Apple Homecare received an overall rating of Requires Improvement following its November 2018 inspection, with breaches of Regulations 12 and 17 identified due to unsafe medicines management, inadequate risk assessments, poor record-keeping and ineffective quality assurance systems. The service demonstrated genuine strengths in compassionate care delivery and staff culture, but significant governance failures placed people at risk of harm.
Concerns (12)
criticalMedication management: “This person mistakenly took an overdose yet the service reassessed the risks associated with their medication administration five months later.”
criticalMedication management: “The records for a second person gave contradictory information on whether medications had been administered. Crosses on their MAR chart over a four-day period indicated that a medication...had not been given as prescribed.”
criticalSafeguarding: “During our inspection we identified an incident that was a potential safeguarding concern...the registered manager also acknowledged that two medication errors...should also have been referred.”
criticalRecord keeping: “A box of unchecked task sheets contained sheets dating back to March 2018. A member of staff told us the reason for this was that they didn't have time to look at them.”
criticalGovernance: “Effective systems and processes were not in place to assess, monitor and improve the quality and safety of the care provided. Regulation 17 (1), (2) (a), (b), (c)”
moderateCare planning: “Care plans failed to consistently contain person centred information. This put people at risk of receiving care that did not meet their needs in the event they were supported by agency staff.”
moderateConsent / capacity: “Neither person had had a mental capacity assessment to determine their level of capacity...No best interest decisions had been taken for either person.”
moderateStaff training: “Three members of staff had not undertaken training on the Mental Capacity Act and two had not undertaken emergency first aid training. Re-training...was overdue for six members of staff.”
moderateSupervision / appraisal: “Staff confirmed they received written updates in the form of memos but said they had supervisions infrequently. It was recognised by management that a more structured approach to regular supervisions and the introduction of appraisals was needed.”
moderateEnd-of-life care: “We did not see details in people's care files about their preferences relating to end of life care...we reviewed the file of a person who was being given palliative care and there were no records relating to their end of life care preferences.”
moderateIncident learning: “An accident and incident log was in use, however there were no entries in the log relating to medication errors.”
minorCommunication with families: “The registered manager acknowledged that they needed to re-assess the communication skills of a person who did not speak English as their first language. The person's relative had been required to interpret.”
Strengths
· Staff were very caring, kind and compassionate, treating people with respect, dignity and promoting independence.
· Robust staff recruitment process including appropriate DBS checks and a good induction programme.
· Sufficient staffing levels maintained with supervisors and registered manager providing cover when needed.
· Staff worked effectively with healthcare professionals to ensure people received appropriate support.
· People and relatives reported high satisfaction with the service and felt safe.
Quality-Statement breakdown (22)
safe: Medicines management and administrationRequires improvement
safe: Risk assessment and mitigationRequires improvement
safe: Safeguarding referrals and reportingRequires improvement
safe: Staffing levels and recruitmentGood
safe: Infection controlGood
effective: Holistic needs assessment and care planningRequires improvement
effective: Staff trainingRequires improvement
effective: Staff supervision and appraisalRequires improvement
Apple Homecare Limited improved from Inadequate to Requires Improvement overall, remediating four prior regulatory breaches, but a continued breach of Regulation 17 (Good Governance) was identified due to inconsistent oversight of staff supervision, training matrices, incident analysis and conditions of registration. People and relatives provided consistently positive feedback about kind, person-centred care and reliable visit timekeeping.
Concerns (7)
criticalGovernance: “some action points rolled over from one meeting to the next, rather than being actioned within agreed timescales.”
moderateIncident learning: “Greater levels of analysis of incidents and accidents continued to be required, to ensure themes and trends were consistently identified, and onward referrals made”
moderateMedication management: “there continued to be medicine errors involving the same staff member, which had not always resulted in referrals being made to the local authority safeguarding team.”
moderateSupervision / appraisal: “records showed some staff supervision and spot checks moved from one month to the next, which did not ensure consistent oversight of performance.”
moderateSafeguarding: “medicine errors involving the same staff member, which had not always resulted in referrals being made to the local authority safeguarding team.”
moderateStaff training: “Greater provider level oversight was required to monitor the completion of staff mandatory training...the service had more than one version of their training matrix”
minorRecord keeping: “the timeframes for this ranged from between three and nine months. This did not ensure that staff always had access to current information.”
Strengths
· Consistently positive feedback from people and relatives about staff being respectful, kind and treating people as individuals.
· Breach of regulation 12 (safe care and treatment) remediated since last inspection.
· Breach of regulation 19 (fit and proper persons employed) remediated since last inspection.
· Breach of regulation 18 (staffing/training) remediated since last inspection.
· Breach of regulation 11 (consent/MCA) remediated since last inspection.
Quality-Statement breakdown (12)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
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Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candour; Engaging and involving people using the serviceGood