This inspection took place on the 20 and 21 August 2018 and was announced by giving the provider 72 hours’ notice. We gave notice of this inspection to ensure people were informed we would be contacting them for their feedback about the service and to check the staff we needed to speak with were available.

Apex Prime Care – Portsmouth is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older and younger adults, including people living with dementia, physical disabilities and sensory impairments. At the time of our inspection the service was supporting 164 people.

A registered manager was in post; 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 registered manager was also the providers regional manager for the south and south east of England. The day to day running of the service was delegated to the manager who was applying to become the registered manager for the service. We have referred to ‘the manager’ throughout the report which is the person with day to day responsibility for the service and not the registered manager.

We found that the registered person had failed to notify the Commission without delay of any abuse or allegation of abuse in relation to people who use the service. It is important that we are notified, to enable us to monitor the quality and safety of the service people receive.

Whilst a system of audits was in place to monitor and assess the quality and safety of the service provided, these audits were not always completed and had not been effective in identifying and addressing all the concerns we found.

We found that risks to people were not always communicated to senior staff responsible for the assessment and management of risks. When risks for people were known, they were not always fully assessed. Guidance was not always provided to staff on how to minimise the risk and care for people safely and appropriately.

People’s medicines were not always managed safely. We found the records kept to evidence people had received their medicines as prescribed were not fully completed. This included the records for topical medicines (those applied to the skin). Care plans did not always include accurate information about the support people required with their medicines or that the correct support had been given by staff. This meant people were at risk of not receiving their medicines which could lead to a deterioration in their health or in them experiencing pain.

Overall there were sufficient staff to meet people's needs. However, people told us they did not always receive their care in an informed, consistent and timely manner that met their preferences. Staff were recruited safely to protect people from the employment of unsuitable staff.

Staff understood their responsibilities to protect people from abuse and records showed safeguarding concerns were acted on appropriately with the involvement of the local authority. People told us that incidents such as falls were safely managed by staff. However, it was not evidenced that learning from incidents was used to make improvements to the service people received.

People's records did not always evidence a mental capacity assessment had been completed to determine if the person had the capacity to agree to their care and treatment. We found inconsistent and incomplete information in people's care plans about their capacity to consent. Not all staff were aware of the principles of the Mental Capacity Act (2005) and how these should be applied to support people to have maximum choice and control of their lives.

People's needs were assessed when their package of care commen