Archived: Apex Prime Care - Hailsham

Updated 8 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place between 25 April and 9 May 2018. It involved visits to the agency’s office, visits to people in their own homes, telephone interviews with people and/or their relatives and conversations with staff. The service was given a couple of hours’ notice of the inspection because it provides a domiciliary care service and we needed to ensure staff were available in the office to be able to conduct the inspection. The inspection was undertaken by an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the agency, including the previous inspection report. This enabled us to ensure we were addressing any potential areas of concern. The provider had sent us an information return (PIR) in which they outlined how they ensured they were meeting people's needs and their plans for the next 12 months. As part of the inspection, we reviewed the PIR. We also reviewed other information about the service, including safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We also contacted the local authority before and after the inspection, to receive their comments.

We met with three people who received a service in their own homes. We received comments on the telephone from five people, four people’s relatives and two professionals. We spoke with nine staff, two of the office staff and the registered manager. We reviewed seven people’s records, including the three people we met with.

During the inspection we reviewed other records. These included six staff recruitment records, training and supervision records, medicines records, the rota of visits to people, risk assessments, quality audits and policies and procedures.

Updated 8 August 2018

This inspection took place between 25 April and 9 May 2018. The inspection involved visits to the agency's office, to people’s own homes, conversations with people, their relatives, staff and professionals. The agency provided 50 people with a domiciliary service. Not everyone using the agency received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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.