Archived: Apex Prime Care - Eastbourne

Updated 18 January 2019

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.

Inspection site visit activity started on 23 November 2018 and ended on 27 November 2018. It included telephone conversations with people, their relatives and to staff. We visited the office location and two people’s homes on 27 November 2018. This enabled us to see people being provided with care. We were also able to speak to the registered manager and office staff.

We reviewed care records as well as the provider’s policies and procedures.

The inspection was announced. The provider was given 48 hours notice as they provide a domiciliary care service. We wanted to ensure that people were expecting our calls and were available to speak with us. The inspection team consisted of one inspector, an assistant inspector and two Experts 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 the inspection we looked at information we held about the service. We looked at notifications that the provider had submitted. A notification is information about changes, events and incidents which the provider is required to tell us about by law. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to decide which areas to focus on during our inspection.

Before the inspection we contacted the local authority for their feedback. During the inspection we spoke with 31 people, five relatives, one friend, eight members of staff and the registered manager. We reviewed a range of records about people’s care and how the service was managed. These included the individual care records for 13 people, medicine administration records (MAR), two staff records, quality assurance audits, an accident report and records relating to the management of the service.

Updated 18 January 2019

The inspection took place on 23, 26 and 27 November 2018 and was announced. The provider was given 48 hours notice as the service provides a domiciliary care service. We wanted to ensure that people were expecting our calls and were available to speak with us.

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.