APT Luton Ltd is a domiciliary care agency that provides personal care at home for people being discharged from hospital on short term care packages for between 10 and 42 days. APT Luton Ltd also provides personal care for people receiving end of life care at home as well as people on long term care packages. At the time of the inspection 134 people were receiving care by the service.

This inspection took place between 31 October 2018 and 13 November 2018, and was announced. This was a planned inspection based on the rating at the last inspection. The rating at the last inspection on 30 October 2017 was requires improvement. This is the fourth consecutive time the service has been rated requires improvement.

We carried out a follow up visit on the 17 December 2018 to get more information to support our judgement. We saw that many changes had taken place and improvements had been made in the areas we were particularly concerned about in November 2018.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During the last inspection people raised concerns around staff’s levels of spoken English being poor, complaints and missed visits. During this inspection we saw some areas where improvements had been made since our last inspection and others where it had not. The impact of this in relation to the risk of harm and poor governance has meant the rating remained requires improvement. The service has been rated overall requires improvement for the fourth consecutive time.

The registered manager ensured the rotas had enough staff on duty and the deputy manager has introduced a system of checking visits manually each day. As a result, people told us the concerns around missed visits had improved. However, from records on daily notes and what people told us, visit times were still being cut short meaning some people felt rushed. Concerns around how complaints were managed has greatly improved and there are now systems in place to effectively manage these.

Other concerns around staff using mobile phones on shift, staff`s poor levels of spoken English and staff speaking to each other in their own languages while supporting people who did not understand those languages had not improved. Some effort by the provider to resolve these concerns had taken place. People told us that this often left them frustrated and concerned that staff did not understand what they said.

We discussed our observations with the provider who was keen to improve the quality of care people received. The provider has informed us since our visit, they were working with a local education centre to provide staff with language support where needed.

During the follow-up visit, we found that action had been taken by the provider to discuss the concerns around language and use of mobile phones with staff. In time this should reduce the concerns that people had.

Overall, people told us they felt safe and were very happy with the care provided except for the areas of communication and short visits. However, we found that staff knowledge and current systems and processes for assessing risk, staff training and medicines meant that people were not always safe from the risk of harm and abuse.

People told us they felt well cared for by staff who knew them well. However, people had concerns over some staff not being able to communicate clearly and unfamiliar staff who did not know how to meet their needs such as how to use hoists.

People had good health care support from external professionals to manage people's nutrition and clinical care.

Staff training was not always effective meaning staff were not always suitably skilled and compet

APT Care Limited is a domiciliary care service providing personal care and support to people in their own homes. They care for people on a long term and short term basis. Short term packages are usually as a result of hospital discharge and the service works flexibly to ensure people's care needs are met with short notice, before more established care packages can be set up for them. At the time of our inspection there were approximately 120 people receiving care from the service, around 30 of which were in receipt of short term care packages.

This inspection was carried out on 26, 27 and 28 July 2017 and was announced. When we last inspected the service, it was rated as 'requires improvement' overall. Responsive was rated 'inadequate'; safe, caring and well-led were rated as 'requires improvement' and effective was rated 'good'. At that inspection we also identified two breaches of legal regulations. We fond that the service was no longer in breach of any regulations at this inspection.

The systems in place for the management of medicines were not always safe and medicines were not always correctly accounted for. During this inspection we found that there had been improvements to the ways that medicines were managed. These systems had highlighted and reduced recording errors, however; further work was needed to ensure that improvements continued in this area.

We also found that action had not always been taken in response to complaints and people did not always feel that they would get a satisfactory outcome as a result of their complaints. During this inspection we saw that complaints had been well managed and responded to. The service still had areas to develop, in particular demonstrating how they used complaints and positive feedback to develop the service.

The service had a registered manager 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.

People and their relatives did not have regular contact with the registered manager, however; they felt well supported by members of care and office staff and had no concerns about the way the service was being run. Staff also felt well supported by the registered manager and the provider and received the training and supervision they needed to perform their roles. There were management and quality assurance systems in place, however; these were not completed on a regular basis and there was no clear evidence to show how they were used to help improve the service.

