We inspected the service on 12 and 13 July 2018. The inspection was announced. APT Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using APT Care Limited receives 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. APT Care provides a service to older adults and younger adults with a disability. At the time of our inspection, 44 people were receiving personal care as part of their care package.
At the previous inspection in December 2016 we identified some improvements were required in four key areas we inspected; ‘Safe’, ‘Effective’, ‘Responsive’ and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'. We identified a breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. This was because the provider had ineffective systems and processes in place to monitor quality and safety. 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 question Well-led to at least good. The provider sent us an action plan and told us they would make the improvements by 14 July 2017.
At this inspection, we found Regulation 17 remained in continued breach because the provider had failed to comply with their action plan. Additional shortfalls identified during this inspection had not been picked up on by internal audits and checks, meaning the governance of the service remained ineffective.
There was a registered manager at the service. 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.
People experienced frequent late calls and there were insufficient staff employed to deliver the hours of care required. Agency staff were used and the registered manager and care coordinator also covered staff shortfalls.
The provider’s staff recruitment procedure was not always fully completed, to ensure people were protected from unsuitable staff. Staff interviews were not routinely recorded. Staff had not received appropriate first aid training to support them to care for people safely and effectively.
Shortfalls were identified with medicines management. This included staff training and competency, how medicines administration records were completed and how some medicines were administered.
Staff were aware of their responsibilities to protect people from avoidable harm and abuse. Accidents and incidents were recorded, reviewed and monitored and action was taken to share any learning.
Shortfalls were identified in the induction, training and support staff received. The Mental Capacity Act 2005 had not been adhered to when people lacked mental capacity to consent to their care.
People’s needs had been assessed to ensure they were known and understood by staff and did not expose people to any form of discrimination.
People received support with nutritional and hydration needs where required, and choices were promoted and respected. People’s healthcare needs were monitored and action was taken when changes occurred, such as informing the person’s relatives and representatives or health and social care professionals.
People did not always receive a consistent caring service because staff were regularly rushed and this impacted on the quality of care received. Independent advocacy service information had been made available to people. Independence was encouraged and people had been involved in the assessment stage before their care package commenced.
End of life care plans were not sufficiently detailed or person centred. Staff had not received training in end of life care. People did not know in advance what staff were expected and if staff were running late, they were not always informed of this. Improvements had been made in the detail of general care plans but these were not reviewed at the intervals the provider expected. People knew how to make a complaint but the system used to record concerns and complaints was ineffective in monitoring where improvements were required.
During this inspection, we found two breaches of the 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 the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.