Archived: Apex Prime Care - Hersham

People’s experience of using this service:

The improvements in management oversight and monitoring which had started at the last inspection had been embedded, which meant people received well-planned and reliable care.

The management team’s communication with people, relatives and staff had improved. This meant people knew which staff would be visiting them and were informed of any changes. Staff received more detailed information about people’s needs, which ensured they had guidance about how to provide the care people needed.

The provider had effective quality monitoring systems and the care provided by staff was monitored through spot checks. People were encouraged to give feedback about their care and this was acted upon. The registered manager investigated any concerns or complaints received and ensured these were resolved.

People received their care from consistent staff, which they said was important. Staff were kind and caring and treated people with respect. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were enough staff employed to meet the agency’s care commitments. The provider’s recruitment procedures helped ensure only suitable staff were employed. Staff understood their roles in keeping people safe from abuse and felt able to speak up about any concerns they had.

People’s needs were assessed to ensure staff had the training and skills to provide their care. Potential risks to people and staff had been assessed and measures put in place to mitigate these. Medicines were managed safely and staff maintained appropriate standards of infection control.

Staff attended an induction when they joined the agency and had access to the training they needed to provide people’s care. Staff met with their managers for supervision, which enabled them to discuss their performance and training needs.

Staff monitored people’s health and reported any concerns they had about people’s wellbeing. This enabled people’s relatives or the management team to arrange appropriate healthcare input. The agency worked effectively with other professionals to ensure people received the care they needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

At the last inspection the service was rated Requires Improvement. The report of this inspection was published on 19 April 2018. People did not always receive a reliable, consistent service. Some people reported that their care workers were often late and they were not always informed if their care workers were delayed. Some staff said they had insufficient travelling time between calls and did not always have time at each visit to provide the support outlined in people's care plans.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 7 February 2018 and was announced.

The agency did not have a registered manager in place at the time of our inspection. Like registered providers, registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The previous registered manager left the agency in October 2017. The current manager had applied for registration with CQC and had attended an interview for this role on 2 February 2018.

Prior to this inspection concerns had been raised by the local authority about the management and oversight of the agency. Safeguarding concerns were not managed appropriately and care visits were being missed. At this inspection we found the manager had worked hard to address areas of concern, which had led to significant improvements in some areas of the service. However these improvements had not extended to all areas of the service, which meant some people did not receive well planned care. We have made a recommendation that the provider implements an action plan to improve the consistency of the service and communication with people, relatives and staff.

People did not always receive a reliable, consistent service. Some people told us their care workers almost always arrived on time but others reported that their care workers were often late. They said they were not always informed if their care workers were delayed. Most staff told us they had enough travelling time between their calls but some staff said their calls were sometimes scheduled back to back, which meant they had no time to travel between calls. Most staff said they had the time they needed at each call to provide all the care people needed. However two staff told us they did not always have sufficient time to provide the support detailed in people’s care plans. Communication within the agency had not been effective as the manager was unaware of the impact of these issues on care provision and people’s experience.

People felt safe when staff provided their care because their care workers understood their needs and any risks involved in their care. Risk assessments had been carried out to ensure that people receiving care and the staff supporting them were kept safe. People told us staff maintained the security of their homes and said staff helped them keep their homes clean and hygienic. Care staff received training in the prevention and control of infection and people said staff wore appropriate personal protective equipment when providing personal care. Where people’s care involved support with medicines, this was managed safely.

There was a contingency plan in place to ensure people would continue to receive their care in the event of an emergency. Accidents and incidents were recorded and reviewed to identify any actions that could be implemented to prevent a recurrence. People were protected by the provider’s recruitment procedures. The provider carried out checks to ensure they employed only suitable staff. Staff attended safeguarding training and understood their responsibilities in terms of recognising and reporting abuse

People’s needs had been assessed when they began to use the service to ensure the agency could provide the care they needed. Staff had an induction when they started work and access to the and training they needed to carry out their roles.

People’s care was provided in accordance with the Mental Capacity Act 2005. People had recorded their consent to their care and told us staff asked for consent before providing their care on a day-to-day basis. Staff understood the importance of enabling people to make choices about their care.

People told us staff prepared meals they enjoyed and knew their likes and dislikes. People’s dietary needs were discussed during their initial assessment and any needs related to nutrition and hydration were recorded in their care plans. Staff attended training in nutrition and hydration in their induction and had regular refresher training in this area.

Staff supported people to maintain good health and liaised with healthcare professionals on their behalf if they wished. People told us staff had responded appropriately if they became unwell, including calling emergency medical services if necessary.

People were supported by kind and caring staff. People had developed positive relationships with their regular care workers and enjoyed their company. They said staff treated them with respect and maintained their privacy and dignity when providing their care. Staff supported people to maintain their independence and people were encouraged to be involved in planning their care.

Each person had an individual care plan drawn up from their initial assessment which provided guidance for staff about the care they needed. Care plans were personalised and contained information about people’s personal histories, which enabled staff to understand their life experiences.

The manager had improved the response to complaints. Any complaints received since the manager had taken up their post had been investigated and complainants had received a response outlining the action taken to resolve the issues raised.

The manager had improved the support provided to staff. Staff told us the manager and care co-ordinators were available for advice if they needed them. Staff were confident the improved management support would have a positive effect on the service people received.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.