People generally felt that their privacy and dignity were promoted by the service, however; there were occasions when this was not the case. Staff were reported to sometimes speak in languages other than English or to use their mobile phones during visits, which made people feel uncomfortable.

Care plans were in place for people and work had been carried out to help develop and improve these. Further work was needed to continue this improvement and to ensure that all care plans were reviewed and updated on a regular basis. In addition people's involvement in the planning and reviewing of their care was not always clearly evidenced.

People felt safe with the care they received from the service. Staff members were knowledgeable about abuse and the reporting procedures they should follow to safeguard people against it. There were systems in place to record accidents and incidents and potential abuse was reported when necessary. There were sufficient numbers of staff to meet people's needs. There were occasions when call times differed from people's expectations, due to the flexible nature of the care provided by the service. There were risk assessments in place to help manage risks to people's health and well-being.

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This inspection took place on the 8, 9, 10 and 11 November 2016 and was announced. When we last inspected the service in November 2015 we rated it as ‘requires improvement’ in each of the areas we inspected. We took enforcement action to protect people using the service, but found during a focused inspection in February 2016 that improvements had been made to address the risks we had identified.

APT Care Limited is a domiciliary care service providing personal care and support to people in their own homes. They provide care to people requiring both long-term and short-term support, usually following hospital discharge. At the time of our inspection, the service was providing care and support to 79 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 2008 and associated Regulations about how the service is run.

While there had been improvements to the quality of the service in some areas we found that others still required improvement.

People told us they felt safe but raised concerns about staff not always arriving on time. While some people received consistent care from the same staff, others reported having many different staff attending to their needs. People’s dignity and privacy was upheld and we were told that the staff team were kind and caring, but some people felt rushed and couldn’t develop positive relationships with their care staff because of frequent changes.

Risks to people were assessed and control measures implemented to support people’s safety. The management of people’s medicines had improved but there were still some inconsistencies in practice.

While there had been significant improvement to the quality of care plans, people still did not always feel involved in care planning or making decisions about their care. People consistently told us that they did not feel that their concerns or views were listened to by the management of service and did not have faith in complaints being resolved. While some complaints were being investigated and resolved correctly, others were subject to delay.

There were enough staff available to meet people’s needs. However the process for recruiting new staff was not always robust and references were not always acquired from previous employers. Staff received a comprehensive induction and completed a range of training which enabled them to carry out their roles effectively. They were able to contribute to the development of the service through team meetings.

There were improved quality monitoring systems in place which were effective at identifying trends and identifying areas for improvement. People were sent questionnaires and surveys to ask for their feedback on the quality of care delivered.

We carried out an announced comprehensive inspection of this service on 24 and 27 November 2015, at which breaches of legal requirements were found relating to people’s safe care and treatment and good governance. Risk assessments were not always detailed enough to provide staff with enough information to provide safe care to people, and records relating to medicines were not completed or audited effectively. The service did not have a robust system for internal auditing to identity improvements that needed to be made.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 12 February 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘APT Care Ltd’ on our website at www.cqc.org.uk.

APT Care provides personal care and support to people in their own homes. The service provides a mixture of long-term care packages and 10 day placements for people following discharge from hospital.

The service had a registered manager 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 and associated Regulations about how the service is run.

Risk assessments were in place for new service users and were comprehensive enough to support staff to help keep people safe from the risk of harm. There was a greater level of detail included in these assessments, which were person-centred, corroborated people’s discharge assessments and included measures to minimise identified risks where possible.

Records of medicine administration records were audited regularly. The service had a system in place to identify any errors or omissions and take appropriate action to address these with staff to reduce the risk of recurrence.

The service had implemented a quality assurance system for identifying improvements that needed to be made. Feedback was sought from staff and people using the service and this was used to highlight any areas for development.

We undertook an announced inspection of APT Care Ltd on 11 March 2015. We told the provider two days before our visit that we would be coming. APT Care Ltd provides support and personal care services to people in their homes. At the time of our inspection approximately 130 people were receiving a support or personal care service from the service.

There was a registered manager 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.

There were appropriate numbers of staff employed and allocated to meet people’s needs and provide a flexible service. People were supported by staff who had been trained to support them safely. People were able to speak to the provider if they had any concerns and staff were kind and caring towards the people that they supported.

