We carried out a review of the data available to us about Apex Prime Care - Portsmouth on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Apex Prime Care - Portsmouth, you can give feedback on this service.
Apex Prime Care - Portsmouth is a domiciliary care agency providing personal care to older and younger adults who require this due to illness, disability, learning disabilities or autism. At the time of our inspection, the agency was providing care to 96 people living in Portsmouth and the surrounding areas.
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
Following the last inspection the provider implemented an action plan to make the required improvements. At this inspection we found there were improvements in the management of risks to people and in their system to assess, monitor and improve the quality and safety of the services provided.
People and their relatives were positive in the feedback they gave about the service. One person told us, “I am very definitely safe with them [carers], they are a big help and always come in with a smile.” Another said, “My family feel confident that I am safe, I am quite happy with the service.”
There were systems in place to protect people from the risk of abuse. Staff understood safeguarding procedures and were aware of how to raise a concern. Risks to people were regularly assessed and reviewed, with appropriate measures in place to minimise risk. Staff were recruited safely and there were enough staff to meet the needs of people receiving care from the service. When needed, medicines were administered by staff who had received training to do so. People were supported by staff who had received infection prevention and control training and had access to necessary PPE.
Quality assurance systems were in place and monitored regularly by the registered manager to review the quality of the service provided to people, for example, audits of care records and concerns. Feedback was sought from people who used the service and any lessons learnt were shared appropriately. The service worked with external professionals to support joined up care provision.
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 (published 21 January 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 requires improvement to good. 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 Apex Prime Care- Portsmouth on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Apex Prime Care – Portsmouth is a domiciliary care agency providing personal care to 128 people at the time of the 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 had a quality assurance system in place, this did not always drive the necessary
improvement in relation to care records, including risk assessments.
Improvements had been made to care plans and included information to reflect the needs, preferences and choices of people. Further work was needed to ensure risk assessments contained enough information and provided specific guidance for staff, in the event of the risk occurring.
People told us they felt safe receiving care from Apex Prime Care. Staff understood their responsibilities to protect people from abuse. The recruitment process was robust and there were enough staff to meet people’s needs. People told us they received consistent support from staff. The management of medicines was safe, and improvements had been made to medicine records.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests; the policies and systems in the service supported this practice.
People and their relatives consistently told us they were supported by staff who were kind and caring and who understood their likes, dislikes and preferences. They were positive about the support they received to access health care professionals, to maintain their health and wellbeing.
People had access to information in formats that were appropriate for them and staff talked about this. However, none of the staff we spoke to understood what the Accessible information Standard was. The Accessible Information Standard (AIS) was introduced by the government in 2016 to make sure that people with a disability or sensory loss are given information in a way they can understand.
Since the last inspection there has been a significant amount of improvement. The registered manager was responsive to our feedback and took immediate action to make improvements where required.
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 (published 5 October 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to risk management and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Apex Prime Care – Portsmouth is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older and younger adults, including people living with dementia, physical disabilities and sensory impairments. At the time of our inspection the service was supporting 164 people.
A registered manager was 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 registered manager was also the providers regional manager for the south and south east of England. The day to day running of the service was delegated to the manager who was applying to become the registered manager for the service. We have referred to ‘the manager’ throughout the report which is the person with day to day responsibility for the service and not the registered manager.
We found that the registered person had failed to notify the Commission without delay of any abuse or allegation of abuse in relation to people who use the service. It is important that we are notified, to enable us to monitor the quality and safety of the service people receive.
Whilst a system of audits was in place to monitor and assess the quality and safety of the service provided, these audits were not always completed and had not been effective in identifying and addressing all the concerns we found.
We found that risks to people were not always communicated to senior staff responsible for the assessment and management of risks. When risks for people were known, they were not always fully assessed. Guidance was not always provided to staff on how to minimise the risk and care for people safely and appropriately.
People’s medicines were not always managed safely. We found the records kept to evidence people had received their medicines as prescribed were not fully completed. This included the records for topical medicines (those applied to the skin). Care plans did not always include accurate information about the support people required with their medicines or that the correct support had been given by staff. This meant people were at risk of not receiving their medicines which could lead to a deterioration in their health or in them experiencing pain.
Overall there were sufficient staff to meet people's needs. However, people told us they did not always receive their care in an informed, consistent and timely manner that met their preferences. Staff were recruited safely to protect people from the employment of unsuitable staff.
Staff understood their responsibilities to protect people from abuse and records showed safeguarding concerns were acted on appropriately with the involvement of the local authority. People told us that incidents such as falls were safely managed by staff. However, it was not evidenced that learning from incidents was used to make improvements to the service people received.
People's records did not always evidence a mental capacity assessment had been completed to determine if the person had the capacity to agree to their care and treatment. We found inconsistent and incomplete information in people's care plans about their capacity to consent. Not all staff were aware of the principles of the Mental Capacity Act (2005) and how these should be applied to support people to have maximum choice and control of their lives.
People's needs were assessed when their package of care commenced and this included their needs in relation to some of the protected characteristics under the Equalities Act 2010. Information about people race and sexual orientation was not included in the needs assessment. This could mean some people’s needs would not be known or considered by the service, if people were not asked about them.
People were supported by staff who had completed an induction and training in line with the provider’s requirements. Staff were supported by senior staff and the manager through regular supervision. Annual appraisals had been planned.
People told us they were mostly satisfied with the support they received with eating and drinking. People were supported to access healthcare services as required.
People told us they received kind and compassionate care which was mostly provided by familiar and consistent staff. People told us their privacy, dignity and independence was promoted and respected by staff. People said that care staff listened to them and respected their decisions, however, some people told us they did not always find this to be the case with the office staff.
We received positive feedback from staff about the leadership of the service. The manager was working to improve the culture of the service and the communication between care staff and office staff. Staff were supported in their roles and responsibilities and action was taken to address performance issues. Improvements were being introduced to improve the systems and monitoring of the service people received.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commissions (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.