About the service:

A Plus Care Ltd is a domiciliary care provider in the East Sussex town of Bexhill, which is situated close to the coast. On the first and second day of inspection, 38 older people received personal care support from the service. On days three and four of the inspection, 27 older people were receiving personal care. Some of these people were living with dementia.

Not everyone using A Plus Care Ltd received the regulated activity ‘Personal care’ that CQC inspects, which includes support with personal hygiene, eating and drinking. Where they do we also take into account any wider social care provided.

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

People’s experience of using this service:

Before the inspection, the provider had limited involvement with the service and had allowed the registered manager to manage it independently. Therefore, when the registered manager left the service earlier than expected, the provider was not familiar with people, their needs, the regulations or their responsibilities. We found two incidents were not reported to the local authority or CQC within relevant timeframes. The provider required guidance in how to complete these referrals. Some areas for improvement identified at the previous inspection had not been actioned. There was a lack of oversight for concerns that had been raised previously with the registered manager. Supervisions, spot checks and team meetings had not been completed consistently. Although the registered manager acknowledged this was an area for improvement, they had not notified the provider. The current CQC rating was not displayed on the website as per regulation.

It was identified at the previous inspection that people without capacity to make decisions, did not have mental capacity assessments. We recommended that research was completed into responsibilities under the mental capacity act. The registered manager had undergone training in this area to develop their knowledge. However, they advised us they were still unclear of their responsibilities. They had not sought any further guidance on this.

Although people told us they felt safe, one person had not received their medicines consistently. Actions were not taken in a timely way by the provider or interim manager to ensure their wellbeing and notify relevant others.

People had assessments that detailed risks to their health and wellbeing and actions staff should take to reduce this. Staff knew people well and how to manage these risks. There were contingency plans for staff shortages or emergency situations that highlighted those people who would need priority support. Staff had a good understanding of potential signs of abuse and of who they would need to report any concerns to.

Despite frequent changes to staff and people’s care packages, the company administrator was managing the rotas well. People still received support from familiar staff. There had been no missed or late care calls since the registered manager had left. The provider and company administrator were speaking to people and staff to understand their care needs and ensure these were being met. The provider also advised they would not be taking on any other care packages until a robust management structure had been implemented.

People and their relatives told us that people’s health and nutritional needs were met. If they required support from staff with appointments, this was given. People had involvement from health and social care professionals frequently to improve their wellbeing. Where staff had identified concerns with the person’s environment, the registered manager had made referrals to professionals to gain equipment that would support them. Staff told us that training was good and gave them the skills they needed to meet people’s needs.

People and their relatives were consistent in their responses that staff were kind, caring and attentive to their needs. Many p

A-Plus Care Ltd is a domiciliary care agency. At the time of our inspection they provided personal care to 23 people living in their own houses and flats. It provides a service to older adults and some younger disabled adults.

Not everyone using A-Plus Care Ltd 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.

This was the first inspection for A-Plus Care Ltd in Bexhill since they became registered in November 2016.

The service had a registered manager. ‘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.’ There was also a Care Co-ordinator, who supported the registered manager to monitor staff and manage office documents.

It was recognised that A-Plus Care Ltd is a fairly new provider and so were developing their systems for monitoring and auditing. However a number of shortfalls were found within record keeping which suggested current auditing processes needed to be developed. Staff had a thorough knowledge of people and their support needs, which meant where shortfalls were identified, there was limited impact to people. However support needs were not consistently identified within care documentation. There were limited assessments with regard to specific support needs, such as Diabetes, Epilepsy or positive behaviour support. Documentation that was missing, incomplete or due for review, was not always identified. Care documentation also lacked information on the process of decision making and did not always address the support needs of those people with fluctuating capacity. There was a potential risk that if unfamiliar carers were to complete call calls, they would not have all the information they required to support people.

Although people’s views of the service were sought during reviews, no further feedback had been sought from relatives, professionals or other stakeholders. This was something that had been identified by the provider and registered manager and that they were in the process of implementing.

There were no protocols for supporting people who required medicines to be given on an ‘as required’ basis. Guidance needed further clarification to ensure that ‘as required’ medicines were effective for people. More detailed information was also needed for people who required medicines to be given covertly. This is when medicines are administered in a disguised format without the knowledge or consent of the person receiving them, for example in food or in a drink.

Staff told us that they received a wide variety of training and people and their relatives were equally confident that staff had the right skills and knowledge to support people effectively. However it was identified that more specialised training relating to Diabetes, continence care, pressure care and positive behaviour support was needed for people who required support in these areas.

People felt safe and staff had a clear understanding on how to safeguard people and protect their health and well-being. There were suitable numbers of staff to meet people’s support needs.

Staff spoke positively about their induction into the service and advised that regular supervision was given. These and regular spot checks meant that they felt positive practise was recognised and areas of improvement identified.

Staff treated people with kindness, compassion and respect and promoted people's independence and right to privacy. People and their relatives were positive in their views of care provided; they also achieved continuity of care through familiar staff attending care cal