The provider had a robust recruitment process in place. Staff received regular training and supervision, they were knowledgeable about their roles and responsibilities.

Staff had the skills, knowledge and experience required to support people well and were able to provide a personalised service to the people they supported and build good working relationships.

Support plans were in place which provided details on how to support people. People who used the service were involved in making decisions about their care and support.

The manager was accessible and approachable. Staff, people who used the service and relatives felt able to speak with the manager and provide feedback on the service. The provider carried out regular spot checks on the service being provided and staff performance. Feedback had also been sought from people using the service and their representatives through questionnaires.

Risk assessments were in place for long term clients but we found that these were not always fully completed for people on short term support packages with the provider.

People were supported to eat and drink well and to access healthcare professionals when required.

Medication was administered by staff who had received training and further training was being provided to ensure staff were fully competent in the safe administration the medication.

When we inspected APT Care Limited on 8 January 2013, they were providing care packages for approximately 30 people in their own homes. We spoke with five people who used the service and their relatives and found they were happy with the care they received. One person told us, "They never let us down. They are always polite and friendly to us."

We reviewed the care records for six people and noted that people were offered support at a level which encouraged independence and ensured that specific needs were met. The people we spoke with told us that staff were always respectful and competent to carry out their roles. One person said, "I have no concerns. They do a good job under great pressure and are always friendly."

We observed from the care records that people were supported to express their views within regular care reviews and were given the opportunity to complete satisfaction questionnaires on a regular basis. The results of which were used to develop the service and make improvements for people and staff.

People also told us that they felt able to raise concerns with the manager or staff team and felt confident that they would be listened to.

This inspection took place on the 24 and 27 November 2015 and was announced.

APT Care Limited is a domiciliary care service providing personal care and support to people in their own homes. They provide care to people requiring both long-term and short-term support following hospital discharge. At the time of our inspection, the service was providing care and support to 111 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 2008 and associated Regulations about how the service is run.

During our inspection we found that the service was in breach of several regulations. You can see what action we told the provider to take at the back of the full version of the report.

Staff received training in safeguarding and understood how to recognise and report signs of abuse, although they did not always understand the service’s whistleblowing policies. People we spoke with told us they generally felt safe when supported by a regular member of the staff team. The service had a safeguarding policy in place and was making the appropriate referrals to the Local Authority and Care Quality Commission. Staff were recruited safely to the service and had undergone the correct pre-employment checks before commencing work with the service. They received full training and induction before they began supporting people.

Short-term care plans and risk assessments were not always detailed enough to keep people safe. Often, information in care plans was taken from hospital discharge notes and didn’t always accurately reflect the person’s needs. Daily notes taken by care staff were not always completed in sufficient detail, and care plans were not always updated or reviewed when people’s needs changed. This was an area identified as “requires improvement” during their last inspection, and the service could not demonstrate to us that they’d made sufficient improvements in this area to keep people safe.

Staff were not always able to tell us how people consented to care being provided. Care plans were not always signed by or on behalf of the person to indicate consent. People told us they weren’t always involved in the planning of their care and didn’t know what information was in their care plans.

Management of medicines was inconsistent. MAR records were often copied from hospital discharge information and were hand written and prone to errors. Records of medicine administration were not always fully completed and there were not adequate systems to audit these records to highlight errors or omissions. Medicines were being administered by staff who did not always fully understand what the medicine was or why it was being given.

People we spoke with felt that staff who cared for them were friendly and compassionate. We found that staff were knowledgeable about people who were supported through long-term packages with the agency and understood their needs well. There were usually enough staff to meet people’s needs, however people told us that calls were sometimes too early or too late, and that care could be inconsistent with different carers visiting on occasion.

The service had a system for handling and investigating complaints. However they did not always implement changes promised in response to these complaints, and there was insufficient evidence of how the service routinely learned from these.

The service did not have an appropriate system in place for internal audits. Quality assurance was instead undertaken through staff surveys and questionnaires.

Staff were positive about the management of the service. There was an open culture in the service which encouraged staff feedback and provided people with the opportunity to discuss issues relating to their care.