This announced inspection was carried out on 13 November 2018. APT Care Ltd Nottingham provides support and personal care for people living in their own homes in Nottingham. On the day of the inspection visit there were 41 people using the service who received personal care.

We carried out an announced comprehensive inspection of this service on 12 and 13 July 2018. Breaches of legal requirements were found and we issued a warning notice in relation to one of these breaches. We asked the provider to act to ensure that the service was responsive to the needs of the people who used the service. We asked the provider to send us an action plan to show how they would address our concerns. We received the action plan on the 6 September 2018.

We undertook this focused inspection to check that the provider had made the improvements against their action plan and now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for APT Care Ltd Nottingham on our website at www.cqc.org.uk.

The service had a registered manager in place at the time of our inspection. 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 received care from a provider who was implementing quality monitoring processes to improve the care they provided. Systems were in place to ensure the quality of the service was monitored and there were improvements in the care people received because of the quality monitoring processes now in place.

We inspected the service on 12 and 13 July 2018. The inspection was announced.

APT Care Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. Not everyone using APT Care Limited 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. APT Care provides a service to older adults and younger adults with a disability. At the time of our inspection, 44 people were receiving personal care as part of their care package.

At the previous inspection in December 2016 we identified some improvements were required in four key areas we inspected; ‘Safe’, ‘Effective’, ‘Responsive’ and 'Well-led'. This resulted in the service having an overall rating of 'Requires Improvement'. We identified a breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. This was because the provider had ineffective systems and processes in place to monitor quality and safety. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question Well-led to at least good. The provider sent us an action plan and told us they would make the improvements by 14 July 2017.

At this inspection, we found Regulation 17 remained in continued breach because the provider had failed to comply with their action plan. Additional shortfalls identified during this inspection had not been picked up on by internal audits and checks, meaning the governance of the service remained ineffective.

There was a registered manager at the service. 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 experienced frequent late calls and there were insufficient staff employed to deliver the hours of care required. Agency staff were used and the registered manager and care coordinator also covered staff shortfalls.

The provider’s staff recruitment procedure was not always fully completed, to ensure people were protected from unsuitable staff. Staff interviews were not routinely recorded. Staff had not received appropriate first aid training to support them to care for people safely and effectively.

Shortfalls were identified with medicines management. This included staff training and competency, how medicines administration records were completed and how some medicines were administered.

Staff were aware of their responsibilities to protect people from avoidable harm and abuse. Accidents and incidents were recorded, reviewed and monitored and action was taken to share any learning.

Shortfalls were identified in the induction, training and support staff received. The Mental Capacity Act 2005 had not been adhered to when people lacked mental capacity to consent to their care.

People’s needs had been assessed to ensure they were known and understood by staff and did not expose people to any form of discrimination.

People received support with nutritional and hydration needs where required, and choices were promoted and respected. People’s healthcare needs were monitored and action was taken when changes occurred, such as informing the person’s relatives and representatives or health and social care professionals.

People did not always receive a consistent caring service because staff were regularly rushed and this impacted on the quality of care received. Independent advocacy service information had been made available to people. Independence was encouraged and people had been involved in the asse

This inspection took place on 9 and 14 December 2016. APT Care Limited is a domiciliary care service which provides personal care and support to people in their own home.

At the time of our inspection APT Care Limited offered support to 47 people living in Nottingham.

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.

People felt safe. Staff were aware of the safeguarding adult procedures to protect people from avoidable harm and had received appropriate training. Risks to people’s health were known by staff but these were not always reviewed regularly.

Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly. However, medicines given as and when required did not always have the appropriate guidance or protocols for staff to follow.

Safe recruitment practices were not always followed which meant that unsuitable staff could have been employed. Staff received an induction but this was not always documented. Appropriate training and supervision was available to staff. There were sufficient staff available to meet people’s needs. However, the service had no systems in place to robustly monitor late and missed call visits.

The registered manager applied the principles of the Mental Capacity Act 2005 (MCA).

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for, but their weight and repositioning charts were not always recorded where needed. People received appropriate choices and support with their meals. People’s healthcare needs had been assessed and were regularly monitored but not always recorded.

Most staff were kind, caring and respectful towards the people they supported. However, staff were task centred in their support. The registered manager confirmed they were looking at changing records so that support is offered in a more person centred way. The provider asked people and their relatives to share their experience about the service provided.

People or relatives were not always involved as fully as possible in their care and support. There was a complaints policy and procedure available. Information was not available to inform people of independent advocacy services.

The recently appointed registered manager had begun to implement daily, weekly and monthly audits of quality and safety of the service. These needed to be sustained over a period of time to confirm their effectiveness. We did not see any audits carried out by the owner [provider] other than quality survey questionnaires.

Most people were very satisfied with the service provided. People who used the service told us they were treated with compassion and kindness and that their privacy and dignity were respected.

People who used the service including staff felt the leadership of the service was not always effective. Most staff were able to explain the values of the service. We had received notifications of the incidents that the provider was required by law to tell us about.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report