ApproCare

ApproCare is an independent domiciliary care agency which provides personal care and support for adults in their own homes. People receiving care and support had a range of needs including, older people, people living with dementia, people with poor mental health, people who misuses alcohol and or drugs, people with eating disorders, people with a physical or sensory disability and people who have a learning disability and or autism.

At the time of the inspection the service was not supporting people who misuses alcohol and/or drugs or people with eating disorders.

The agency provides care for people in the local Isle of Sheppey area and Sittingbourne. At the time of our inspection, they were supporting 59 who received support with personal care tasks

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Peoples needs were not always identified and recorded. Staff supported people to play an active role in maintaining their own health and well being. Staff supported people with their medicines in a way that promoted their independence.

Right Care: People’s care, treatment and support plans did not always reflect their range of needs. Staff knew how to protect people from poor care and abuse. Some people told us they received kind and compassionate care. Staff protected and respected people’s privacy and dignity.

Right Culture: Staff turnover was high, which meant some people did not always receive consistent care from staff who knew them well. There were not effective systems and processes in place to ensure the quality and safety of services. Some staff did not feel valued but all staff we spoke with told us they believed their work was important and they enjoyed caring for people.

The last rating for this service was good (Report published 28 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and organisational culture. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. Based on our inspection of safe and well led we found the service required improvement.

You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ApproCare on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the number of trained staff available to provide care, the assessment of people’s needs, how this is communicated to people, how risks to them are identified, shared and addressed. We also found poor governance systems and processes for the service.

Please see the action we have told the provider to take at the end of this 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.

¿ ApproCare is an independent domiciliary care agency which provides personal care and support for adults in their own homes. People receiving care and support had a range of needs including, the elderly, people living with dementia and people who have a learning disability. The agency provides care for people in the local Isle of Sheppey area together with Sittingbourne and Medway. At the time of our inspection they were supporting approximately 75 people who received support with personal care tasks.

People’s experience of using this service:

¿ People told us they felt safe with the staff who knew how to meet their needs, in the way they preferred. One person said, “I feel safe when the carers use the standing lift on me; they know what to do.” People were at the centre of their care and support; care plans enabled people to maintain their independence. Care records were regularly reviewed to ensure they met people's needs. Staff knew what action to take to protect people from the risk of abuse. Another person said, “The carers are excellent. I will score the service I receive 9/10.”

¿ People's needs were assessed prior to receiving a service. People's protected characteristics under the Equalities Act were supported. Potential risks posed to people and staff had been mitigated. Staff supported people to attend healthcare appointments and express their views about their support.

¿ The registered provider was mindful to be sure there were enough staff before considering supporting new people.

¿ People told us staff were skilled in carrying out their role. Staff said they were supported by the registered provider and management team.

¿ People told us the staff were kind and caring; staff promoted people's privacy and dignity at all times.

¿ People were encouraged to raise any concerns they had or make suggestions to improve the service they received. Action was taken to improve the service people received.

¿ Staff felt there was an open culture where they were kept informed about any changes to their role. Staff told us the management team were approachable and listened to their ideas and suggestions.

¿ Systems were in place to monitor the quality of the service; regular audits were carried out by the management team.

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

Rating at last inspection:

¿ Good (Report published 22 April 2017).

Why we inspected:

¿ This was a planned comprehensive inspection.

¿ At this inspection, we found that the overall rating remained the same.

Follow up:

¿ We will continue to monitor the service through the information we receive. We will carry out another scheduled inspection to make sure the service continues to maintain a Good rating.

ApproCare is an independent domiciliary care agency which provides personal care and support for adults in their own homes. The agency provides care for people in the local Isle of Sheppey area together with Sittingbourne and Medway. At the time of our inspection they were supporting approximately 58 people who received support with personal care tasks.

Rating at last inspection

At the last Care Quality Commission (CQC) inspection on 09 and 10 August 2016, the service was rated overall Good and Requires Improvement in ‘Effective’ domain.

Why we inspected

We carried out an announced comprehensive inspection of this service on 09 and 10 August 2016. We found a beach of legal requirements. After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches of Regulation 9 of the Health and Social Care Act Regulated Activities Regulations 2014 Person centred care. The provider told us they would meet the regulation by September 2016.

We undertook this focused inspection to check and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ApproCare on our website at www.cqc.org.uk.

Why the service is rated Good.

