from a consistent team of care workers.

Care workers were kind and caring and treated people with dignity and respect. Caring relationships were seen throughout the day of our inspection. Care workers knew the people they cared for well. People spoke positively about the care and support they received from care workers.

Recruitment practice was safe and care workers understood the importance of leaving a person’s property secure at the end of a care call. Care workers were vigilant of people’s health care needs and ensured they had access to health care professionals to maintain their health. Care workers understood the need to share information about changes in people's health. People receive adequate food and drink and where necessary the registered provider uses food and fluid charts to monitor how much people are consuming

We identified some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.