This inspection took place on 13 April 2018, and was announced. 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 27 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. The service employed 14 full time staff including the office staff. The service was a family run business that aimed at offering a family based provision to the people they cared for. The senior management team consisted of the nominated individual, registered manager and the deputy manager, all of whom have been a part of the business from the onset.

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 documen