Apex Healthcare Service Ltd

Apex Healthcare Services Ltd is a domiciliary care service (DCS). DCS provides support and personal care to people within their homes. This may include specific hours to help promote a person's independence and well-being. At the time of the inspection 49 people using the service were designated support with personal care. The service was predominantly catering for younger and older adults, with a varying level of personal care needs. 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.

People’s experience of using this service and what we found

The service had processes in place to ensure people were supported by suitable staff however they could not always evidence they had taken a full employment history of staff. This was being rectified by the management team. We made a recommendation that they familiarise themselves with the current regulations regarding recruitment.

People’s needs were assessed, planned and reviewed to ensure they received support that met their changing needs. Staff managed people’s risk assessments and care plans to ensure they were person-centred. A person’s record keeping needed to be further strengthened to evidence when actions had been taken. We made a recommendation that the service ensure all records are accurate and contemporaneous.

All accidents and incidents and medicines were recorded and reviewed by the management team.

The provider had an effective system to ensure that staff received appropriate training. The care certificate modules formed part of the induction training. All training the provider considered to be mandatory was up to date. Staff worked in partnership with professionals from health and social care to meet people’s needs. People’s files and care plans contained evidence of referrals.

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.

People received support that was individualised to their personal needs. People's care plans placed their views and needs at the centre. Staff were knowledgeable about the choices and preferences of the people they provided care and support to. Complaints were managed robustly and in a timely way.

There were effective management systems in place, with a clear staffing structure. The service had formed good working relationships with partners, which included the local authority, social workers and district nurses. The management team had a clear and effective process for continuous learning and service improvement.

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

Rating at last inspection

The last rating for this service was requires improvement (report published 30 June 2018) 13 April 2018.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was 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 information 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.

This was the first inspection completed for the service that registered with the Care Quality Commission in February 2017.

The service had appointed a new manager who registered in February 2018. 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.

We found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person did not always ensure people were provided with care and treatment in a safe way. Measures had not been taken to mitigate all identified risks to reduce the risk of people suffering harm. People who required specialist care were not always supported by staff who had the appropriate skills or competency to safely provide support and medicines were not always appropriately managed.

We found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person did not always ensure that staff had been provided with the necessary training, had been appropriately competency assessed and had been offered the opportunity to further their skills to enable them to complete their role effectively.

We found a further breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person did not have established systems or processes in place to assess, monitor and improve the service. You can see what action we told the registered person to take at the back of the full version of the report.

The service had robust recruitment processes that ensured staff were safe to work with vulnerable people. Thorough checks on character including references, disclosure and barring checks were completed prior to staff commencing employment. Staff underwent a comprehensive induction that included completion of mandatory training and shadow shifts prior to working independently.

Staff understood how to safeguard people from potential abuse. They reported no hesitation in whistle-blowing if the need arose. A large poster was visible in the office that covered the safeguarding protocol, reinforcing the need to report concerns.

The staff were reportedly polite, considerate and caring. People and families reported how they maintained people’s dignity when assisting with personal care, speaking to them calmly and advising them what they were going to do next. People told us that staff would seek their permission before assisting them with personal care. They sought reassurance that people were happy with the task being completed in a particular way. This meant that people felt involved in their care. Reviews took place as required, with a thorough record maintained of how people wished to be supported. However, this information was not transferred to the care plan. The service had recently amalgamated documents. This meant that one document for both the initial assessment and care plan was used. However, we found this did not, contain sufficient information on how people needed to be supported. Whilst conversations with staff and people illustrated that care was provided in line with people’s needs and their choice, the documentation did not contain any information on how to deliver care. The provider recognised that the current staff team knew people well and therefore were providing care to people in a personalised way. Any new staff may not have the necessary knowledge initially to do so. Following the inspection the provider sent us a copy of the new care plan that contained information as required.

Quality assurance surveys were completed bi-annually. An action plan was generated from the feedback that helped inform any changes to be made to the service. The provider further completed governance audits on a monthly basis. These however were not detailed. They did not illustrate any actions the service needed to take and the timeframe within which issues were to be resolved.

The service was open and transparent. Staff reported feeling confident that they could visit the office and raise any issues as and when these arose. Similarly, people were confident to raise concerns. The service had a good complaints procedure. We saw evidence of complaints being appropriately investigated and recorded. The service had received a series of compliments from families and professionals. The staff team and the service were praised for their adaptability and warmth towards people.