Archived: Apex Prime Care - Eastbourne

Apex Prime Care – Eastbourne is a domiciliary care agency. It provides personal care to people living in their own homes. It can provide a service to older people, those living with dementia, people who have a physical disability or a sensory impairment and people who have mental health needs. Not everyone using the service received the regulated activity. CQC only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection there were 114 people who used the service, 90 of whom received the regulated activity of personal care. Some people funded their own care, however, most people had their care publicly-funded.

The service is owned by Apex Prime Care who have services across the south of England. The service had a registered manager. A registered manager is a ‘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 home is run.

After the last inspection, which took place between 20 March 2018 and 4 April 2018, the service was rated as Inadequate and was placed into Special Measures. We took enforcement action by issuing three Warning Notices to ensure that improvements were made. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good. This was because there were concerns about the management of medicines and the failure to raise safeguarding referrals with the local authority when there were concerns about people’s care. There was a lack of understanding about the Mental Capacity Act 2005 (MCA). Assessments of people’s needs had not always been conducted in a timely way. There was insufficient guidance provided to staff about people’s needs and preferences. Insufficient oversight of the systems and processes within the service were concerns. There was mixed feedback about the leadership and management of the service.

At this inspection, which took place on 23, 24 and 27 November 2018, it was evident that improvements had been made. The provider had reviewed their processes, had sought external support from social care professionals and had introduced new electronic systems. These enabled the registered manager to maintain a better oversight of people's care and the practices of staff. The provider was no longer in breach of the Regulations. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. We did, however, find areas of practice that needed further improvement, embedding and sustaining in practice.

People were asked their consent for day-to-day decisions that affected their lives. However, people were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible. Policies and systems did not support this practice. This was an area of practice in need of improvement.

There were good systems in place to provide the registered manager with sufficient oversight of the service and the care delivered. The registered manager had liaised with external professionals to help improve the service. They had prioritised the improvements that were required. They acknowledged that the changes that had been made needed to be developed further and embedded and sustained in practice. People, their relatives and staff continued to feel that the scheduling of their visits were not well-managed. Staff did not have sufficient time to travel from one person to another and this sometimes effected the timeliness of people’s visits. Feedback about the responsiveness of the staff based within the office continued to be an issue. Some people, relatives and staff felt that the office staff were not always helpful or approachable when they had concerns about people’s care. Despite being asked about their choice of gender, some people’s expressed wishes had not been respected. These were areas of practice in need of improvement.

People told us that they received a service that made a difference to their lives. They told us that they felt safe. One person told us, “The carers provide me with security because I know that someone will come in the morning and find me if I have fallen”. Staff had a good understanding of how to support people safely and knew what to do if they had concerns about people’s safety. There was a reflective approach to providing care and the management team and staff learned from situations to ensure that care continually improved. There was sufficient staff to ensure people received their care visits. People were protected from the risk of infection and cross-contamination. Risks to people’s safety were assessed and minimised.

Positive relationships had developed between people and staff. Staff took time to get to know people and observations showed that staff demonstrated empathy and kindness. People told us, “The service has got good carers” and “The carers are absolutely brilliant”. People were treated with dignity and their privacy was maintained. One person told us, “They are very aware of my dignity. They ask my permission if there is anything unusual to do”.

People's needs were assessed and they were involved in their care. Care plans provided staff with detailed information and guidance about people’s needs. People were supported to maintain their skills and independence. Care was person-centred and tailored to people’s needs. Efforts had been made to gather information about people’s backgrounds, their hobbies and interests to provide staff with an insight into people’s lives before they started to use the service. People were supported to maintain their interests and have contact with family and friends.

Quality assurance processes ensured that people received the quality of service they had a right to expect. People, their relatives and staff told us that they were involved in decisions that affected people’s care and the running of the service. Concerns and complaints had been dealt with in accordance with the provider’s policy.

People were supported to live healthy lives. People were supported to have their medicines safety and on time. Staff were responsive when people were unwell. There was good partnership working with external healthcare professionals to ensure best practice and maintain a coordinated approach to people’s care.

People and their relatives felt that staff had appropriate skills and were competent. One person told us, “The care staff are absolutely brilliant. They are as good as gold they are”. Staff had a good understanding of the people that they supported. Most people told us that they received care from consistent staff who knew them and their needs well.

As part of some people’s care packages, they were supported to have sufficient quantities to eat and drink. Staff promoted people’s independence when offering support. People were involved in shopping for items of their choice.

Many of the people supported by the agency were older persons, some people also lived with long-term medical conditions, some had substance abuse related 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 meals preparation. Services were provided to people who lived in Eastbourne 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.

This was the service’s first inspection. At this inspection, the service was rated as Inadequate over all. We found they were in breach of six of the 2015 Regulations of the Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s safety was not ensured across a range of areas. This included assessment of risk for people, including risk of falling, support with moving about in a safe way, preventing risk of infection and assessment of dietary risk. The provider was not auditing accidents and incidents to ensure lessons were learnt and risk factors reduced. The provider had also not ensured all medicines errors had been consistently reported to the Local Authority and had not ensured people were appropriately supported when taking their medicines.

The provider had not ensured all people had full assessments of their care needs. Some people’s care plans did not outline their care needs, to ensure care workers had full information on how to meet their individual needs. When people’s care plans were reviewed, the provider had not ensured all people’s changed care needs were up-dated to reflect their current care needs.

Where people needed support in consenting to care, the provider had not ensured people had relevant mental capacity assessments completed or ensured that decisions made on behalf of people were made in their best interests.

People told us they did not consistently receive continuity of care from care workers they knew. This was echoed by care workers we spoke with. People and care workers told us information systems, such as when care workers were running late, were not always effective. This meant people felt they were not always communicated with about relevant matters.

A range of people felt they had raised concerns. Systems for raising concerns were not robust and the registered manager therefore did not know about the types of matters which people felt they had raised about their care.

The provider did not have effective systems for the audit of care provision. This meant they were not aware of issues which affected people and staff, this included the on-call system and reports of some care workers not following care plans. Where audits had been completed, the information was not used to assess wider issues for people and drive forward improvement. The lack of effective audit also meant the provider had not identified a wide range of records relating to people’s needs had not been made, were unclear or incomplete.

People and staff felt the provider had effective systems to ensure staff were supported by training and supervision. All of the staff we spoke with were aware of their responsibilities if they suspected a person was at risk of abuse.

The provider had safe systems for recruitment of staff and analysing if there were sufficient number of staff employed to support people.

People all confirmed how kindly and supportive staff were to them, saying how much they appreciated their visits from care workers and how much they felt respected and involved by the care workers who visited them. Care workers spoke warmly about the people they supported and clearly enjoyed supporting people to live in their own homes and fostering their independence.

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.