At this inspection, we found that people received good quality care and support. People told us they received care which met their assessed needs.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Deprivation of Liberty Safeguards.

People were supported with meal planning, preparation and eating and drinking. Staff supported people, by contacting the office to alert the provider to any identified health needs so that their doctor or nurse could be informed.

Further information is in the detailed findings below.

ApproCare is an independent domiciliary care agency which provides personal care and support for adults in their own homes. The agency provides care for people in the local Isle of Sheppey area together with Sittingbourne and Medway. At the time of our inspection they were supporting approximately 51 people who received support with personal care tasks.

The service did not require a registered manager because the person in control of the day to day running was the registered provider. 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 and their relatives gave us positive feedback about the service they received.

Most people received good quality care and support. One person had not received care which met their assessed needs. This meant they developed an infection and had been in discomfort for longer than necessary.

Although the provider had a good understanding of the day to day running of the service there were no formal audits and checks taking place to ensure the service was effectively monitored and improved. The provider had made informal checks of the service but these had not been recorded. We made a recommendation about this.

Risks to people’s safety had been assessed and recorded. Some risk assessments lacked detail on measures to reduce risks. We made a recommendation about this.

Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support. There were suitable numbers of staff on shift to meet people’s needs.

Medicines were appropriately managed and administered. Medicines records were clear.

Procedures and guidance in relation to the Mental Capacity Act 2005 (MCA) were in place which included steps that staff should take to comply with legal requirements. Staff were clear about how they supported people to be independent and make choices.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse.

Staff had received regular support and supervision from their line manager. There were suitable numbers of staff on shift to meet people’s needs.

People’s information was treated confidentially. People’s paper records were stored securely in locked filing cabinets.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

People’s care plans detailed what staff needed to do for a person. The care plans included information about their life history and were person centred.

People had choices of food at each meal time which met their likes, needs and expectations. People were supported to be as independent as possible.

Relatives told us that staff were kind, caring and communicated well with them.

People and their relatives had been involved with planning their own care. Staff treated people with dignity and respect.

People were given information about how to complain and how to make compliments. Complaints had been dealt with appropriately.

People’s views and experiences were sought through review meetings and through surveys.

People told us that the service was well run. Staff were positive about the support they received from the provider. They felt they could raise concerns and they would be listened to.

Communication between staff within the service was good. They were made aware of significant events and any changes in people’s behaviour.

We found 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.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. During our inspection people who used the service told us that staff delivered the care recorded in their care plans.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. Staff had access to support and advice at all times from a manager.

The registered manager ensured that staff underwent checks before starting work at the service. For example they checked a person's character by carrying out Disclosure and Barring Service checks (DBS). This was formally known as a Criminal Records check.

Staff had been trained in safeguarding people from abuse and staff understood their responsibilities to protect vulnerable people.

There were systems in place for making regular checks on the staff delivering the care to people in their own homes. People who used the service told us staff were competent in their roles and that they were supported safely. One person said 'I feel safe with staff and trust them; I do not have any concerns'.

Is the service effective?

People had an individual care plan which set out their care needs. We saw that people had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. People who used the service told us that staff were reliable and that they were happy with the service they received.

The manager of the service carried out checks on staff whilst they were delivering care and support. People who used the service had been asked their views about the standard of service they had received.

Is the service caring?

We found that people were treated with respect and their dignity maintained. People appeared relaxed and comfortable with the staff that supported them. We saw that people had a positive relationship with staff. We visited a person who used the service in their own home. They told us that the staff were caring, and that they followed their agreed care plan. They said 'Staff do everything I ask them to do, they are marvellous.'

Is the service responsive?

The service reviewed people's care plans to ensure they were up to date. The owner of the service was available for people to contact. People who used the service told us that they did not have any concerns and that they knew how to raise complaints.

There were policies and systems in place which ensured that the provider could learn from incidents that occurred to prevent them from occurring again.

Is the service well-led?

The provider continually monitored areas of risk in the service and made checks on quality. This included visiting people who used the service to ask what their views were of the service provided.

The manager ensured that people's care was planned. Staff understood people's needs because they followed people's assessments and care plans. Systems were in place to monitor quality and safety. The manager ensured that staff were recruited with the right skills and experience for the client group they cared for. Staff received an induction when they started with the organisation. Staffs received on 'going training and were supervised by the manager. The manager gave staff the opportunity to develop their skills and knowledge in line with their job description and responsibilities.