Archived: Apex Care - Totton

Updated 12 November 2016

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.

The inspection took place on 19 September 2016 and was unannounced. This visit was undertaken by one inspector. The same inspector returned to continue with the inspection on 21 September 2016. Another inspector visited four people to assess the quality of care they received. An expert by experience contacted 16 people or their relatives, who were receiving care provided by the agency. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. An inspector also spoke with ten staff on the telephone.

Before the inspection we reviewed the inspection we held about the service. This included information provided by the agency, concerns and complaints we had received and information provided by the local authority.

During our visits to the offices we spoke with the general manager, two staff, two area managers and with the nominated individual. We looked at care records held for seven people and at four staff records. We also reviewed other records relating to the service such as quality monitoring visits and information relating to staff recruitment and training.

Updated 12 November 2016

The inspection took place on 19 and 21 September 2016. The visit on 19 September 2016 was unannounced. We visited four people in their homes on 22 September 2016 to discuss with them the care they received. We subsequently spoke with ten staff over the telephone and 16 people who used the agency. Our last inspection of the agency took place in August 2014 where we found they were meeting all assessed standards of quality and care.

At the time of our inspection Apex Care Totton was providing care and support to 101 people in their own homes. People who were being supported by the service had various needs including age related frailty, dementia and physical health conditions.

There was not a registered manager in place although the agency had recently appointed a general manager. The nominated individual said the general manager would be applying to become registered in due course. 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 agency had expanded rapidly since April 2016 as they had taken over a number of other domiciliary care agencies. Staff who had worked for the previous agencies also transferred over to Apex Care Totton but some did not stay.This had resulted in the service becoming overstretched and at times they were not able to cover all people's care packages..

People involved with the service felt communication had been poor. When they had tried to contact the agency, the response had not always been reliable. The difficulties experienced had a negative effect both upon the confidence people had in the agency and in the way in which the service had been delivered. At times the lack of effective communication had compromised the health and wellbeing of people using the agency.

The management team acknowledged the quality of the service had been compromised because of the rapid expansion. They were working on improving their reliability and the standard of care and support they provided. They had apologised to people for the disruption experienced over the summer. At the time of our inspection some improvements had been demonstrated for example people were reporting staff were visiting more consistently at the time they expected them. However there were breaches in legislation in a number of areas:

There were not sufficient staff deployed to meet people's needs in a consistent and timely way. The agency was relying on some support from the local authority to ensure they could cover people's calls.

Staff did not have sufficient guidance to support people consistently when risks to people's health and welfare had been identified.

The management of medicines needed to be more consistent to ensure staff, where they provided support with this, acted in in line with people's needs.

Staff were not provided with sufficient training or support to meet people's needs and people's capacity to consent to their care and support had not always been appropriately addressed.

People were not always provided with the gender of carers of their choice. People's documented care needs were not always accurate or up to date and so the agency could not be assured the care provided was appropriate, and met people's needs and preferences.

Quality assurance processes were not yet robust.

People felt safe with their care worker and most said they responded quickly to offer appropriate support when their health care needs changed. People highly praised their regular carers and care staff also demonstrated a real desire to do a good job. They were knowledgeable about the needs of the people they supported and clearly cared about them.