Background to this inspection
Updated
2 September 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 1 inspector and 2 Experts by Experience who made phone calls to people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. A new manager had been in post since 11 April 2023 and had applied for their DBS. We had not received their application to register.
Notice of inspection
This inspection was announced.
We gave the service 24 hours’ notice of the inspection. This was because we wanted to be sure there would be staff at the office to speak to us.
Inspection activity started on 9 June 2023 and ended on 31 July 2023. We visited the location’s office on 13 June 2023.
What we did before the inspection
We reviewed information we held about the service since they registered with CQC. We used information gathered as part of a monitoring activity which took place on 27 September 2022 to help plan the inspection and inform our judgements. We sought feedback from the local authority, local Healthwatch and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with 12 people who used the service and 7 relatives about their experience of care provided. We received email feedback from 6 care staff. We spoke with 9 members of staff including care assistants, senior carers, other senior staff, directors, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included 9 people’s care records, 3 staff recruitment files, staff training data and records relating to the management of the service.
Updated
2 September 2023
About the service
APT Care Central Bedfordshire and Bedford is a domiciliary care service providing personal care to people living in their own homes. The service provides support to people living with dementia, mental health, physical disabilities, sensory impairment, older people, younger adults and learning disability and autistic spectrum disorder. The service also provides an interim ‘home recovery’ service supporting some people who have just returned home from hospital.
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. At the time of our inspection 110 people using the service received the regulated activity.
People’s experience of using this service and what we found
People were at risk of poor care and support because the governance systems were not effective and needed strengthening and embedding into practice. Although audits were taking place they had failed to identify and address the issues we found during our inspection of the service.
Systems and processes to safeguard people from the risk of abuse were not robust. We found incidents that met the threshold for a safeguarding concern were not always shared with the local authority and CQC.
We found no evidence people had been harmed. However, risk management of people’s care required improvement. Not all risks were assessed.
People’s medicines were not always managed safely. We identified issues with medicine records.
Staff had not received training to meet people’s specialist care needs.
There were enough staff to meet people’s care and support needs. Staffing levels were increased if people required additional care.
People were protected from the risks of infection. People told us staff wore personal protective equipment (PPE) to reduce the risk of spreading infections.
People’s needs had been assessed before they started using the service; and people told us they were involved in making decisions about their care. People and their relatives told us staff were kind, caring and respected their privacy and dignity.
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. Mental capacity assessments had been completed by staff with family members.
The service worked with a wide range of key organisations who were also involved in people’s care.
At the time of the inspection, the location did not provide care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
Right Support: Staff supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives.
Right Care: Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
Right Culture: Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating
This service was registered with us on 11 June 2021, and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.
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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.