Apex Prime Care Poole

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Incidents and accidents were documented and reviewed to identify themes, patterns and lessons that could be learned. The service used an electronic system to record, review and analyse incidents, accidents and events.

Staff were involved in learning from events as these were shared amongst the team.

People and their relatives told us they knew how to contact the registered manager and the office team.

The service worked with people and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services.

A person told us about their hospital stay and subsequent discharge home. The person said, “The communication (between the service and the hospital) was great.”

A health and social care professional told us, “I have found the office and management helpful and responsive in relation to any issues raised and happy to engage in interaction and discussion.”

In relation to people being discharged from hospital another health and social care professional said, “The service is quick to inform us of issues and put in corrective measures to ensure the person is safely cared for.”

The service provided people with a paper folder which remained in their home. This folder contained the provider’s contact information and some information about people in case the person was admitted to hospital.

Safeguarding procedures were in place and the provider had an up-to-date safeguarding policy. The service shared concerns and reported them to the local authority as required.

People and their relatives told us they felt the service was safe and they knew how to raise concerns. One relative said, “[The person] is safely cared for.” Another relative told us, “The office is approachable and responsive.”

Staff told us they knew how to raise concerns with the registered manager. One staff member told us, “If we have any concerns, we can alert the registered manager via email or phone call.” Another staff member said, “People are safe because any little concern from them is taken seriously by the office team. They take action immediately.”

Risks to people's safety and wellbeing were not always fully assessed and recorded.

Risk assessments did not always provide staff with enough detail about how identified risks should be managed and mitigated. For example, there was incorrect and limited information available on the risks and support needs of people with diabetes and epilepsy. This meant staff may not respond appropriately to changes in the person’s medical condition placing them at increased risk of harm.

The registered manager responded to our feedback and started to make changes to people’s risk assessments and care plans during the inspection.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Risks associated with a person’s home environment were identified during the person’s initial assessment.

The registered manager told us they were reviewing all equipment in people’s homes that was used by staff, to ensure the service dates were recorded on the provider’s electronic system.

Staff told us they knew how to report maintenance concerns. A staff member said, “[People’s environments] get assessed before we are sent out to them. The team in charge of safety carries these checks out. And we can raise any concerns we observe.”

The service did not always make sure staff received effective support and development. They did not always work together well to provide safe care that met people’s individual needs.

Training records showed not all staff were up to date with their essential training in line with the provider’s policy, including safeguarding training, training to support people with some health conditions and training in relation to end of life care. This meant the provider could not be assured staff had the qualifications, competence and skills to provide care that met people’s needs. This placed people at increased risk of avoidable harm.

Staff rotas were not always planned to ensure people were getting their care at the agreed time. Some staff were scheduled to do back-to-back visits without allowing for travel time between visits. Staff did not always remain with people for the full, allocated time of care visits. Staff were not always provided with an explanation as to why staff had left earlier than scheduled. This meant people were not always getting the time allocated to them in their visit.

Staff told us they did not have enough time to travel between people’s homes, and this impacted on the care they were providing. Comments included, “We are given 5 minutes to commute between clients or sometimes none at all, regardless of the distance or the time of the day. This poses an immediate problem for the staff to determine how much time to spend with the person as staff are constantly having to clock watch in order to allow themselves travel timeto the next person so rushing through tasks is inevitable”, “In the rota sometimes they miss out 5 minutes driving time or if it’s more than 5 minutes to another client then it brings us late to the next client. Staff rush to the next client”, and “We look after mostly elderly people who need patience and time … important tasks can easily be overlooked when rushing and can place the person in danger.”

Whilst some people and relatives expressed their satisfaction with care, others were concerned visit times did not meet people’s wishes and needs. Comments included, “Carers are on time and when they leave, they say what time they’ll be back”, “Staff stay for the allocated time”, “Erratic time keeping at weekends”, “Care is rushed”, and “Sometimes care is rushed in the evening.”

A health and social care professional told us, “The people report that staff are rushed on their visits, do not spend the allotted time with them, do not greet the person or speak directly to them.”

We were also told some staff did not have a good understanding of manual handling processes and that it was difficult to get in touch with the office team.

Staff received supervisions and competency checks. The provider had systems in place to monitor punctuality and duration of calls. These did not identify the shortfalls we found at this inspection.

The provider assessed and managed the risk of infection. Staff had completed infection control training.

People and relatives told us staff used personal protective equipment (PPE). One relative said, “Yes staff wash their hands.” Another relative told us, “Staff wear a uniform. They wash their hands and wear gloves. [The person] would soon tell me if they didn’t.”

Staff told there was a plentiful supply of PPE and they regularly collected PPE, such as gloves, aprons and shoe covers, from the office.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People told us they felt supported with their medicines. Comments included, “Staff manage [person’s] medication really well”, and “Staff communicate well and they’re kind, they watch me take my medication.”

Staff confirmed they had their medicines training and had no concerns regarding the management of medicines in people’s homes. One staff member said, “Our senior carers or someone from the office come for spot checks to make sure that we are following the care plan and giving the correct dose and medicine to the client.” Another staff member told us, “We know what medicines people have because we have the medication records section in the app and it lists all the medication for each person.”

Where the service had supported people with their medicines, this was assessed and the levels of support needed was identified in people’s care plans. Records showed that people received their medicines safely in the way prescribed for them.

Risk assessments were in place for higher-risk medicines such as anticoagulants and prescribed creams which may be flammable.

Staff had training and competency checks to support them with administering medicines safely. Detailed medicines audits took place regularly, and we saw these identified areas and actions for improvement, which were recorded when completed.