About the service: APT Care Ltd (Bedford) is a domiciliary service that was providing personal care to 28 people at the time of the inspection. Only 22 of those people were receiving the regulated activity of personal care.

People’s experience of using this service:

People told us they felt safe and thought staff were kind and caring.

One relative said, “[Staff members name] is very good they are there most of the time and are an excellent carer. I love the way they talk to [my family member] [staff members name] sits on their bed and has a chat. It's just so nice to see. I don’t have to worry.”

The registered manager had systems and processes in place ensuring risks were well managed and care was personalised and reviewed.

Staffing levels, skills and experience were not always suitable to meet the needs of people. Some staff were not able to demonstrate a clear understanding of how to keep people safe and support consent and decision making.

The provider implemented safe systems for the management of medicines which included staff training and assessments of staff competency. However, more information was needed when recording the outcomes of competency checks and audits.

Staff had a good understanding of preventing the spread of infection by using the protective equipment and good hand hygiene.

The registered manager shared lessons learnt with staff and managed complaints and concerns in an open and honest way.

People told us, they felt involved and listened to in relation to their care needs. People also said staff respected their wishes and preferences and were supported by them to make decisions.

People were supported to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff supported people with meals and drinks and to access specialised healthcare when needed.

Care visits were timely and the registered manager and the staff team were clear about their roles and the impact of good care.

The registered manager showed ways they were working with other agencies and providers to share ideas and improve their service.

Rating at last inspection: At the last inspection the service was rated Good (Published 22 December 2016). Overall, since the last inspection, the service rating has dropped.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The service met the characteristics of good all effective, caring and responsive and requires improvement in safe and well-led. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 24 and 28 November 2016 and was announced.

This was the second comprehensive inspection carried out at APT Care Limited.

APT Care Limited is a domiciliary care agency providing personal care, support and companionship to people in their own homes. At the time of our inspection the service was providing personal care to 33 people.

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 and associated Regulations about how the service is run.

People felt safe. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were risk management plans in place to protect and promote people’s safety. Staffing numbers were appropriate to keep people safe. There were safe recruitment practices in place and these were being followed to ensure staff employed were suitable for their role. People’s medicines were managed safely and in line with best practice guidelines.

Staff received regular training that provided them with the knowledge and skills to meet people’s needs. They were well supported by the management team and had regular one to one supervision and annual appraisals.

Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation. Where the service was responsible people were supported by staff to access food and drink of their choice to promote healthy eating. If required, staff supported people to access healthcare services.

People were treated with kindness and compassion by staff; and had established positive and caring relationships with them. People were able to express their views and to be involved in making decisions in relation to their care and support needs. Staff ensured people’s privacy and dignity was promoted.

People received care that was responsive to their needs. Their needs were assessed prior to them receiving a service. This ensured the care provided would be appropriate and able to fully meet their needs. People’s care plans were updated when there was a change to their care needs. The service had a complaints procedure to enable people to raise a complaint if the need arose.

The service had quality assurance systems in place, which were used to good effect and to continuously improve on the quality of the care provided.

During our inspection in December 2015, we found that records relating to medicine administration were not accurately maintained. We found MAR sheets that did not contain information such as dosage, route or time for medications to be given. We found Medication Administration Sheets (MAR) were often illegible and contained information that was not clear. We also found information within daily notes that indicated that topical medication was being administered to an individual, but found that no MAR sheet had been created to properly record this information.

We found that the audit systems in place were not effective as they were not identifying the faults within the MAR.

We found that care plans and risk assessments were not being regularly updated and that staff were giving care to an individual, that was not recorded within the care plan as it was out of date.

This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to the outstanding breaches of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for APT Care Limited on our website at www.cqc.org.uk.

This inspection was unannounced and took place on 27 April 2015.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that MAR sheets were filled out and audited correctly. All staff found to have made errors were given a supervision to discuss the errors, and were placed on a monitoring plan to make sure their practice would improve. Care plans and risk assessments were now updated and reviewed, and the care documented within daily notes matched what was in the care plans.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

APT Care Limited is a domiciliary care agency providing personal care and support to people in their own homes, within the Bedford area. They provide care to both long-term clients and short-term clients following hospital discharge. At the time of our inspection the service was providing care and support to approximately 40 people.

This inspection took place on the 14 and 17 December 2015 and was announced.

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.

Risk assessments were in place but were not always robust in identifying what control measures were in place or what action staff should take to minimise potential risks. They were often out of date which meant they were not always reflective of people’s needs.

Management of medicines was inconsistent and staff did not always follow the provider policy in the recording of medication. Records of medication administration were not always fully completed and there were not adequate systems to audit these records to highlight any errors or omissions.

Staff training needs were not always being met and staff had not always been suitably trained to carry out their duties effectively. It was not evident that the training was delivered by someone with the appropriate level of knowledge or qualifications.

Care plans were not always signed by or on behalf of the person to indicate consent to care. People and their families were not always involved in planning and review of care. Care plans were often task-focussed and did not enable staff to provide a person-centred approach in the delivery of care.

Daily notes recorded by care staff were not always completed in sufficient detail, and care plans were not always updated or reviewed when people’s needs changed.

The service had quality audit systems and checks in place; however they had failed to highlight areas for development and improvement and were therefore not effective.

Staff had been recruited safely to the service and had undergone the correct pre-employment checks before commencing work with the service. There were sufficient numbers of staff on duty to meet people’s needs.

People received a healthy and balanced diet at the service and were able to choose what they wanted to eat each day.

The service supported people to access health professionals if they needed it.